IONIZING RADIATION:
SOURCES AND BIOLOGICALEFFECTS
United Nations Scientific Committee
on the Effects of Atomic Radiation
1982 Report to the General Assembly, with annexes

UNITED NATIONSNew York, 1982

NOTE
The report of the Committee without its annexes appears as Official Records of the General Assembly, Thirtyseventh Session, Supplement No. 45 (A/37/45).
The designations employed and the presentation of material in this publication do not imply the expression of
any opinion whatsoever on the part oft he Secretariat of the United Nations concerning the legal status of any country,
territory. city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries.

UNITED NATIONS PUBLICATION
Sales No. E.82.IX.806300PANNEX G
Medical exposures

CONTENTSParagraphs

Paragraphs

INTRODUCTION ....................... .
I. DIAGNOSTIC
X-RAY
EXAMINATIONS ............................. .
A.

B.

C.
D.
E.
F.

Trends in frequency ............... .
1.
General survey .............. .
2.
Survey of developing countries
Trends in technique and exposure ....
1.
Trends in reduction of exposure2.
Mass chest x-ray examinations .
3.
Dental examinations ......... .
Mammography ............. .
4.
5.
Computed tomography ...... .
Absorbed dose in the patient ....... .
Genetically significant dose equivalent
Effective dose equivalent .......... .
Summary ....................... .

II. DIAGNOSTIC
USE
PHARMACEUTICALS
A.

OF

1-13

Dose estimates for radiopharmaceuticals ............................ .
I.
Absorbed dose .............. .
2.
Collective dose ............. .

91-96
91-94
95-96

III. THERAPEUTIC USE OF RADIATION

97-114

Trends in frequency and techniques .. .
1.
External beam therapy ....... .
2.
Brachytherapy .....•.••......
3.
Therapeutic use of radiopharmaceuticals ................ .
Dose specifications In radiotherapy . . .
1.
General .................... .
2.
Dose to the gonads .......... .
3.
Dose to other organs ......... .
4.
Dose from therapeutic use of radiopharmaceuticals .......... .
5.
Genetically significant dose
equivalent .................. .

97-103
97-100101
102-103104-114104-105
106-108
109-110

IV. CONCLUSIONS .................... .

115-129

References .•..............•...•..........

364

14-84
14-19
14-16
17-19
20-53
20-26
27-28
29-40
41-47
48-53
54-60
61-67
68-78
79-84

RADIO-

Trends in frequency and techniques ...

B.

A.

B.

85-96
85-90

Introductio11
1. Medical irradiation of the human body is done in
the course of diagnostic x-ray procedures, in diagnostic
nuclear medicine by internally administered radionuclides. and in radiation therapy. In many countries
medical exposure gives the largest man-made contribution to the population dose. In developed countries
such exposure may approach the contribution fromnatural sources, and much effort is devoted to minimize
it. This Annex follows the trends in medical procedures
giving rise to exposure and in relevant doses to patientsand to the population; it also presents data on the
distribution of doses among irradiated persons.
2. The Committee has reviewed information on the
medical irradiation of patients in a number of reports

111

112-114

Page

since 1958 [U3, U4, US, U6, U7]. Doses to patients fromvarious medical procedures have been assessed, both inorder to follow trends and to make it possible to see
which procedures are most significant with regard topossible radiation risks. For any one procedure thedosimetric information is complex, with considerable
variation of the absorbed doses in different organs. It istherefore not easy to find a simple basis for comparisons.
3. In its 1958 report, the Committee was mainly interested in exposures relevant to the risk of hereditaryeffects. The genetic significance of a gonadal dose
depends on the child expectancy of the exposed
individual. Therefore, the age distribution of patientssubject to various radiological examinations must be
considered in the assessments. This led the Committee333to the introduction of the genetically significant dose(GSD) (see Annex A), which was the quantity ofprimary interest in 1958. It was evident that the majorpart of the genetically significant dose was contributedby rather few types of examinations. At that time there
was little biological ground for quantitative assessmentof any somatic risk of a stochastic nature. The correlation between leukaemia and radiation exposure of theactive bone marrow was being studied and theCommittee included some assessments of mean marrowdoses.
4. In its 1977 report [U7], the Committee made aneffort to estimate mean doses to other tissues. e.g.,
thyroid, lung and breast. In the evaluation or the signilicance of such exposures, assumptions need to be madeon the dose-response relationship for cancer inductionin these organs. Because of the long latent periods
involved, this would also strictly call for considerationof the age at exposure.
5. Some discussion of the possible development of asomatically significant dose equivalent is included in
Annex A. However, refinement of this concept is felt to
imply a precision of knowledge that is at present
lacking. Development of the concept of a somaticallysignificant dose equivalent is, however, considered to
be useful to supplement the conventional informationon the genetically significant dose because the emphasisthat has been given to the latter might distort therelative importance of the various examinations fromthe point of view of total risk.
6. In 1977, the International Commission on Radiological Protection (ICRP) [I6] introduced a method for
calculating a quantity later called effective dose equivalent, for the purpose of application of dose limits inradiation protection of workers (see Annex A). Thismethod involved a weighting of the mean organ dose
equivalents with factors derived to reflect the relativerisk of cancer and severe hereditary effects fromexposures of the corresponding organs. The effective
dose equivalent, as defined by ICRP, is the sum of all
the weighted organ dose equivalents.
7. The effective dose equivalent as calculated isindependent of age and sex, because the organ
weighting factors are average values for both sexes andall ages. It is obvious, therefore, that they are not basedon the best estimate of risk for any given individual andthat they are not intended to apply to populationgroups with sex- or age-distributions which substantially differ from the normal. It was not the original
intention of ICRP that the effective dose equivalent
should be calculated for patients.
8. In its effort to find a quantity that would indicate
the significance, from the point of view of total risk. of
the heterogeneous exposure of patients, the Committee
found that the organ weighting factors that would beappropriate could only be estimated with great uncertainty and could not be shown to deviate substantiallyfrom the weighting factors used by ICRP, although fora different purpose. The Committee therefore decided
to estimate the effective dose equivalent for patientsand presents that quantity in this report, enabling dosecomparisons which are believed to be more relevant
than in previous reports, where only organ doses andthe genetically significant dose were given. The reader
is advised to interpret the results with caution becauseof the shortcomings of the concept when applied to
medical exposures.
334

9. In particular, the effective dose equivalent would
not satisfactorily reflect the true risk when applied togroups of patients with substantially reduced life expectancy (as in radiotherapy of some malignant disease) orwith age- and sex-distribution grossly differing fromthose in a normal population (for example, inmammography or pelvimetry).
10. When effective dose equivalents arc compared, it
must therefore be recognized that they may over- or
under-estimate the risk, depending upon the way inwhich the group of patients differs from a normal
population. There is not yet sufficient information on
the dose-response relationships for somatic stochastic
effects to permit a reliable quantitative correction insuch cases. For the total collective dose equivalent
contribution from medical practice, specific calculations must ideally be made for the population ofinterest.
11. There is a very great potentiality for variation ofindividual organ doses, depending upon the value of anumber of physical parameters that influence the dose
per examination. It is also found that doses are in fact
very different from hospital to hospital, depending
upon the radiological technique and equipment. In
order to assess average dose values representative forlarge population groups, it is therefore necessary to
make extensive surveys. Data reported from single
clinics, or calculated on the basis of some assumed
practice, cannot usually be taken to be representative.
These uncertainties influence the reliability of any dose
estimates per caput for large regions of the world, suchas the genetically significant dose and the per caputmean marrow dose as earlier assessed by theCommittee, and of the effective dose equivalent.
12. Trends in frequencies of the various radiologicalprocedures are reviewed in this Annex. Individualabsorbed doses in the various organs per unit
procedure, and the effective dose equivalent per type ofprocedure, are also compiled and discussed. Recent
reports on exposure of patients have considered organ
doses and the accuracy and precision of their measurements, and are reviewed here. Efforts have also been
devoted to the compilation of biological data on the
distribution of radionuclides administered to patients.
Much of this information has been used to deriveabsorbed doses in organs, and effective dose equivalents, from the medical use of radionuclides [K2, K3].
13. Dosimetry of the tissues outside the treatment area
during radiotherapy cannot be quantified in the samemanner and to the same extent as in diagnostic
exposure. This is mainly due to the lack of publishedinformation on absorbed doses in tissues outside thetreatment area. For these reasons the chapter on thetherapeutic use of radiation is rather more descriptive
than quantitative.

I.

DIAGNOSTIC X-RAY EXAMINATIONSA.

TRENDS IN FREQUENCY

I.

General suney

14. In the 1977 report [U7] there was a brief review ofthe frequency of diagnostic x-ray examinations invarious countries. Surveys made in Japan up to 1974, in
Sweden up to 1974 and in the United States in 1964 and1970, were analysed in terms of frequency of diagnostic

x-ray examinations by type. Since then new surveys
have become available from Australia [S20], Finland[L7], Federal Republic of Germany (T8], Japan [H26],
Poland [JS]. Romania [F3], Sweden [Nl, Nll], the
USSR [K11] and the United Kingdom [K12]. The data
available have been expressed in terms of the annual
per caput examination rate in order to allow comparisons between countries to be made. Various examinations have been grouped according to the organ orsystem examined.
15. The classification scheme for diagnostic radiological examinations, recommended by a joint
ICRP/ICRU report [114]. is adopted in this report as ameans of presenting statistics of x-ray diagnostic examinations. To that recommended classification scheme it
was necessary to add three additional categories: x-ray
examination of the breast (mammography), computed
tomographic scanning (CT-scan) and other examinations not included elsewhere.
16. In industrialized countries, the frequency ofvarious examinations per 1000 inhabitants is given in
Table 1 which includes only the most recent data
available [F3, H13, Hl4, H26, JS, K12, L7, M19, Nl 1,
S20, T8]. Earlier compilations are found in previous
reports (U3, U7]. It is difficult to draw overall conclusions applying to countries whose reporting systems
may not be comparable. However, existing data point
to examination frequencies, per 1000 inhabitants, of
between 300 and 900 in these countries, excluding
dental examinations and mass miniature radiography,
for which reporting is not consistent (however, see also
paragraphs 28 and 29). The frequency of examinationsof different anatomical sites estimated for various
world areas, is given in Table 2. It is interesting to notethat by far the most common types of examinations arethose of the thorax and of the skeleton.

2.

Survey of developing countries

17. Data on the availability of diagnostic radiologicalequipment, and on the frequency of diagnostic x-ray
examinations in developing countries, are particularly
difficult to obtain. The WHO has recently made major
efforts to increase this knowledge by analysing theavailable sources [W11. W12) and by sending out aquestionnaire which was worked out in co-operation
with UNSCEAR (W13].
18. The current situation of radiodiagnostic services
in each of five WHO regions. including most of thedeveloping countries, is summarized in Table 3 [W12],
which provides information about the distribution of
the numbers of diagnostic x-ray equipment. The above
data are not truly representative of the availability ofthe equipment in various regions because most of it isconcentrated in urban areas, particularly in the larger
cities, while the rural population has very limited accessto such facilities.
19. The annual frequency of diagnostic x-ray procedures, as reported by WHO regional offices, is shown in
Table 4, subdivided for various types of examination[W3, SS). The total frequency of diagnostic x-ray examinations in developing countries is often between 100
and 200 per 1000 inhabitants, or lower, which is muchless than in industrialized countries.

B.

TRENDS IN TECHNIQUE AND EXPOSURE
I.

Trends in reduction of exposure

20. In recent years, efforts. including testing andevaluation of various types of films and nuorescentscreens, have been made in many countries to reduce
unnecessary exposure of the patient. The results ofthese efforts are particularly good in regard to dental
examinations [Jl). The data of Neuweg [N4), Johnson[JI). and Bunge [819, B20], who reported averageannual exposure during the 1970s, show little or no
reduction in medical exposures for selected examinations.
21. Various technical improvements in diagnostic
radiology, such as rapid films, more sensitive screensand image-intensifying television systems, may bepresumed to reduce the dose to the patient. if appliedcorrectly. However, a study of diagnostic procedures in
Sweden from 1960 to 1975 revealed little decrease of
the dose, despite technical improvements. On the other
hand, the study showed a significant reduction of thedose for selected examinations. due to the introductionof high sensitivity screens and to a reduction of thenumber of films [G4].
22. Many data show that there is still a great variability in entrance doses for standard patients, brought
about by the difference in sensitivity of the various
detector systems used. According to several studies in
the Federal Republic of Germany, the United Kingdom
and the United States, the ratio between the lowest andhighest entrance dose is about 1 :100 [819, Jl, K30, US,
U9, W20, W21].
23. In 1971 a programme for a nationwide evaluationof the trends in the use of x rays, the NEXT project,
was set up in the United States. The survey procedureallows estimation of radiation exposure to the patientand its variation in the course of time [Jl, U9, U12.
U13]. In addition, other parameters may be studied. For
example, the ratio of beam-area to film-area (S~am/Smm) used in the various projections was found to varyfrom 1.1 to 2 for various examinations. Few significant
differences were found in the above ratio and in the
exposure levels for different facilities or for different
operators. The mean ratio for chest radiography
decreased from 1.6 to 1.2 during the period 1973-1978.
Hospitals and radiology facilities had significantly
lower Sbcam/Smm ratios than other groups (internal
medicine, general practitioners, health agencies).
Among operators, trained radiology technologistsdelivered lower values of the Sbcam/Sr.1m ratio and lower
values of the exposure-area product than did nontrained personnel [WlOJ.
24. In another case, improvements in the protection ofpatients during the period 1970-1975 resulted in a 15%
decrease in the annual dose per individual averaged
over the whole body, in spite of an increased frequencyof examinations during the same time (22]. In otherreports the mean gonad dose and the genetically significant dose did not change appreciably because thefrequency of examinations giving the highest contribution to the gonadal dose was rather stable [K27, K28,
T3, T4, TS, T6, DJ.
25. Other studies indicate that many diagnostic facilities produce poor quality images, and give unnecessary
radiation exposure, because of poor equipment
performance [S4]. The introduction of quality assurance335

programmes in diagnostic radiology and nuclear
medicine. recommended by ICRP [120) and WHO[W22), can be of great value in improving the diagnostic
information content. thus leading to a reduction ofradiation exposure.
26. A noteworthy reduction in the use of fluoroscopy
has been reported from France [S34]. In that country, in
1976, there were some 13 OOO fluoroscopic installations
used for general medical purposes: by 1982 the number
was 5000, of which 2000 were operated by specialists in
cardiology and chest diseases. It is expected that theremaining 3000 fluoroscopic installations will havebeen eliminated by 1985 [Pt 2).
2.

Mass chest x-ray examinations

27. In most countries about 50% of all medical x-ray
examinations are of the chest. There is a trend toabandon fluorography in favour of radiographic
techniques. There is also a decline in mass chest x-ray
examinations in some industrialized countries because
the incidence of tuberculosis is declining; furthermore,
there is now good evidence that early detection of lungcancer by radiological techniques is not associated withany significant improvement in the prognosis of thecondition [B28, L9, S33).
28. Information from various countries and areas on
gonad exposure from mass survey examinations of thechest was given in the 1962 report [U4], the frequency of
examination per 1000 total population ranging fromabout 100-300 in most industrialized countries. At thetime most surveys were performed by miniature radiography although in some countries examinations werestill performed by fluoroscopy. Declining trends arenow seen in the data reported from Sweden, the United
Kingdom and the United States, where current
frequencies are below 50 examinations per 1000 inhabitants. Other countries, however, still report frequencies
above 300 examinations per 1000 inhabitants [F3, Hl4,
Kll, S20].

3.

Dental examinations

29. Dental radiography is the most frequent type of
diagnostic x-ray examination in many industrializedcountries. There are however great difficulties in
obtaining accurate statistical data on the frequency ofdental x-ray examinations. In some countries thenumbers are included in medical x-ray examinations
and in others they are reported separately. Japan
reports, for 1980, an annual frequency of 851 dental
films per 1000 inhabitants; the corresponding value for
the United Kingdom in 1977 is 212 dental films [K12,M19].
30. The radiation exposure caused by dental x-ray
examinations may be reduced by increased filtrationand collimation of the beam, adequate shielding of thehead and by the use of faster films. In 1957 Baily [B1]
was able to reduce the average facial exposure, inroutine full-mouth set of 14 apical film examinations ofadults, with 60-kVp x rays, from 5.9 mC kg-1 with nofiltration to 4.1 mC kg-I with 1 mm Al additional filter.
Corresponding exposure values for the examination ofchildren were 1.6 mC kg-I with no filtration and 1.3 mC
kg-I with 1 mm additional Al filter. Because no collimation was used, the exposure to the thyroid wasincreased with additional filtration from 0.22 mC kg-I
336

to 0.28 mC kg-I for adults and from 0.09 mC kg-1 to
0.13 mC kg-I for children. 1n the same investigation the
exposure to the bony structure per full-mouth set of 14
films ranged from 2 mC kg-I to 6 mC kg-I for adults,
and from 0.8 mC kg-I to 2.3 mC kg-I for children.
depending on operating voltage and added filtration[81).
31. Bjllrngard et al. [B9] studied the absorbed doses
from full-mouth radiographic examinations. They
reported absorbed doses in the lens of 15 mGy, in the
thyroid of 5 mGy, and a maximum skin dose of 260
mGy. Further studies by the same group (810] reported
doses to the lens from 4 to 110 mGy, to the thyroidfrom 2 to 9 mGy, and maximum skin doses from 70 to
500 mGy. A study of the doses delivered in various
anatomical sites of the head and neck from 14-film
periapical examinations was carried out by Richards etal. [RJ]. Values in this series that were comparable withthe previous one were about 6 times lower, due to theuse of faster films [R3, 810).
32. O'Shaughnessy and Mitchell [OlJ performed asystematic study of the relative amounts of primary andsecondary beam received by tissues, in relation tovarious changes made to the x-ray equipment andtechniques (cone length, filtration, collimation). Collimation of the beam was the most important single
factor in reducing unnecessary radiation.
33. A laboratory investigation was performed by
Winkler [W9] to determine the reduction in exposure to
be gained by the use of small rectangular x-ray beams
restricted to the approximate size of the film, combinedwith a shield to absorb most of the radiation behind it.
The absorbed dose during a 22-film intra-oral examination was reduced significantly with the use of arectangular film holder. In the skin the absorbed dose
was 11 ± 4 mGy without, and 4 ± 2 mGy with, film
holder. Corresponding values for salivary glands were
5.3 mGy and 0.9 mGy, respectively, and for mandibularbone at the area of the third molar 21 mGy to 7.8 mGy.
In the cornea of the eye the absorbed dose was reduced
from 3.4 mGy without, to 0.2 mGy with, film holder.
34. Weissman and Sobkowski [W7] reported on acomparative clinical dosimetric evaluation of four
intra-oral periapical radiographic survey methods,
including the device proposed by Winkler [W9]. Theirresults showed that the absorbed dose to the cornea ofthe eye could be reduced from 8.6 mGy to 0.2 mGy bycone shielding and rectangular collimation of the
primary beam. The absorbed dose in the thyroid was
reduced from 0.6 mGy to 0.06 mGy. They concluded
that radiographic methods using unshielded cones
result in unnecessary irradiation without improvementof the image and should no longer be accepted.
35. The effect of adding accessories to a conventional
x-ray machine to reduce patient exposure during fullmouth dental radiography was investigated by Yiilek et
al. [Yl, Y2]. Maximum reductions were observed at theeyes (80%) when the x-ray machine was protected by acylinder of 1 mm Al and 0.1 mm Pb and the patient wasmade to wear 0.1 mm Pb-shielded glasses. With, in
addition, a shield around the neck to protect the sites
below the neck, reductions of absorbed doses amounted
to 70.6% in the thyroid, 59.9% under the collar bone and44.5% at the gonads [Yl, Y2).
36. Bushong et al. [821) carried out measurements onpatients undergoing full-mouth (18 films) examinations

at three different facilities. Skin exposure in the
primary beam area was I mC kg-I al the facility
employing slow films and 65-kVp x rays. Ultra-speed
films and 90-kVp x rays resulted instead in an average
exposure of 0.2 mC kg-I. Panographic examinationsdelivered average exposures of about 8 ~tC kg-I. The
study of Ice et al. [11] compared radiation exposuresfrom various types of position-indicating devices. Bothat 65-kVp and at 90-kVp it showed that lead-lined
cones are most effective in reducing patient skin
exposure outside the useful beam in clinical dental
radiography.
37. A study was also conducted by Alcox andJameson [A2] of exposures at selected areas of the headand neck from conventional dental radiographic procedures. Their results indicated that the exposure at any
specific area of the patient's face was much Jess thanthe exposure at the tip of the cone. Thyroid exposure, inparticular, was around 0.3 µC kg-I per film, which was
about 1% of the exposure at the tip of the cone.
38. Absorbed doses in the marrow of the skull,
mandible and cervical spine were measured by Whiteand Rose [W8] during dental examinations of phantoms
using intra-oral, panoramic and cephalometric radiography. Table 5 shows the mean dose equivalent to themarrow at different sites and for various types of
examination. Mean absorbed doses to various organs
and tissues from intra-oral and orthopantomographic
examinations have been evaluated in detail by using
phantoms [118, 14, M4, S23].
39. Pantomographic radiology, which provides animage of all teeth from root to crown on a single film,
has become increasingly used in the last few years. Its
introduction, however, has led to a considerable
increase in the number of patients examined [Wl 7].
Pantomographic equipment from seven manufacturers
has been investigated along with other procedures for
obtaining similar information using conventional
dental x-ray sets (Table 5). Absorbed doses in the headand neck region ranged from 0.1 to 0.8 mGy for the
pantomographic technique and from 0.01 to 6.4 mGy
for the conventional one. The mean values for theabsorbed doses in the marrow were 0.05 and 0.08 mGy,
respectively [86]. Thus, the patient exposure for bothtechniques is of the same order of magnitude.
40. A study of the absorbed dose in panoramic view
or full-mouth examination (11 intra-oral films) was
performed on 22 patients [N12]. The average absorbed
dose values from the panoramic view was 0.05 mGy
and from a full-mouth examination 0.1 mGy. Corresponding absorbed dose values in the cheek were 0.09
mGy and 3.3 mGy, respectively, and in the skin 0.13
mGy and 3.5 mGy [N12]. In organs outside the beam
the difference decreased and no significant difference
was found in the gonads where the absorbed dose wasabout 0.01 mGy for both techniques.

4.

Mammography

41. The number of mammography examinations is
steadily increasing. Data have been reported from
Sweden [Nl 7] where the total number of examinations
increased from 17 (1977) to 40 (1979) per 1000 women.
In the same study the number of mammography examinations for screening purposes increased from 11 to 22
per 1000 women in the same period of time. Similarly,
in the United States, the number of examinations inwomen of 35 years or older went from 30 to 72 and in
women of 40-46 years of age rose from 56 to 136 per1000 women over the same time. Screening of female
breast for malignancy in the United States is treatedextensively in a special report [N18].
42. The imaging media used in mammography may be
medical x-ray films or various combinations of films
and screens. Xerography is also a special method ofimaging used for mammography, whereby the image is
produced by the use of a photoconductive surface,electrostatic charges and xerographic-type processing.
Owing to the "edge enhancement" effect of xerography,
this technique is advantageous for the detection ofcertain types of breast diseases, such as dense fibrocystic conditions [Ul 1].
43. A programme was established in the United States
to redqce unnecessary examinations, to improve theimage quality and to collect data on radiation exposure[Jl). This programme, known as BENT (Breast
Exposure: Nation-wide Trends) made its first evaluation in 1976. The mean exposures for xerography,
film-screen and non-screen medical and industrial film
techniques have been reported by a number of investigators [A3, H2, 12, Pl, UlO, Ull] and are shown in
Table 6.
44. lf current risk estimates for radiation carcinogenesis are to be applied to mammography, then therelationships between surface exposure and absorbed
dose in tissues at risk should be considered. Information specifically related to mammography isavailable and several authors have adopted mid-breast
dose as the critical parameter on which risk analyses
should be based [E4. Kl, Pl. UlO, Zl].
45. The most relevant indicator of the risk of
mammography would be the energy imparted in thegland tissue of the breast, but before this quantity canproperly be applied to the problem of risk assessment
more information would be needed on the amount anddistribution of the tissue at risk in individual cases. One
could, however. assume very roughly that the linear
density of the gland tissue might be 35 g/cm and its
total mass 175 g, on the average. On these assumptions,the average absorbed dose per unit exposure to theglands of an average breast has been calculated for
different radiographic techniques and found to vary
between 1 and 4 mGy [H2].
46. The evolution of the mammographic technique isalso summarized in Table 6. The average absorbed dose
and the mid-breast dose are given for various systems[A3, Kl6, M16, Pl 1, S24, UlO]. There is a steadydecrease in all dose values during the period of study.
Some further reduction of absorbed dose might beachievable without compromising the mammographic
image quality [S24]. These improvements would include
photon energy control, scatter removal
andimprovement in detector response [M16].
47. The probability of an increase in five-year survival
as a result of early detection and treatment of breast
cancer has been used as a specific estimate of thebenefit of mass application of mammography [K.29].
Mammography increases the probability of diagnostic
detection of stage I breast cancer by 3 times; thedetection of stages II and III is however less efficientby comparison with other methods of examination [F5,G5, K.29). The five-year survival after treatment may be
improved by 11%, following mammography. If this337

benefit is then compared with the risk of developing
fatal malignancies, it may be calculated to exceed therisk by a factor of 2 to 30 (according to the different
techniques used) [K29).
5.

Computed tomography

48. Diagnostic radiology has generally used methods
for two-dimensional imaging of the body. Since 1971 a
new tomographic method has been introduced in whicha finely collimated x-ray beam is used for scanning
across the plane of interest at various discrete angles.
The attenuation of the transmitted beam is recorded bya detector and the relevant data are processed bycomputer with a mathematical algorithm to generate across-sectional image of the body in terms of relative
attenuation coefficients in the layer examined. Becauseof the paramount role of the computer in the imaging
procedure the method is called "computed tomography" (Cl) [814).
49. Computed tomography is considered to be thegreatest improvement in the diagnostic use of ionizing
radiation since the discovery of x rays, and it
overshadows other major technical achievements, suchas tomography. image intensification, cine- and videoroentgenology. The value of CT-scanners was quickly
recognized and technical developments have proceededvery rapidly.
50. The number of CT-examinations in Sweden from1973 to 1979 is given in Table 7. In 1979, 8 headscanners and 7 whole-body scanners were in operation.
The average number of examinations per head scanner
was about 2050, and per whole-body scanner about
1300. In the same year about 2 head examinations andabout 1 whole-body examination per 1000 population
were performed in that country [N17]. In Japan, thefrequency of CT-scanning examinations in 1979 was
reported to be 0.44 for head examinations and 0.24 forwhole-body scans, per 1000 population [N14).
51. If one images a uniform material. for example, awater bath, in a CT-scanner, one finds that the values of
the attenuation coefficient µ are not all the same but are
distributed approximately at random around an
average value. The standard deviation of µ, designatedas Oµ, is called the noise of the apparatus; it is a very
important measure of its performance, because thenaturally-occurring variation of the attenuation coefficient between various normal tissues, and between
normal and pathological tissues, is quite low. The noise
depends on various parameters, such as the size of thepatient or its body diameter, the mean energy of thephotons and their energy spread, the width of thepicture elements, the thickness of the scan and the skindose [C4, CS, M6].
52. The x-ray beam of CT-units is highly collimated,particularly in a plane perpendicular to the axes of thetrunk or the head. For single scans the x-ray beam isgenerally collimated to a length ranging from 3 to 15
mm perpendicular to the scan plane [M6]. For
dual-scan CT-units the length is essentially double.
53. The eye may receive as much as 50 mGy for acomplete CT-examination of the head [H30, l12]. The
distribution of the skin doses varies with the angle ofrotation. In the first-generation scanners having a 180°
angle the highest absorbed doses for organs in the scanwere around 35 mGy and the lowest about 0.5 mGy per338

scan. With other systems (360° rotation) a different
distribution of the absorbed doses is obtained, andmaximum doses in the skin can be as high as 560 mGy,although for normal clinical use they are around 60
mGy [B24, H21, H23, l13, K8, N3, N15, M6, P5, R2,
Sto, VI, W3]. Absorbed doses in the skin, the centre of
the body and the gonads from CT-examinations arefound in the following references: [83, B13, H21. K8,
K9, L8, M6, N5, P3, P4, W3, W18]. Organ doses andrisk-weighted absorbed doses have been calculated by
the Monte Carlo technique for head and whole-bodyscans. The data are given per slice and are normalized
to exposure-free-in-air at the axis of rotation [K32].
Absorbed doses in various organs, and the average
number of slices in different CT-scanning procedures,as derived by Stieve et al. [S15], are given in Table 8. A
comparative study of doses from kidney CT-examinations, contrasted with conventional radiography, hasbeen pc;rformed [Kto, S18] and the results are given in
Table 9.
C.

ABSORBED DOSE IN THE PATIENT

54. The geometry in external irradiation is describedby the projection and view - anterior/posterior (A/P),
posterior/anterior (P/ A), lateral (LA1) - x-ray fieldsize at image receptor plane, x-ray field location
relative to anatomical landmarks, and source-to-imagereceptor distance. The conversion of exposure toabsorbed dose in the body organs is obtained by using
the tissue/air ratio. This is defined as the ratio of theabsorbed dose at a given point in a tissue-equivalentphantom to the absorbed dose which would bemeasured at the same spatial point in free air within avolume of the phantom material just large enough toprovide the maximum electron build-up at the point ofreference [15].

55. Estimation of organ doses from x-ray diagnostic
procedures can be made either by direct measurements
or by calculations. In vivo measurements are difficult
and, with internal organs, phantom studies must be
performed [15, Hl5). For calculations, the Monte Carlo
method has been used extensively and the results ofsuch estimates can be of considerable help in estimating
the absorbed dose in various organs [K15, R6, R7].
56. Estimation of the effective dose equivalentdepends on the availability of data about absorbed
doses in the gonads, the breast, the red bone marrow,the lungs, the thyroid, the bone surfaces, the skin and
up to five other most exposed organs or tissues [16). The
distribution of organ doses measured or estimated forthe same type of examination usually spans several
orders of magnitude, with coefficients of variation
ranging from 100 to 300%. This is in spite of considerable advances in the techniques of diagnostic
radiology, many of which were actually expected toreduce the variability mentioned above [U9, Ul2, UI3,
W21].

57. Values of absorbed doses in diagnostic x-ray
examinations are presented in various ways by different
authors. Some authors report the absorbed dose inorgans relative to the exposure or absorbed dose at theentrance surface [K15]. By measuring one of thesevalues during a whole examination, the absorbed dose
to various organs may thus be estimated individually.
Most authors, however, report average absorbed doses
in various organs, either per exposure or per full examination. Unless stated otherwise, all values in this reportrefer to a full examination. The number of films used
per full examination varies considerably and this makes
it very difficult to estimate a good average [HI).
58. The absorbed doses in various tissues exposed in
the course of diagnostic procedures. as reported from alarge number of surveys conducted in different
countries, are found in the following references: gonads[B5, F3, H27, JS, K30, L2, S20, U15, W15): breast [B5,1-115, JS, L2]: red bone marrow (85. 818, CS, F3, H3,
Hl 1, H15, H27, JS, K30, L2, S9, S20, WSJ; lungs (135,
1-115, H27, JS, L2]; thyroid [85. H15, H27, JS, L2]; bone
surfaces [Hl 5, JS]; skin [H15, JS, K30, S20): remainder[H15, H27, JS, K30]; uterus and other organs [82, H12,
H30, I 12, L2]. Great differences between various
reports are due to different techniques. The reported
organ doses for all types of diagnostic examinations
range from less than 0.01 to about 50 mGy per examination.
59. Tabulation of all these data would have made thetext unnecessarily complex. The Committee therefore
decided to show, as an example, representative datafrom Japan and Poland, as supplied to the Committeeby the delegations of those two countries. These are theonly two series where reasonably complete values of theorgan doses are available for calculating the effective
dose equivalent (see section E). The relevant data areshown in Tables 10. 11 and 12.
60. These data show that there are inhomogeneities in
the presentation, and, for those entries which arecommon, the differences in the values are very large.
These differences must be attributed, to a great extent,
to the variations in the techniques of exposure, and, inpart, to the dosimetric techniques used. The extreme
variability of the data base made it impossible for theCommittee to carry out an independent assessment ofeffective dose equivalent which might have a moregeneral applicability. It should be emphasized that thedata from Japan and Poland cannot be considered
representative of the situation applying in othercountries.

D.

GENETICALLY SIGNIFICANT DOSE
EQUIVALENT

61. The genetically significant dose equivalent for a
population is a widely used measure of the genetic
detriment from medical irradiation. Its definition isfound in Annex A. section 11.B. Details of many GSD
surveys have been given in the previous reports of theCommittee and are summarized in the 1977 report [U7].
Since that time a few further data in various countries
and areas have become available and are reviewed inthis Annex [D5, H26, K21, S20, W2IJ.
62. The variation with age in the frequency of allradiological examinations per 1000 population has
been studied in the United Kingdom [D5]. The results
indicate a general increase with age, with a superimposed increased frequency for very young children,
teenagers and people in their early twenties. The
increase in frequency for each age group and for both
sexes relative to that found in 1957 is most marked for
examinations of children and of old people (particularly women). A relatively larger increase in examinations of children and older people was also seen in the
United States between 1960 and 1970 [U10].

63. The GSD from diagnostic radiology in National
Health Service hospitals of the United Kingdom in
1977 was estimated to be 113 µSv, with a standard errorof about 12 ~tSv, arising mostly from uncertainties in
the frequency data. A summary of diagnostic radiology
performed in 1977 in other hospitals and the contributions to GSD is given in Table 13 together withcomparable data for 1957 [A6]. The GSD from all typesof diagnostic radiology was estimated to be 118 µSv in
1977. Although this is somewhat lower than the figureof 141 ~tSv from the 1957 survey, the difference is lessthan twice the standard error of the mean GSD andtherefore does not provide strong evidence of adecrease. The main contributions to the GSD in the
United Kingdom in 1977 were examinations of thepelvis and Jumbo-sacral area, upper femur and hip,urography, cystography and barium enemas. The
contributions are broadly similar to those found in
1957, e)lccpt that there has been a fall in the contribution from obstetric examinations from 45 to 6 µSv. On
the other hand, there has been an increase by a factor oftwenty in the contribution from cystography, largely
due to an increase in the frequency of this examination[D5].
64. The variation with age in the frequency of allradiological examinations in Australia shows a patternsimilar to that in the United Kingdom. The numbers of
all x-ray diagnostic examinations per 1000 population
were 209 under 2 years, 163 in the age group 2-14 years
and 450 over 15 years, with a mean of 370. The examination rate of the foetus was 15.4 per 1000 population.
The GSD from all x-ray diagnostic examinations inAustralia during 1970 was estimated to be 149 µSv. The
highest contributions were from urography, lumbosacral spine and obstetrical examinations [S20].
65. The most recent estimates of the GSD frommedical examinations in Japan were based on a 1974
nation-wide survey of randomly sampled hospitals andclinics. The resultant annual GSD for 1979 was 150µSv, which was approximately the same as that of 1974,
although the annual number of examinations had
increased in the meantime by about 30%. Table 14
shows a comparison between the 1979, 1974 and 1969
data. The GSD in the USSR due to diagnostic x-ray
procedures was found to be 230 µSv per year, about
two-thirds of which were attributed to radiography andthe rest to nuoroscopy [Kl 1].
66. On the basis of the data in Table 8 the annual
GSD from CT-scanning in the Federal Republic of
Uermany was reported in 1977 at about 0.8 µSv. It wasforeseen that this value might increase by a factor of 5
to 6 when optimal use of CT-tomography is reached[SIS].
67. The most complete series on the GSD equivalentfrom diagnostic radiology has been reported fromJapan. Table 15 summarizes the values for the various
years and types of examination [H4, H5, H6, H7, H9,
HlO, H13, Hl4, H16, H17, HIS, H19, H26, H27, H28,
H35, M3, M4, MS, M 19).

E.

EFFECTIVE DOSE EQUIV ALE NT

68. The calculation of the effective dose equivalentfrom diagnostic procedures must take account of thetechnical parameters involved, i.e., beam quality,
typical entrance exposure and the number of films for339

each view. The expression of dose equivalent in an
organ per examination is given by the formula(I)

where k is the type of view involved in the examination(i.e., A/P, P/ A or LA1); Ok is the number of films forview k in the examination in question; DT,k is theaverage absorbed dose in an organ for view k; and Q is
the quality factor. This factor is taken to be unity for
x rays used in diagnostic radiology.
69. The effective dose equivalent, Hcrr,1 for an examination of type I is thus obtained from the following
equation

Herr,t = LWT HT,I

(2)

T

where the weighting factors WT are those given by ICRP
[16] and reproduced in Annex A, Table 3. In the case of
the weighting factor for skin, ICRP [17] recommended avalue of 0.01 to be applied to the mean dose over theentire body surface. The average field size used in x-ray
examinations covers about 5% of the body surface.
Therefore the mean dose used in the calculation of theeffective dose equivalent is only a small fraction of theabsorbed dose in the skin at the entrance field.
70. The weighting factors WT given by ICRP forvarious organs are average values for both sexes and allages in a population with normal age distribution. The
assumed variation of the individual risk of latestochastic effects with age has been shown in ICRP
publication 27 [119]. For patients undergoing diagnostic
examinations, the age- and sex-distributions often
deviate from those in a normal population. Considering
all other uncertainties in dose and risk assessments,
such deviations are not believed to invalidate the use of
the ICRP weighting factors except in a few cases. The
breast is an organ for which the risk assessment is particularly sensitive to the composition of the exposedgroup. The main risk relates to young women, but the
ICRP weighting factor, being an average for men andwomen of all ages, would underestimate the risk for thiscategory, e.g. for mammography patients. Olderpatients would run no risk of hereditary harm and little
risk of radiation-induced cancer, because of the Jonglatent periods. For patient groups with a highproportion of old individuals, the effective dose equivalent will therefore overestimate the risk.
71. The weighting factors WT are given for the organs
which are assumed to contribute most to the total risk at
a given dose. In addition to the weighting factors
specified for these organs. a weighting factor of 0.06 isallotted to each of the five other organs which are
estimated to receive the highest doses. This is equivalent
to applying a weighting factor of 0.30 to the average
dose for these five organs (the .. remaining" organs). In
some cases, e.g., if these organs include the eyes and thebrain, for which a weighting factor of 0.06 probably
overestimates the risk, the contribution of the"remainder" to the effective dose equivalent may be too
high.
72. The ICRP weighting factors are derived fromassumptions of the risk of lethal cancer. The effective
dose equivalent therefore reflects the risk of dying fromcancer. If also non-lethal cancers were to beconsidered, they would have to be given a detriment340

weight in relation to lethal cancers. This involves avalue judgement. The risk of additional non-lethal
cancer is particularly high in the case of exposure of the
thyroid and the breast. In case of examinations wherethese organs receive proportionally high doses, theeffective dose equivalent will underestimate the total
detriment.
73. The weighting factor for the gonads is derived
from assumptions of the risk of severe hereditary effects
in the first two generations of offspring. It will thus
underestimate (by a factor of two) the total risk ofhereditary harm in all generations.
74. Modified weighting factors could be derived tocompensate for the over- and under-estimation of risk
which will occur by the use of the ICRP weighting
factors. ·However, if other factors are used, the derived
quantity is no longer the effective dose equivalent, since
this is linked, by definition, to the weighting factors
given by ICRP. Since, in most cases, the errors are
expected to be less than a factor of two. the Committee
does not feel that such (apparent) precision would bejustified. It would tend to give the false impression that
it is possible to derive a quantity which would
accurately indicate the true risk. It must be emphasizedthat any organ-weighted dose is only a very crude
indicator of the real risk.
75. Calculations of the effective dose equivalent fordifferent types of diagnostic x-ray examinations havebeen reported from Poland, 1976, and Japan, 1979. Recalculations of these data were submitted to theCommittee in 1982 by the delegations of these twocountries and are given in Table 16. They show large
variations for individual examinations.
76. The total collective effective dose equivalent fromdiagnostic x-ray examinations in Poland in 1976 wasreported to be 20 OOO man Sv, which corresponds toabout 600 man Sv per million people. Examinations of
GI-tract, lumbar spine and urography give the highest
contribution, with about 25% each [JS]. Very recent
unpublished information submitted to the Committeeby the delegation of Poland indicates that the value of
600 man Sv may be an underestimate.
77. The collective effective dose equivalent fromdiagnostic x-ray examinations in Japan, in 1974, wasestimated to be 200 OOO man Sv which corresponds toabout 1800 man Sv per million population. Examinations of the stomach, which is a frequent examinationin Japan [H15], gave by far the highest contribution.
78. The Committee had no other quantitative information from which to obtain a reasonable estimate ofcollective effective dose equivalent applying generally
to the population of the world. The data from Poland
and Japan differ by a factor of about 3. On theassumption that these data might be applicable to otherareas, then the annual collective effective dose equivalent attributable to medical irradiation for diagnostic
purposes might be of the order of 1000 man Sv per
million population in industrialized countries. This isan annual per caput effective dose equivalent of 1 mSv.
In developing countries, having a lower frequency ofradiological examinations, the value would be correspondingly less.

F.

SUMMARY

79. Data on the frequency of x-ray examinations havenow been reported from many countries. Per 1000 total
population, the number is found to vary between 300
and 900, excluding mass surveys and dental examinations.
80. Mass chest surveys show a decreasing trend, being
below 50 per 1000 people in some industrializedcountries. but in other countries still as high as 300 or
more per 1000 people. Reports of dental x-ray examinations are not common, but the relevant value isprobably in the region of 0.2-1 film per person per year
in developed regions. There is an increase in thenumber of patients examined by pantomographic
dental x ray; the exposure of these patients iscomparable with that from conventional techniques.
81. Mammography techniques currently in operation
result in a considerable reduction of the dose absorbed
in breast tissue. This has stimulated interest in theexamination, and the number of patients undergoing it
is steadily increasing.
82. Computed x-ray tomography has introduced a
new dimension in diagnostic radiology. Technicaldevelopments have taken place rapidly during the last
decade. Recent figures point to an examination
frequency of 1 to 3 per 1000 total population per year,
two thirds of which are performed on the head. This
technique has also resulted in a decrease of complex
angiographic examinations and radioisotope tests. The
net effect of such changes may be a lower exposure of
the population.
83. Absorbed doses in various organs and tissues
resulting from diagnostic x-ray examinations were
found to be in the range of less than 0.01 to about 50
mGy per examination. The few available assessments
indicate that the effective dose equivalent for the mostcommon types of x-ray examinations ranges fromabout 0.05 mSv to about 10 mSv per full examination.
In the absence of any other data. the Committee has
tentatively, for the purpose of this report, used theround number of 1000 man Sv per million population
as the annual collective effective dose equivalent forindustrialized countries. In developing countries, where
the frequency of radiological examinations is lower, thevalue would be correspondingly less.
84. Because of the differences in the classification ofdiagnostic x-ray examinations in various countries it is
not easy to compare data from one country to another.
There is therefore a need for an internationallyaccepted classification scheme for diagnostic x-ray
examinations to be used in reporting frequencies anddosimetric data.

II. DIAGNOSTIC USE OF
RADIOPHARMACEUTICALSA.

TRENDS IN FREQUENCY ANDTECHNIQUES.

85. The use of radionuclides in the field of diagnostic
nuclear medicine has been rapidly increasing all over
the world. Since this medical specialty began its development about 30 years ago, the frequency of examinations has steadily increased. Studies have indicated acontinuing rate of growth, in the number of examina-

lions performed, by about 25% per year during
1965-1975 in the United States, which has decreased toabout 10-15% per year since that time [B16]. For some
European countries the annual growth rate is now of
the order of a few per cent [H36, H37, N2, Rll, R12,
S26, S27], while figures from Australia indicate an
average growth rate of about 7% per year during
1970-1980.
86. Reasonably complete statistics are only available
from a few countries (Australia, Austria. Denmark,Sweden, United States) [f6, K13, M8, N2, S13, S25,
S26, S27, U16]. For Berlin (West) there are statistics forthe period 1953-1975; per 1000 inhabitants the mostrecent figures on the number of examinations are: 1968,
10.3; 1970, 15.0; 1975. 32.1; 1978, 33.9 [H36]. There isalso a value for Munich for 1978, 47.8 [Rl2]. In Austria
the frequency in 1977 was reported to be 17.5 per 1000
inhabi~ants [F4, F6].
87. The examination frequency of various organs byradiopharmaceuticals (examinations per 1OOO inhabitants) increased from 8.4 in 1971 to 13.6 in 1976 in
Sweden [N2]. In the United States the examination rateincreased from 3.7 in 1966 to 37 in 1975 [M8, U7, U16].
In Denmark it increased from 3.8 during 1973-1974 toa plateau of about 14 in 1978 and 1979 [S13, S25]. For
some countries, the relative frequency of various
nuclear medicine procedures is shown in Table 17 [K13,N2. M8, S13, S25, S27, U7, U16]. The data indicate that.
in general, the relative frequency of examinations ofliver, lungs and kidneys is approximately constant, thefrequency of the thyroid examinations is decreasing,while that of bone examinations is increasing. The
frequency of brain scintigraphy has decreased during
recent years and has been replaced by computed
tomography.
88. The annual frequencies of in vivo diagnostic
nuclear medicine procedures per 1000 inhabitants in
two countries, as reported by WHO, are shown in Table
18, while Table 19 gives the frequencies for a number ofother countries, subdivided into the various types ofprocedure [W13].
89. The recent introduction of nuclides such as 99mTc
has had a great impact on the development of nuclear
medicine. In Annex F of the last report of UNSCEAR[U7] the trends for liver scanning, for which t9SAu
colloid was being replaced by 99mTc colloid, wereclearly demonstrated. The increased use of 99mTc is also
evident in Table 20, together with the main trends forthe most widely used radionuclides [N2]. The relative
frequency of use of pharmaceuticals for various nuclear
medicine procedures in the United States is also given
in Table 20 [H16, M8]. Exhaustive data on the application of various radiopharmaceuticals in nuclear
medicine are also available from Denmark and Sweden
for the 1970s [M20, N2, S13, S25, S26, S27].
90. The scintillation gamma camera is the standard
imaging instrument in nuclear medicine. The major
reason for this is the excellent spatial resolution
possible with the thin sodium iodide crystal when 99mTc
is used. The increase in the number of gamma cameras
installed in Europe is shown in Table 21 [P9]. These
data should not be taken to infer that there has been an
equal increase in the total number of procedures
performed, since, in many instances, gamma cameras
have simply been replacing rectilinear scanners. Newer
techniques of single-photon and positron-emission341

tomography have been developed, but, at present, theseare predominantly used for research purposes.
B. DOSE ESTIMATES FOR
RADIOPHARMACEUTICALSI.

Absorbed dose

91. Many biological parameters innuence the mean
absorbed dose to organs after administration or radionuclides. For the purpose of dose assessment. and formost radiopharmaceuticals in use, the relevant
biological data are taken from animal experiments andare assumed to be applicable to man, when results fromhuman studies are not available. However, these data
are often incomplete and not suitable for the calculation of the effective dose equivalent. As in the case of
external irradiation, this latter value should thus betaken as the best approximation to be obtained under
the circumstances [R12, RB, R14, R18].
92. Physical methods for the calculation of the dosefrom internally-administered radionuclides are now
well established. They are based on the concept ofmean absorbed dose per unit cumulated activity (timeintegral of activity), as developed by MIRD [MlO] andadopted by the ICRU [116]. Experimental evaluation oforgan doses from various radionuclides confirms thevalidity of the calculations [G 1].
93. Table 22 gives, for various radiopharmaceuticals,
the mean absorbed dose per unit administered activity
in the most heavily exposed organs, in the gonads, andin the whole body and the effective dose equivalent perunit of activity of administered radiopharmaceuticals.
The values have been estimated from data published by
MIRO [MlO], Kaul et al. [K2, K3, K20, K21, K23],
Kereiakes et al. [K22], Roedler et al. [R4, R5, Rl 1, R12,
R13, R14] and from the recent Swedish compilation ofdoses from radiopharmaceuticals in medical use [NB].
Calculation of the effective dose equivalent has been
made possible by a development of the MIRO concept
to estimate the contribution from the activity in the"remainder'' organs and tissues [ClO, R15, R16, R17].
The values of effective dose equivalent are not applicable to therapeutic uses of radiopharmaceuticals.
94. With administered activity in the range of 100 to
800 MBq of various 99mTc-labelled radiopharmaceuticals the effective dose equivalent for the most common
examinations is estimated to be in the range of 1 to 10
mSv per examination. For thyroid uptake measurements, with an average activity of 0.4 MBq of 1311 theeffective dose equivalent is about 6.4 mSv per examination, assuming 35% uptake. For thyroid scintigraphy(activity 1.5 to 3 MBq of 131 I) the effective dose equivalent is about 85 mSv per examination. In Sweden,
where thyroid examinations are still done with 1311, thisnuclide gives the most significant contribution (about60%) to the collective effective dose equivalent.
2.

Collective dose

95. A nation-wide survey was carried out in Japan in
1977 to collect data on the irradiation of the populationfrom diagnostic uses of radiopharmaceuticals. The
resulting genetically significant dose equivalent was
about 3.6 µSv per year. The annual effective dose equivalent was estimated to be in the order of 20 µSv perperson. With a population of about 108 people, this342

would result in an annual collective effective dose
equivalent of about 2000 man Sv [H17].
96. In an attempt to estimate the collective effective
dose equivalent from various radiopharmaceuticals in
Sweden it was found that the most significant contribution comes from 131 I [PlO]. By using reported values of
the average administered activity per procedure and of
the frequency of procedures, the Committee derived thefollowing values of the collective effective dose equivalent, expressed in man Sv per million total population:
Australia, 20; Denmark, 60; Sweden, 80; United States,
150 [F6, N2, MS]. These numbers are of the order of
2-15% of the collective effective dose equivalent fromdiagnostic x-ray examinations that the Committee has
adopted in this Annex for industrialized countries.

III. ,THERAPEUTIC USE OF RADIATIONA.

TRENDS IN FREQUENCY ANDTECHNIQUES
1.

External beam therapy

97. The IAEA, with assistance from the WHO, haspublished information on the use of high energy
radiotherapy units and trained personnel in radiotherapy centres throughout the world [12]. Owing tounavoidable delays in the flow of information and indata processing, the published information is often
outdated by several years: moreover, it is often difficult
to obtain complete data from all countries [W14].
98. For the year 1976 the total number of high-energy
radiotherapy units installed in the world was reported
as being 3117 in 2174 institutions. Some 4000 radiotherapists and 1600 physicists were estimated to be involvedin this work. Of all the high energy units, 75.6% utilized
6DCo and 5.6 % 137Cs, 6.9% were betatrons and 10.7%
were linear accelerators. For the years 1970-1976 thepercentage increase in a number of countries was
between 20% and 50%, the higher rate applying tocountries where few units were previously installed [12].
99. Only limited data are available for the frequencyof radiotherapy procedures. Table 23, from data
published by the WHO [W13], gives the frequency ofsuch procedures in three countries; this table also
includes some data on the therapeutic use of radiopharmaceuticals.
100. Neutrons have been used in radiotherapy, fromtime to time, since their discovery. Summaries of thetype and output of equipment used in a number ofcentres, and the numbers of patients treated, have been
published [M22, S19, T2]. Research is currently being
undertaken in some countries on the clinical use of 1tmesons and heavy ions.
2.

Brachytherapy

101. Brachytherapy designates the therapeutic use of
encapsulated radionuclide sources applied in close
vicinity of the tumour to be irradiated. In interstitialbrachytherapy the source is implanted into the tumourmass. Intra-cavitary brachytherapy is performed byintroducing the radiation sources into one of the body
cavities. Data available from Japan on the frequency ofuse of brachytherapy, of the various nuclides and about
the major categories of tumours treated, are reported inTable 24.

3.

Therapeutic use of radiopharmaceuticals

102. Radioiodine has been used since 1946 in thetreatment of hyperthyroidism and of thyroid
carcinoma. Phosphorus-32 was introduced at about thesame time for the therapy of polycythaemia vera andstill remains the best therapeutic agent for this disease.
On the other hand, the use of the same nuclide for thetreatment of leukaemia has become less common withthe discovery of other chemotherapeutic antileukaemic
drugs.
103. Table 25 shows the annual number of treatments
per million population in Sweden during the last
several years using radiopharmaceuticals [N2]. There isa trend to a slight increase of thyroid treatments and aconstant rate of treatments for polycythaemia vera. The
use of 198Au colloid for treatment of metastases in thepleural or peritoneal cavities has almost ceased and so
has the treatment of rheumatic arthritis with othernuclides. The use of radiocolloids for therapy of
diseases of the knee or other joints seems to haveincreased slightly. In Japan, treatments for thyroid
diseases with IJIJ were only about 56 per million in1977 [H17]. In Berlin (West) the number of 131J treatments per million inhabitants was reported as follows:
1968, 257; 1970, 188; 1975, 129; 1978, 305. For the same
number of people 198Au treatments were about 35 and32p treatments about 23, constantly over the years [K24.
R19].
B.

DOSE SPECIFICATIONS IN RADIOTHERAPY
1.

General104. The total absorbed dose of ionizing radiation at
any point in a patient can be separated into acomponent from the primary beam and one fromscattered radiation. The absorbed dose component
from the primary beam is a function of attenuation andgeometry. The absorbed dose component fromscattered radiation depends upon the field size, beam
quality and distance from the central axis. Several
methods have been described to determine thiscomponent [815, 825, NlO].
105. For 60Co radiation the total dose outside theprimary beam is dominated by scattered radiation.
while at 4 MVp the leakage contributes at least half thedose outside the beam at 30 cm from the beam axis
[Kl 7]. At energies above 10 MeV there is production ofphotoneutrons which contribute to the dose outside theprimary electron beam [H41, M18. S29, S30].
2.

shaping devices. However, modern radiotherapy
commonly makes use of field-shaping because of theconsiderable improvement in therapeutic gain that itallows. Measurements by Jetne [J3] showed that asmuch as 50% of the absorbed dose in the gonads during
treatment of Hodgkin's disease may originate fromscattering in field-shaping devices; similar effects havealso been seen in other types of treatment [N6]. Thus,
precautions should be taken to reduce this portion of
the gonadal dose.
108. Extensive measurements of gonad doses inphantoms irradiated with a given surface dose havebeen reported for cobalt units, conventional x-ray units
and 10-MV linear accelerators [H19]. These data havebeen summarized in Table 28.

3.

Dose to other organs

109. The 1977 report of the Committee (Annex F)
reviewed the available information on mean marrowdose. Since then bone marrow doses were evaluated inJapan, using dose distributions measured in phantoms
and the technical factors of radiation therapy as used inthat country [H 19]. The per caput mean marrow dose
was reported to be 540 µGy per year for males and 980µGy per year for females [H19]. Table 29 gives theabsorbed doses in various organs outside the treatmentarea, expressed per unit absorbed dose in the beam
entrance surface. Per unit skin surface, these doses varyfrom less than 0.001 to 0.3 mGy per Gy of the entrance
dose.
110. The absorbed doses outside the pelvic
compartment in radium treatment of patients withcancer of the cervix have been studied [S28). A series ofmeasurements was performed in water phantoms
simulating a standard adult, an adolescent (12-yearold) and a child (3-year-old). Encapsulated radiumsources were positioned in the pelvis compartment andin an arrangement normally used in the treatment ofcarcinoma of the cervix. The results indicate that whena patient is treated with a standard radium techniquethe absorbed dose in the bone marrow is 10 Gy or
higher for the pelvis, and between 1 and 5 Gy for thethighs and abdomen. Absorbed doses in the bone areabout 0.1 Gy for thorax and legs and 0.01-0.1 Gy forhead and feet. These doses are delivered in approximately 30 days. Several epidemiological surveys ofleukaemia in patients with cancer of the cervix treatedwith radiation were reported [B26, H31, H33, K18], but
the studies did not involve actual dose measurements.

Dose to the gonads

106. Table 26 shows the fraction of absorbed dose to
the gonads at two different treatment field locations.
The x-ray field size was 10 x 10 cm2 at 100 cm source-toskin distance (SSD) and the electron field was definedby a cone of 12 cm diameter at 120 cm SSD [N9]. Table
27 shows the average gonadal doses from 60Co gamma
radiation from various treatment conditions, asmeasured by thermoluminescent dosimetry. Extensive
measurements of the absorbed dose to the gonads from
60Co irradiation were also carried out by Novotny et al.
in the Alderson phantom and in vivo [N8].
107. Most of the above measurements were carriedout with treatment fields without filters and field-

4.

Dose from therapeutic use of radiopharmaceuticals

111. The absorbed dose to the ovaries and to theuterus in the course of 1311 treatment of thyroid cancer
or hyperthyroidism was estimated in one instance by invivo measurements and by calculations. The calculated
value per unit of administered activity amounted to
46 ± 19 and to 37 ± 18 µGy M8q-1 to the uterus andto the ovaries, respectively. The value measured insidethe uterus cavity was 49 ± 29 µGy MBq-t (B23]. Further
data on the absorbed dose to various organs outside thetreatment area per unit administered activity aresummarized in Table 30 [K24J.
343

5.

Genetically significant dose equivalent

112. Recent data on genetically significant dose equivalent estimates in radiotherapy are summarized inTable 31. An average value applying at present inEurope might be in the order of 7 µSv a-I [S2, S3, S4],
while Australia and the United States report values
around 23 µSv a-I [S20, Tl].The genetically significant
dose equivalent may also be classified according tovarious parameters: Table 32 shows some values of
GSD by type of disease in clinical departments or in
private practice in Berlin (West) (1973) and in Munich(1971) [S2. S3, S4]. About 16% of the patients that hadmalignant disease were treated in private practice. and
84% in clinical departments; the child expectancy ofthis group was assumed to be zero. In a Japanese study
performed in 1971 [HS] the genetically significant dose
equivalent was classified by age and sex, for malignant
and for benign conditions and the relevant findings are
given in Table 33. Comparable figures for 1978 aregiven in the same table.
113. The genetically significant dose equivalent frombrachytherapy has been estimated in Japan for 1971 on
the basis of a nation-wide survey. In that year thenumber of brachytherapy treatments in the country wasaround 5 104 , 60% of which were due to treatments ofcancer of the cervix by 226Ra and 60Co gamma sources.
The relevant genetically significant dose was estimatedto be 0.12 µSv. For comparison, the GSD from x-ray
diagnostic radiology amounted to 265 µSv and thatfrom teletherapy to 9.8 µSv [H8, H35).
114. The effective dose equivalent has not been
evaluated for patients receiving radiotherapy, for thefollowing reasons: (i} the concept of effective dose
equivalent is based on the assumption of "linearity",i.e., proportionality between dose and response. If
organ doses exceed a few gray, the risk of nonstochastic effects becomes significant and the effective
dose equivalent is no longer a reasonable indicator ofrisk. Such doses are given in the treatment field inradiotherapy; (ii) patients treated for malignant diseaseoften have a short life expectancy, either because of age
or as a result of the disease. This will invalidate theassumptions behind the choice of the organ weighting
factors for the derivation of effective dose equivalent:(iii) few data are available on the actual dose distribution outside the target volume; (iv) in the therapeutic
use of radionuclides, the metabolic data assumed innormal dose assessments may not be valid.

IV.

CONCLUSIONS

115. The frequency of x-ray examinations (including
mass surveys and dental examinations) is in the rangeof 300 to 900 per 1000 inhabitants per year in a numberof industrialized countries, excluding mass surveys anddental examinations. In the same countries, examinations of the skeleton and the thorax prevail among thevarious organs examined. In developing countries, thefrequency of examinations is often between 100 and
200 per I OOO inhabitants per year, skeleton and thorax
being also most frequently examined. Mass chest
surveys show a decreasing trend in most industrializedcountries, while other types of examinations (dental
pantomography, mammography and computed tomography) are becoming more frequent. New diagnostic
techniques, such as ultrasound and nuclear magnetic
resonance imaging, are being developed as alternatives344

to x-ray examinations. However, it is difficult to predict
now whether these new technologies might result in adose reduction from x-ray examinations in the future.
116. Improvements in radiological techniques may
entail increases or decreases in radiation dose. In someinstances, considerable gains in clinically importantdiagnostic information or therapeutic efficiency havebeen associated with moderate increases in dose. In
other instances, the dose has been substantially reduced
without loss of diagnostic or therapeutic value. In bothcases, the objective has been to minimize the clinicallynecessary exposure.
117. The absorbed dose in the patient depends on
many factors, such as geometry and beam quality.
Estimation of organ doses may be done using theMonte Carlo method or by actual dosimetry measurements. • The absorbed organ doses reported for
diagnos.tic examinations have been reviewed, and theyvary widely, often by as much as three orders ofmagnitude for the same examination in the same
country. The reported organ doses for all types ofdiagnostic examinations range from less than 0.01 toabout 50 mGy per examination. In developed countries
the genetically significant dose equivalent fromdiagnostic radiology is of the order of 0.15 mSv per
year.
118. The use of the effective dose equivalent has been
expanded to include medical exposures, although theconcept is unusable in some important diagnostic andradiation protection situations (e.g., mammography).
The validity of applying the concept of effective dose
equivalent to the other types of diagnostic examinations
depends upon the actual age and sex distribution ofpatients for each particular type of examination. Suchdata are currently lacking for most countries. For thisand other reasons (e.g., questionable applicability of
ICRP weighting factors to the case of medical irradiation) the Committee cautions the reader about theinterpretation and application of the results, but feelsthat the concept is more meaningful than the GSD formaking comparisons with other sources.
119. Estimates of the effective dose equivalent havebeen made in two countries for different types of x-ray
examinations. They range from less than 0.05 to about
10 mSv per full examination. These values are useful incomparisons of the detriment from different types of
examination but were not used by the Committee toassess collective dose equivalents. For the purposes ofthis report, the Committee has used the round figure
1OOO man Sv per million population as a tentative value
for the annual collective effective dose equivalent fromdiagnostic x-ray examinations in industrializedcountries. In developing countries, where the frequencyof radiological examinations is lower, the value would
be correspondingly less.
120. The above tentative value is subject to a numberof uncertainties due mainly to the variability of theabsorbed doses in various organs in the course ofdifferent radiological examinations, and to the wide
variations that have been reported for the same type of
examination. Future work may usefully be directed
towards obtaining accurate additional data on thefrequencies of examinations and on the doses absorbed
in various organs and tissues so that firmer and more
precise estimates of collective effective dose equivalents
may be obtained.

121. The frequency of diagnostic nuclear medicine
examinations in most industrialized countries is atpresent of the order of 10 to 40 per 1OOO inhabitants per
year. The rapid growth of these values that has takenplace during the last decade appears now to be levellingoff. In developing countries, frequencies in the range of
0.2 to 2 examinations per 1000 inhabitants per year arc
currently found.
122. In developed countries the use of 99rnTc-labelledradiopharmaceuticals has replaced the use of longerlived compounds for most imaging procedures.
However, 131 I continues to be used for thyroid therapy
and in some labelled compounds. Data on types ofisotopes used in developing countries are not available.
123. The effective dose equivalent received bypatients in the course of nuclear medicine diagnostic
examinations with the most frequently used radionuclide. 99mTc. was found to be in the range of 1 to
10 mSv per examination.
124. The annual collective effective dose equivalentfrom the diagnostic use of radiopharmaceuticals may
be estimated to be in the range of 20-150 man Sv per
million of total population in industrialized countries,
which is a small fraction of the collective effective dose
equivalent from diagnostic medical x-ray examinations.
125. The number of high-energy radiotherapy
machines installed in the whole world may at present
be estimated at about 4000. About 4000 radiotherapists
and 2000 physicists are estimated to work at present inradiotherapy centres in the world. While most developing countries are reported to use 60Co-teletherapy
and Jow-e.nergy x-ray therapy units, developed
countries are adopting increasing numbers of highenergy electron accelerators.
126. Absorbed doses in the target region during
radiotherapy treatments are quite high, commonly

20-60 Gy given in fractionated courses. Absorbed doses
in organs and tissues outside the target area depend on
scattered and leakage radiation. They may vary fromless than 0.001 to 0.3 mGy per Gy of radiation in theentrance surface.
127. The genetically significant dose equivalent due toradiotherapeutic treatments has been recently estimatedin 4 countries to be between 0.7 and 23 µSv per year.
128. Since the contribution from diagnostic x-ray
examinations dominates over all other components, theindividual average effective dose equivalent from all
medical exposure may be taken to be of the order of 1
mSv per person and year in developed countries (seeparagraph 119). Differences in the radiological
techniques, and in the spectrum of diseases over thewhole population, may bring about considerable variations. Qn the assumption that the individual average
may be proportional to the annual frequency of radiological procedures, the variation of the individual
average dose equivalent could also be by a factor ofthree between various developed countries. If thefrequency of diagnostic examinations in developing
countries is taken to be one-tenth of that in developed
countries (and that of radiotherapy still lower) it may
be estimated on the same assumption that theindividual average dose equivalent might be correspondingly lower. The value that might apply globally
could, therefore, be 0.4 mSv per person and year.
129. A precise estimate of the collective effective dose
equivalent from medical exposure is not possible atpresent owing to the lack of appropriate informationfrom most countries and the lack of applicability tocertain categories of exposure such as radiation
therapy. The Committee would like to express the wish
that in the future, medical irradiation statistics bereported in such a way that some evaluation of thegenetically significant dose equivalent and of theeffective dose equivalent may be possible.

345

,.,.
~

0--

Ta b l e
Annual fre9uenci of dia9nostic x-rai examinations
in various countries exeressed in number of examinations eer 1000 inhabitants

Type of examination

01
02
03
04
05
06
07
08
09
10

11

12
13
14
15
16

17
18
19
20
21
22
23
24
25
a/

b/

z1

Austra- Fin- Germany ,Fed.Rep.
lia
land(1978) rT8J
(1970) ( 1975)
F
Total
[S20]
[L7] MHip and upper femur
8.7
Femur
13.5
Pel vis7.6
Pel vimetry
0.7
Lumbo-sacra l
15.2
Lumbar spine
8.8
Urography
12.0
Retrograde pyelography
0.8
Urethrocystography
0.6
Stomach and upper G. I. T.
1.6)al Radiographyb Fl uros copy
17.1(c) Mass survey
Small intestine
6.8
Abdomen
14.3
Abdomen (obstetrical)
2.6
Hysterosalpingography
1.0
Cholecystography
9.4
Chest (lungs, heart)(a) Radiography
118.8(b) Fluoroscopy
1.4(c) Chest mass miniature 146. 7
Head
40.9
Dorsal spine
7.3
Thorax13.4
Arm and hand
37.4
Lower leg and foot28.5
Dental80.9
Breast0.3
CT-scanOther403. 3~_/ 4 . 1

7.7

11.8

15.7 22.0

37.3

9.3 12.6 21.9
21. 7 21. 7 20.3 42.0

M

6.3
3.2
1.9

1.2

2.9

67 .8

4.1

382.2 168.7 165.2 333,951.4 56.8 108.2
16.5 19.2 35.7
63.7
36. 7
46.2
170.0 32.4
0.6
21.2

41.9 78.6
48.1 94.3
89.5 71.9
27.3 27 .9

Total

9.0 15.3
1. 7 4.9
2.8 4.7
1.0 1.0

27.8 23.8 51.6
9.6 5.2 14.8
5.8

127.4 29. 7 38.1

F

2.6

66.8
71.4
21. 3
3.6
17 .6

Romania(1977) [F3]Poland( 1976) [JS]Japan (1979)[Hl3,Hl4,H26,Ml9]
M

F

Total

23. 'j£129. 'j£/ 52 .6~/

5.6

5.3

10.9

M

F

Sweden(1977)
Total [Nll]

3.1
15.5
3.3

2.0 5.1
9.2 24.7
1.8 4.1

18.2

18.8

36.9

3.6

3.5

7.0

8.4

52.7 118.7
58.4 129.8
15.6 36.9
4.4 8.0
17.4 35.0
1.5
1.5
1.1
1.1
16.7 17 .9 34.6

19.2
4.0
13.2
1.6
2.6
17.8
18.5
1.1
3.2

M

F

a/

a/

Total

8.2 10.7 9.9
5.7 7.3 6.5
12.9 18.3 15.6
6.5 6.6 6.5
10.8 12.8 11.8
10.2 7.7 8.9
1.0

1.0

1.0
10.1

10.1

10.1

36. 7

5.3 2.9 8.2
64.4 43.5 107.9

17.5

19.8 16.9
1.0
8.3

1.1
8.9

2.1
17.2

10.8

8.9

19.7

5.0
15.2

3.7

0.5
8.9

0.5°
12.6

2.6

0.4
5.8

0.4
8.4

15.1
11. 7
2.2
0.6
11.8

6.7 5.8
18.4 16.8
1.2 0.6
0.8 0.4
10.1 7.3

194.3 140.6 334.9 88.6 81. 7 170.3 29.0 15.4 44.4 159.6
2.4 1.8 4.2
4.0 2.4 6.4 229.3 142.5 371.8
165.5 135.5 301.0 174.0 154.9 328.9 214.1 219.7 433.8
33.5 25.6 59.1
39.8 39.0 78.8 16.8 20.2 37.0 43.3
9.6
3.2 3.5 6.7
12.6 11.2 23.8
17 .2
12.1
7.6 19.7
6.1
4.0 10.1
18.9 9.4 28.3 32.6 21.2 53.8
9.3 5.9 15.2 46.0
31.8 29.0 60.8 29.9 23.3 53.2 27 .5 18.3 45.8 66.0
2.1
248.0 311.0 559.0 18.5 25.4 43.9 16.5 18.3 34.9
6.4
1.2
1.2
7.6 4.9 12.5
6.0
6.1
5.8 11.9
16.3 15.6 31.9
0.6 0.6 1.2

National Health Service, per 1000 males and females. respectively.
Including all skeleton and bones.
Including whole femur, lumbo-sacral and lumbar spine examinations.

United Kingdom(1977) [Kl2]4.6

140.4 120.3 130.4
2645.2 39.4 42.3
4.0 5.8 4.9
8.3 9.8 9.0
50. l 39.1 44.6
55.2 47.4 51.3
6.9 6.5
6.1
1.7 0.8
1. 3 1.3 1. 3
23.0

Table2

Relative freguenc~ of diagnostic x-ray examinations
1n various areas
Japan Austra- Europe Unitedliaa/StatesAfrica [SB]Type of examination

Head and neckThoraxDigestion organs
Urogenital organs
Skeleton, extremities

Type of hospital
General Regio- Smalland uni- nal and ruralvers ity di strict
7.6
37.9
7.5
11.6
35.4

4.3
53.B
1.2
2.9
37.8

3.6
58.5
0.1
3.3
34.5

1979

1970

[H26)

[S20]

1977
1970
(F3, JS
Nl 1,K12) [UB)

7.0
43.2
18.4
7.7
24.7

6.0
58.9
5.2
4.7
25.2

7.9
50.2
7.7
7.0
27.2

7.7
52.0
10.4
11.0
18.9

!.I Poland, Romania, Sweden and United Kingdom.
T a b l e

3

Percentage of the population with availabilityof diagnost1c x-raf machines ,n WHO regions

Wll](Number of countries is given in parentheses)

Number Thousandsof x-rayofmachings persons
per 10 per x-ray
personsmachine
> 100

99-50
49-33
32-20
19-13
12-10
9.9-6.7
6.6-5
<5

> 10
11-20
21-30
31-50
51-75
76-100101-150
151-200> 200

Region (WHO classification)
Africa1.0 (1)0.7 (2)
19.6 (3)22.8 (2)
6.6 ( 1)49.3 (8)Eastern
America MediterraneanSoutheast
Asia

Western
Pacific

24.4 (9) 1.9 (2) 0.2 (1) 0.2 (1)71.0 (3)55.0(11)
3.7 (1)
6.8 (3) 6.2 (420.4 (3)7.3 (5) 6.4 (4
92.6
15.2
0. 5 (2)(5(1) 4.7 (1)0. 7 (2) 18.1 (241.1 (45.3 (2)2.4 ( 1)
1.9 ( 1)3.0 (2) 11.1 (2)

Table

4

as
expresse

Type of examination
01
02
03
04
05
06
07
08
09
10
11

12
13
14
15
16
17
18
19
20
21
22
23
24

25

Barbados
1978

Hip and upper femur
11.3
Femur
Pe 1visPelvimetry
Lumbo-sacra l
14.9
Lumbar spine
Urography
6.2
Retrograde pyelography
0.42
Urethrocystography
4.1
Stomach and upper G.l.T.
6.9
Small intestine, colon, etc. 2.2
Abdomen
0.15
Abdomen (obstetrical)
6.1
Hysterosalpingography
1.04
Cholecystography
2.1
Chest (lungs, heart)
91.0
Head
24.0
Dorsal spine
0.51
Thorax12.0
Arm and hand
Lower leg and footDentalBreastCl-scanOther
0.13

Brazil
1978

38.0
15
0.68
7.0
42.0
0.4

Chile
1978

Colombia
1978

Cuba
1978

2.5
15
7.9

0.15

1.4

2.4

30.0

9.2
9.4
27.2

0.26

6.9
5.1
o. 35
0.19
17
6.4
7.9
0.23
0.7
17.2
45.9
14.7
4.2

30.0

1.59

0.11
78.9
7.3
63.0
0.46

20.1
21.9
10.5
6.1
17.4
3.0
13.8

3.6

I. 77
0.17
11.1
65
1.36
0.02
4.6

0.25
1.48
0.03
6.7
0.62

6.4
0.4
3.9
77.0

Fiji
1978

Guatemala Sri Lanka
1978
1979

0.16
0.02
1.11
0.25
0.06
o. 56
0.97
2.7

39.0
0. 35

0.54

1.43
1.07
0.07
0.14
0.07
0.40
0. 11
0.30
0.28
0.32
0.07
12.9
0.33
0.43
0.48

0.8
0.07

1. 78

347

Ta b l e

5

Mean

sites

Site

Mandible
Calvaria
Cervica 1 spine

Panorex

Panelipse

Orthopantomograph

Intra-oral

4 films
75-kVp
14 mA

80-kVp
15 mA

80-kVp
15 mA

141
59.6
131

318
122
237

239
93.1
532

Ta b 1e

21 films
80-kVp
15 mA

Co 11 imatedintra-oral
21 films
80-kVp
15 mA

Lateralcepha 1ometric
20 exp.
70-kVp
200 mA

8500
91.2
1160

2820
101.8
24.1

188
129
151

6

.

Data onYear
Target Focal
x-ray unit
spot
introduced( rrrn)Before
1969
1971
1972
1975
1976
1977

w

Mo
Mo
Mo/W
Mo/W

w
w

techni ue
10

Detector sys tern

Filtration Film/focus
distance

Absorbed dosein the breast
MidAverage plane

Industrial film
Electrostatic
Screen-film
Direct film
Electrostatic
Screen-film
Screen-film
Electrostatic

70
44
44

Inherent
0. 7 Al
0.003 tlo
or 0.5 Al
1.8 1.1 Al
1.8 1.5 Al
0.15 0.03 Mo
0.15 0.2
3.2
1.0
1.0

60
60
30
94

Ta b l e

16
8.2
2.8
16.9
4.1
1.2
1.5
0.75

7

Number of Cl-examinations eer !OOO eoeulation in Sweden[ NI 7]
Type ofe xami nation

1973

1974

1975

1976

1977

1978

1979

Head
Whole-body

0.03

0.20

D. 33

0.51
0.01

1.22
0.21

1.94
0.54

2.00
1.00

Total

0.03

0.20

0.33

0.52

1.41

2.48

3.00

Table

8

Effective dose equivalent and absorbed dose
.1 n gonads, eyes, and thyroidfrom various CT scanning erocedures[SIS]
Dose in organor tissue
Effective dose
equivalent (µSv)
Absorbed dose (µGy)
Gonads (M/F)
Eyes
Thyroid348

Head(8-14 slices)

Thorax(10-18 slices)

Abdomen(18-20 slices)40-10060-11080-120! /5
4000-6000
40-200I /1

10-50/10-150
10
3-10

140

8.5
5.5
1.7
3.3
0.65
0.7
0.6

T a b l e

9Com arison of absorbed dose in skin and onads
rom -scann1ng exam1nat1ons o t e 1 ney
or from conventional urography[SIB]

Absorbed dose in skin (mGy)
Gonad dose (M/F)(mGy)

Cl-scanning(average of
10 patients)

Urography

31
0.02/0.46

166
0.9~1112.1.

a/ With gonad shielding 0.06 rrGy.

Ta b 1e10

Doses in or ans and tissues from various dia nostic x-ra

examinations in Ja an

The data were supplied to U!/SCEAR by the delegation of Japcm, 1982'!., as derived from [H27]

Average dose equivalent H~ (mSv) in the various tissues
per full x-ray exa ination (radiography)
Type of examination

01
03
06
07
09
10
11
12
15
16

17
24

Hip and upper femur
Pe 1visLumbar spine
Urography
Urethrocystography
Stomach and upper G.I.T.
(a) Radiography(b) Photofluorography
Small intestine
Abdomen
Cholecystography
Chest (lungs, heart)fa) Radiographyb) Tomography( c) Photofl uorography
Head
Cl-scan (head)

ThyroidBonesurface

Mean ofother fiveorgans ortissues

GonadsBreastRed bonemarrow

2.7
0.5
0.09
0.11
2.6

0.00040.00060.006
0.007
0.0011

0.018
0.3
0.4
0.6
0. 34

0.0014
0.003
0.9
0.12
0.0011

0.002
0.003
0.009
0.009
0.002

0.054
0.9
1.0
1.8
1.0

0.52
0.9
1.9
2.7
0.9

0.05
0.06
2.9
0.18
0.01

0.11
0.6
0.00140.0018
0.007

2.8
2.5
3.4
0.8
0.7

1.8
4.0
0.06
0.004
0.04

0.03
0.17
0.004
0.002
0.006

8.4
7.5
10.3
2.3
2.5

2.8
5.5
5.1
0.9
0.9

0.00010.2
0.0006
0.001
0.006

0.3
35
0.5
0.03
0.3

0.07
0.7
0.3
0.3
2.5

0.3
16.3
0.9
0.09
0.4

0.10
0.014
0.05
0.13
2.7

0.2
2.0
1.0
0.8
7.4

0.12
3.9
0.13
0.17
1.3

Lung

a/ These values should be used for males, as those for females are slightly different, mostly forthe gonads.
Ta b 1e

11

Doses in or ans and tissues from various dia nostic x-ra examinations in Ja an
The data were supplied to UNSCEAR by the delegation of Japan, 1982a, as derived from [H27]

Average dose equivalent H~ (mSv) in the various tissues
per full x-ray exa ination (fluoroscopy)
Type of examination

01
03
06
07
09
10
11
12
15
16
17

Hip and upper femur
PelvisLumbar spine
Urography
Ureth rocys tography
Stomach and upper G.l.T
Sma 11 intestine
Abdomen
Cholecystography
Chest (lungs, heart)
Head

GonadsBreastRed bonemarrow

0.4
0.04
0.004
0.07
0.10
0.05
4.7
0.06
0.015
0.00010.00000.00010.00010.00040.002
0.00040.3
0.004
0.00080.014
0.08
0.0002

0.11
0.06
0.04
0.3
0.12
5.3
12.2
0.11
0.4
0.02
0.002

Lung

Thyroid

Mean ofBoneother fivesurface organs or
tissues

0.00040.00050.06
0.04
0.00044.8
0.17
0.00180.07
0.08
0.00080.00060.00050.006
0.003
0.0008
0.08
0.01
0.001
0.01
0.03

0.015
0.17
0.07
0.6
0.4
22
28.6
0.3
1.2
0.05
0.007

O.OOll

0.15
0.17
0.14
1.0
0.3
7.4
14 .3
0.4
I. 7
0.03
0.0015a/ These values should be used for males, as those for females are slightly different, mostly forthe gonads.

349

Ta b 1e

12

Doses in organs and tissues from various diagnostic x-ray examinations in Poland
The data ~ere oupplied to UNSCEAR by the delegation of Poland, 1982, as derived from [JS)Type of examination

Mass miniature radiography P/A{70-kVp; HVL 2.9 mm Al)
Chest radiography
P/A(70-kVp; HVL 2.9 mm Al)
Chest tomography
A/P(70-kVp; HVL 2.9 mm Al)
Stomach and upper G. I. T.
P/A{f1 uoroscopy){90-kVp; HVL 4.2 mm Al)
Urography
A/P{80-kVp; HVL 3.6 mm Al)
Cervical spine {fluorography) A/P{70-kVp; HVL 2.9 mm Al)
A/P
Dental (fluorography){60-kVp; HVL 2.0 mm Al)
Humeral joint (fluorography) A/P(60-kVp; HVL 2 mm Al)
A/P
Hip joint {fluorography){80-kVp; HVL 3.6 mm Al)
Cholecystography
P/A{70-kVp; HVL 2.9 mm Al)
Cho 1angiography
P/A(70-kVp; HVL 2.9 mm Al)
Sinuses (fluorography)
P/A(70-kVp; HVL 2.9 mm Al)
A/P
Lumba-sacral spine( fl uorography)(80-kVp; HVL 3.6 mm Al)!_/

Dose equivalent (mSv)

View

Lungs

Bone
Liver
Thyroid surface
a/

0.46

0.75

0.20

0.83

0.07

0.03

0.11

0.18

0.05

0.20

0.02

0.02

46.0

2.0

15.0

25.0

3.6

4.15

3. 75

!. 3

6.2

6.4

0.6

11.1

4.0

8.95

2.3

3.3

9.85

0.22

5.95

45.0

<0.01

5.2

0.68

1.9

13.5

1.2

0.03

0.02

0.01

0.08

0.01

0.01

0.14

0.01

<0.01

0.71

0.02

0.09

0.30

0.04

<0.01

5.0

0.09

0.47

0.38

<0.01

0.85

4.4

0.97

0.20

2.75

1.55

0.02

4.95

1.4

0.92

0. 34

3.60

1.85

0.02

6.50

2.05

<0.01

0.02

1. 7

0.08

0.33

3.05

<0.01

2.35

0.85

0.8

2.20

0.03

1.50

12.5

GonadsBreast Red bonemarrow

<0.01

0.11

<0.01

As representative of the remainder.

NOTE:

1. The data refer only to adult patients {above 14 years of age).
2. Examinations in adults account for 91,7 % of all x-ray examinations in Poland.
3. The examinations included in the table account for 78.S % of the total number of
x-ray examinations of adults in Poland in 1976.
4. For the application of the ICRP weighting factors and procedure for calculationof the effective dose equivalent the data are averaged for both sexes.
5. As a first approximation the absorbed dose in the liver was assumed to represent
the dose for the "remainder" of tissues.
6. In the case when absorbed dose in a given organ was lower than 0.01 rnSv, the value
0.01 mSv was taken for calculation of the effective dose equivalent.

350

TableType of examination
and/ortype of institution

13

1957

1977

Thousandsof examinations

GSD
(µSv)

Thousandsof examinations

GSD
(µSv)

The Armed Services
Hospitals not in the
National Health Service
Private medical radiology
Mass miniature radiology
Other

412

4.1

418

2.2

286
100
4770
288

2.4
0.8
0.1
1.0

323
250 2_/
1400
135

I. 7
1.3

Total

5856

8.4

2526

5.2

Hospitals in the
National Health Service

13000

132.4

21338

112.6

Total (excluding dental)
Dental

18856
2000

140.8
0.1

23864
5750

117 .80.3

Total (including dental)

20856

140.9

29614

118.1

Table

14

a/ Including chiropractors.

Sunrnary of diagnostic radiology in Japanand genetically significant dose e uivalent(comparison between the years 1969, 19 4 and 1979)
[H26)

1

1969
Total number of examinations
Number of examinations
per 1000 population
Genetically significant dose(uSv)

Tab l e

1974

1979

6.4 10 7 7. 3 10 7 9.6 10 7
621

664

830

257

165

150

15

Genetically significant dose equivalentfrom d1agnost1c x-ray exam1nat1ons 1n Japan[H4,H5,H6,H7,H9,H10,Hl3,H14,H16,Hl7,H18,H19,H26,H27,H28,H35,M3,M4,M5,Ml9)
GSO

Type of medical irradiation1960

x-ray radiography
174
x-ray photofluorography
Chest
5.7
G. I. T.
x-ray fluoroscopy
50
Dental intra-oral radiography
Dental orthopantomography

1969

1974

152

111

7.9
0.4
105

(uSv)
1975

1980

100
0. 32
1. 5

0.13
0.00088

1979

49.9
0.08
0.01

351

T a b l e

16

Estimates of the effective dose e uivalent mSv
from various 1agnost1c x-ray exam1nat ons 1n apan an Poland
The data t.iere suppUed to UNSCEAR
by tlze delegations of those tzJo countries,
as derived from [ H27) and [JS]Type of examination
01
03
06

07
09
10

11
12
15
16

17

22

Japan [H27] 1979

Poland [JS]1976Radiography

Fluoroscopy

0.84

0.16

0.46

0.07

0.78
0.98
0.99

0.06

Hip and upper femur
PelvisLumbar spine
Urography
Urethrocystography
Stomach and upper G.I.T.
(a) Radiography(b) Fl uoroscopy(c) Photofluoroscopy
Small intestine
Abdomen
Cholecystography
Cholangiography
Chest (lungs, heart)(a) Radiography(b) Fluoroscopy(c) Photofluoroscopy(d) Tomography
Head(a) Conventional(b) CT-scan
Cervical spine
DentalHumeral joint

0.38

2.71
4.87
17.85

0.14

1.67
4 .15

2.77
2.98
0.48
0.44

4.2

7.81
0.16

0.61

1. 36
1. 75

0.06

0.13

0.04
0.29

0. 22
11.05

8.57

0.13

0.001

0.32

1.09

1.54
0. 023
0.14!I The data refer only to adult patients (above 14 years of age) andare averages for the two sexes.

352

Ta b1e17

Re Jati ve frequency (eer cent) of diagnostic nuclear medicine erocedures,n various countries

Type of examination

NERVOUS SYSTEM
Brain scintigraphy
Regional brain perfusion imaging
Cisternography
Craniopharyngeoma imaging
NECK ORGANSSalivary glands
Thyroid-uptake
Thyroid-scintigraphy
Parathyroid scintigraphy
THORAX
Lung scintigraphy(per fusion)
Lung ventilation study
Cardiovascular imaging
Myocardial ~cintigraphy
AV shunt
DIGESTIVE TRACT ORGANS
Liver-spleen
Liver-gallbladder
Liver-pancreas
SpleenStomach and GI-bloodor protein loss
Vitamin 812 absorption
UROGENITAL ORGANS
Renography
Kidney GFR test
Kidney scintigraphy(dynamic and static)
Kidney, ureter, bladder
Adrenal glands imaging
Placenta imaging
SKELETON AND MARROW
Skeleton scintigraphy
1Scintimetry of joints)Bone marrow imaging
Ca-metabolism! OTHER
Deep vein thrombosis
Iron kinetics
Lymph scintigraphy
Blood cell survival timeand plasma volume
Peripheral circulation
Whole-body profile
Other
Number of a 11 types of
examinations
Total in thousands
per 1000 population

Jenmark

Australia

United States

1970
[Kl3]

1980
(LIO]

1973
f Sl3]

1975 /76
[S25]

1977
[S26]

1978
[ S27]

1979
[S27]

1966
[U7]

1977
[MB]

1978
(Ul6]

24.2

18.4

17.6

19. 25

20.26

16.50

14.29

8.6

47.3

23.2

1. 51
0.14

1.90
0.11

1.31
0.11

I.BO
0.14

0.14
6.00
8.16,

5.21
8.31

0.04
4.90
9.1

41.6
21.0

5.3
6.6

1.0
8.5

3.58
0.54
0.23

3.2

7.2
3.1

12.8

0.5

27.2
9.2

1.5
9.0

10.4
7.8

8.60
6 .39
0.01

13.1

11.3
3.4

2.16

4.0
0.89
0.12
0.15

3.7
0.3
0.08
0.49

3.88
0.6
0.45

5.06
0.25
0.09

8.35
0.52
0.1
0.31

8.54
0.84
0.07
0.35

8.44
0.81
0.03
0.36

8.57
0.89
0.03
0.51

I. 7

12.9

21.5
1. 7

0.9
0.4

4.1

2.9
0.7
8.4

14.6
0.6
o. 7

21.1
0.8
0.2

0.6
1.0

0.1
0.3

4.18

0.97
3.16

1. 73
2.27

1.18
2.07

1.08
1.86

1.6

0.5

5.4
2.1

19.66
3.32

17.22
3.5

17.6
4.02

17.6
4.04

0.9
0.6

0.4

1.6

1.4

15.5

S.E6
0. 52
0.09
0.86

4.79
0.55
0.05
0.48

5.94
0.97
0.07
0.30

5.71
0.81
0.06
0.21

1.8

3.5

24.4

2.9

7.08
0.04
0.01

11.3
0.05
0.05

14.43
0.06
0.01

17 .65
0.2
<0.01

5.8

17.2

0.07

0.31
0.04
0.18

0.48
0.04

0.33
0.03
0.2

1.48
2.71
0.02
!. 72

1. 72
3.12
0.02
0.87

1.5

3.1

72. 7
14.3

71.7
14.1

1.8
1.2
0.1
1.0
0.4
0.1

0.1

0.04

1.0

0.8

1.99
4.29

1.4

2.0
0.1

6.2

0.83

1.59
3.06
0.03
1.27

52.0
4 .1

117 .3
8.0

3.8

57.8
11. 4

68.3
13.4

0.29

0.36

23.0

0.9

14.0

8000
3.71

36. 7

353

Table 17, continued

Type of examination

NERVOUS SYSTEM
Brain scintigraphy
Regional brain perfusion imaging
Cisternography
Craniopharyngeoma imaging
NECK ORGANSSalivary glands
Thyroid-uptake
Thyroid-scintigraphy
Parathyroid scintigraphy
THORAX
Lung scintigraphy(per fusion)lung ventilation study
Cardiovascular imaging
Myocardial scintigraphy
AV shunt
DIGESTIVE TRACT ORGANS
Liver-spleen
Liver-gallbladder
Liver-pancreas
SpleenStomach and GI-bloodor protein loss
Vitamin 812 absorption
UROGENITAL ORGANS
Renography
Kidney GFR test
Kidney scintigraphy(dynamic and static)
Kidney, ureter, bladder
Adrenal glands imaging
Placenta imaging
SKELETON AND MARROW
Skeleton scintigraphy
Scintimetry of joints
Bone marrow imaging
Ca-metabolism
OTHER
Deep vein thrombosis
Iron kinetics
Lymph scintigraphy
Blood cell survival timeand plasma volume
Tumour and abscess
imaging
Peripheral circulation
Whole-body profile
Other
Number of a 11 types of
examinations
Total in thousands
per 1000 population

354

Sweden

TN2]

1971

1972

1973

1974

1975

1976

1977

1978

9 .06

9.4

11.19

12.9

13.19

14.04

13.3

13.3

0.29
0.25
0.01

0.38
0.19

0.01
8.22
11.11
0.03

0.02
4.86
11.99
0.02

4.21
2.00
0.34
1.01
0.16

0. 77
0.4
1.02
0.18
14.0
I. I
0.59
0.09

17 .24
19.83

17.7
14.9

15.81
14.95

12. 7
14.6

10.73
12.6

9.2
11.8

1.97
2.64

2.5
2.5

2. 55
3.15

2.9
2'.8

3.05
1.28

3.87
2.40

0.03

0. 045

0.08

0.23

1.16

10.94

11.34

11.9

0.13

12.0
0.07
0.59

12.91

0.27

11.35
0.005
0.51

0.84

0. 72

13.0
0.15
0.47
1.18

3.93

4.3

3.4

2.5

2.61

2.21

0.096
1.86

0.25
2.0

20. 39

22.0

24.03

23.3

26. 34

22.95

17.68
4.46

16. 7
5.15

1.35

1. 7

1.26

1.8

0.99

1.09

l. 76
0.20
0.11
0.4

1.02
0.20
0.12
0.25

1.21

1.5

3.7

5.3

7.06

10.01
0.08

11.8
1.15
0.08
0.07

14.82
0.91
0.1

4.44

0.27
0.65
0.19

0.89
0. 57

0.08
0.64
0.18

0.46
0.74
0.17

0.84
0.6
0.06

1.68
0.24
0.012

1.25
0.52
0.054

1.53
0.55
0.06

3.15

2.4

2 .34

2.5

2.28

2.05

1.89

2.67

0.58

0.2

0.5

0.22
0. 36

0. 39
0.07

6.9

5.13

3.53

4.0

3.93

0.01
0.33
4.1

0.20
0.29
0.82
0.9

0.01
1.16
0.81
1.03

66.9
8.29

71.2
8. 79

88.4

95.7
11. 7

98.9
12. I

112
13.6

114

13.8

120
14 .5

10.9

Ta b l e

18

rocedures
surve , 1979

CountryYear

Frequency
per 1000
population

llunna

1972
1973
1974
1975
1976
1977
1978
1976
1977
1978

0.16
0.17
0.18
0.20
0.20
0.24
0.22
o. 79
0.85
0.81

Cuba

T a b 1 e

19

(Annual. nwnbel' of examinations pel' miUion population in parentheses)

Type of examination

NERVOUS SYSTEM
Brain scintigraphy
Regional brain per fusion imaging
Ci s temography
Craniopharyngeoma imaging
NECK ORGANS
Thyroid-uptake
Thyroid-scintigraphy
THORAX
Lung scintigraphy (perfusion)
Cardiovascular imaging
Myocardial scintigraphy
DIGESTIVE TRACT ORGANS
Liver-spleen
Liver-gallbladder
Liver-pancreas
SpleenVitamin 812 absorption
UROGENITAL ORGANS
Renography
Kidney GFR test
Kidney scintigraphy (dynamic.static)
Placenta imaging
SKELETON
Skeleton scintigraphy
OTHER
Iron kinetics
Lymph scintigraphy
Red cell survival time or volume
Tumour scintigraphy
Other

Cuba

Burma

Colombia

Guatemala

33

25.7

9.6

6.6

268 (8.1)

220 (8.56)

567 (59)

147 (22)Peru

Sri Lanka

17

14.2

Number of population (in mi 11 ions)40 (2.8)
2000 (118)

1 (0.03)31 (1.8)2776 (84)1468 (44.5)

1700 (66)1200 (47)3230 (336)2004 (209)466 (71)19500 l1147)
5330 313)

3 (0.1)80 13)
115 4.5)

48 (5)4 (1)393 (23)115 (17)2205 ( 130)4051 (285)1222 (86)15 (0.5)
1774 (53.8)

680 (26)270 (28)
43 )4.5)
72 7.5~67 (7.0

10 (0.6)980 (102)340 (20)47 (1.4)
143 (4.3)

150 (5.8)315 (12)195 (7.6)30 ( 1.2)

9 (0.27)120 (4. 7)

64 (6. 7)

550 (32)

57 (5.9)

10 (0.6 ~5 (0.343 (2.5)

8 (0.24)993 (30)65 (2.0)
4 (0.1)2 (0.3)140 ( 14.6)
17 ( 1.8)
234 (24.4)

446 (26)
74 (4.4)

34 (2 .4)
50 ( 13.5)500 (35)
1 (0.07)

10 (O. 7)

20 (1.2)355

Ta b 1e20

er cent of radio harmaceuticals
c ne l!roce uresRadionuclide

3H
14c
18F
22 ,24Na
32p
42K

Chemi ea 1 form

1970
[Kl3}

water, labelled compounds
0.08
labelled compounds
fluoride0.7
chloride
0.08
phosphate
0.3
chloride
4S,47cachloride
51cr
chromate. RBC
2.0
55Fe
citrate57cocyanocobolamin, bleomycin
0.6
58co
cyanocobolamin (vit. B-12)
0.4
59Fe
citrate
0.45
64cu
ion
65zn
ion
67Ga
citrate68Ga
citrate75seselenomethionine
0.85
81 Rb/SlmKr gas
82Br
bromide85Krgas dissolved in saline
85Srchloride87msr
chloride
0.5
pertechnetate, labelled corn- 53 3
99~cpounds, colloid and particles •111 InDTPA
11 Jmln
DTPA, colloid and particles 2.8
1231
iodide, labelled compounds
1251
iodide, labelled compounds
1.35
127xe
dissolved in saline
1311
iodide, labelled compounds
31.1
1321
iodide131 csiodide0.35
133xe
gas and dissolved in saline 0.02
169Yb
DTPA
0.3
197Hg
chlonneodrin, BMHP
1.55
198Au
colloid0.85
201n
chloride203Hg
eh 1ormeodri n
0.02

356

Denmark

Australia

SwedenUnited States

1976!S25 J

1977[ S26]

1978
[S27]

1979
{S27J

1976
\N2]

1977
{N2J

1978
fN2J

0.97
0.46
0.03
0.19
<0.01
0.23
0.46
3.5

0.17
0.4
0.1
0.17
<0.01
0.08
0.77
4.0

1.14
0.38

0.37
D.32

0.4
0.54

0. 32
0.51

0.31
0.55

0.08
0.01
0.01
, 0.47
4.35

0.8
0.5
0.03

1.46
1.84
0.13
0.29

1.42
0,94
0.04

1.28
0.86
0.04

0.04
0.09
0.04
0.04
<0.01
0.04
0.03
0.01
<0.01
0.04
0.76 0.04,0.09 0.04,0.03 0.03
4.27
4.9
4. 32
5.6
0.04
0.2
0.24
1.16
1.35
0.98
1.29
o. 79 0.88 0.88 0.81
0.03
0.2
0.33
0.31

2.0

0.54

0.64

o. 77

0.32

0.03

0.1

0.07

0.03
0.1

0.12
0.02
49.8

0.13

0.03
0.16
0.01

1980
{llO}

D.05

0.04

1.0

89.0
0.02
0.1
0.3
0.02
0.9
0.3
3,4

1.6

0.08
0.01

0.06
0.13

0.73

0.46
0.05

0.06
0.06
0.04
0.34
<0.01

0.83

<0.01
0.78

<0.01
0.64

1976
[M8J

1978
{U16]

0.05

0.03

0.04
0.19
0.01

2.8

2.8
0.4

0.14

56.2

56.7

57.8

45.8

49.8

54.5

0.06
0.52

0.09
0.31
0. 11
7.92
0.1
21.4
0.55

0.14
0.25
0.06
7.61
0.17
21.0
0.41

0.03
0.54
0.05
10.5

0.6
0.01
0.08
8.42

0.19

29.7

27.9

23.04

8.0

8.38

3.49
0.01

4.29
0.01

2.91
0.1
0.03
0.19
0.47

2.62
0.04

2.2

3.1

3.B
0.05

0.16
0.66

0.06
0.75

0.93
0.12
6.5
0.01
26.5
I. 31

7.73
0.01
22 .1
0.56

4.15
0.06
0.35

3.88
0.03
0.01

0.04

0.01

0.29

0.1
8.56

80.5

81.7
0.09

4.1
0.01

0.03

0.07

0.8
0.19

Ta b l eandEstimated installations of scintillation cameras
o ulation er scintillation camera in Euro e 1978
w1t annua growt rate rom l
to 1
(P9]

Country

Populationin millions

Austria
7.51
Belgium
9.84
Bulgaria
8.81
Czechoslovakia
15 .15
Denmark
5. 1
Finland
4.75
France53.28
Gennan Dern. Rep.
16. 76
Gennany, Fed.Rep.of 61. 32
Greece9.36
Netherlands
13. 94
Hungary
10.69
Italy
56.7
Norway4.06
Poland35 :01
Portugal
9.8
Romania
21.85
Spain
37.11
Sweden8.28
Switzerland
6. 34
United Kingdom
59.06
Yugoslavia
21.91

Installed
scintillation
cameras1978

Growth of
installations
as compared
to 1977 (%)

34
63
3
28
37
28
134
8
498
13
104
3
86
22

26
5
50
4
6
17
7
14
44
44
22
50
32
10
10
0
0
25

11

4
7
35
69
45
206
23

T a b 1 e

Mean absorbed dose inRadionuclide
and compound
3H waterType ofadmi ni strati on
i. V •oral

3
H inul ini.v.

11c monoxide
14 c inulin

inhalation or i.v.
i.v.

13 N anmoni um
fluoride
22 Na chloride
24 Na chloride
32 P phosphate
42 K chloride
45 ca eh 1ori de51

cr chromate
chrom I 11 ion
erythrocytes
denaturederythrocytes
ethylene diamine
triacetate5\e ion57co vitamin B12
bleomycin
58
co vitamin B1259F e 10n. comp 1ex

21i • v.
i.v.
i. v. or oral
i .v. or oral
soluble i.v.
oral
insoluble oral

oral
oral
i. v.
i .v.
i. V,

i.v.

oral
i. V.

oral
i.v.

220
160
2940
540
140
170
400
2100
120
720
130
3560
660
180
3180
2450
3120
1060
120
140
290
950

8

10
26
64

22
in the onads and in the whole bod
a m1n1stere act1v1t

Mean absorbed dose per unit administered activity (µGy/MBq)
Tissues most heavily exposed
whole body, 15colon, 33: G.I.T., 30
kidneys: nonnal, lno outflow, 1300
heart, 23; lungs, 9-12
kidneys: normal, 8
no outflow, 11000
lung, 49; kidneys , 5skeleton 30-60; bone marrow, 50
skeleton,6200; bone marrow,4400
bone marrow, 450; skeleton, 410
skeleton,7600; bone marrow,8000
colon,
5400; G.I.T., 2000
colon, 21000; G.I.T., 1500

i. V.

i. V •

Population per
scintillation
camera (1000)

skeleton, 19000;
bone marrow, 5900
colon, 6300: G.I.T., 130
colon, 160; G.I.T., 30
skeleton, 90; bone marrow, 70
spleen, l50D; kidneys, 240
spleen, 3400-24000; kidneys,140
kidneys: normal, 0.007
no outflow, 1500
bone marrow; 4000; liver, 1000
liver, 25000; kidneys, 4300
kidneys, 100; liver, 50
liver, 85000; Udneys, 10000
spleen, liver, 17000
bone marrow, 13000

Testes

Effectivedose
Ovaries Whole body equivalent(µSv /MBq)

15

15

0.1

0.1

15
15-22
0.1

2.5

2.5

3

15
15

5
11

3
5-12
3200
340
1300

5-12
3200
350
1300

220
300

220
300

2.5
5-20
3100
400
2200
1900
1300
250
2600

10
21
3100
340
1700
2400
2700
220
1400

3.5
70
80

41
70
100

520
6.3
65
140

670
35
45
210

17
0.2

25
0.8

50

400

91
30
20
500
12000

3

230
1100
28
2600
6300

o. 5

250
3500
15
5000
6400

2

550
2900
29
5900
12000

357

Table 22, continued

Tissues most heavily exposed

Testes

Effectivedose
Ovaries Whole body equivalent(µSvMBq)

colon, 190; bone marrow, 160
intestine, 57; colon, 46
bladder, 500; kidney, 54
liver, kidney, 6800;
pancreas, 3200

65
11
13
3000

76
13
23
1400

70
14
10
2200

110
23
41
2900

440
850
4
2
I
7

410
1100

370
1500
4
4

430
1000

Mean absorbed dose per unit administered activity (µGy/MBq)
Radionuclide
and compound

Type ofadministration

67 Ga citratei.v.
68 Ga citrate
i.v.
DTPA a/i .v.
75 s L 1.
.
e -se eno met h'1on1ne
1.v.
82 sr bromide
85 sr chloride
87msr
99m
Tc pertechnetate

i.v.
i.v.
i .v.
i. v.
oral
i .v.

albuminden a tu red red
blood cellst.v.
dimercaptosuccinate i.v.
DTPA a/red bTood cells
phosphate complex i.v.
iminodiacetate complex, i.v.
colloides
i .v.
macroaggregatesi.v.
plasmini.v.
111 In ion
i. V •
leucocytes
i. V •
bleomycin
i. V.
DTPA a/i •V •
throml:iocytes
i. V •
113min ion
i •V •
inhalation
aerosoldenatured red
blood cells
i. V.
DTPA a/i .v.
colloTd
i. V •
123 1 iodide
i.v.
albumini.v.
o-hippuratei.v.
125 1 iodidei.v.
a 1bumi ni •v .
i.v.
fibrinogeno-hippuratei.v.
131 I iodide
i. V.
albumini. V.
macroaggregatesi. V •
o-hi ppurate
i. V.
127xe gas
inhalationin saline
i. V •
133 xe gas
inhalationin saline
i. V,
169 Yb DTPA a/i.v.
198Au colloidi. V.
201 n ion
i. V'
a/ DTPA = diethylenetriaminepentaacetate.

358

skeleton, 5500; bone marrow 4500
skeleton, 20; bone marrow, 10
ventricle, 68; thyroid 35
colon, 110; G.l.T., 55
liver, 35; heart, 21 ,< 1
spleen, 150; pancreas, 43
kidney cortex, 280; kidney av.185
3kidneys:normal, 10; no outflow 420 3
spleen, 30; lungs, 25
skeleton, 14; kidneys, 95gallbladder, 45; liver, 25Iliver, 92: spleen, 56< 1
lungs, SO: thyroid, 23
2
4
spleen, 51; liver, 40
liver, 880; bone marrow, 850
spleen, 2800; liver, 610
liver, 210
31
kidneys: normal, 15; no outflow, 7600
spleen, 6700: liver, 170

1ungs, 200

4< 1

spleen, 1100; pancreas 21
1
kidneys: normal ,50; no outflow 710 4
liver, 140; spleen, 42
1thyroid (35%), 5200; ventricle, 53 3
spleen, 42; lungs, 29
16kidneys: norrnal,10; no outflow 1500 3
8thyroid (35%) ,330000; liver, 140
170
spleen, 550; lungs, 400
spleen, 260; lungs, 170
44
kidneys: normal,10; no outflow 7500 1
thyroid (35%), 530000; ventr., 340 26
spleen, 800; lungs, 670
460
lungs, 1900; liver, 410
120
kidneys: norrnal,10; no outflow 4500 3
broncus epith., 14; lungs, 1lungs, 6; fat tissue, 1
0.3
0.3
broncus epith., 30; lungs, 3
0.3
lungs, broncus, 25; fat tissue 3
kidneys: normal, 28; no outfl.32000 13
liver, 11000; bone marrow, 730
10colon, 220; kidneys, 200
750

4
6

25
8

5
3

1

5

5
6

4

6
9
2
2
6

45
4
< 1

2
5

2

7

7

3

7

4
5
3
7
73
140
45
94

20
13
16
13
210
330
47
490

4
2

4
30

5
2
3
9

17
2
190
220
60
2
260
480

0.4
0.4
0.4
17
38
100

53
16

5

8

2

6

9

18
4
12
210
53
38
480
120
4

7

II
25

so

3

0.2
0.4
0.4
0.4
7

380
35

72

15
14
170
21
15
10000
290
95
11
16000
680
360
16
0.3
0.5
0.3
0.7
43
1000
94

Tab l e

23

fre uenc
as reporte

1978(Annual frequency pe1• million population in parentheses)

BunnaRadiotherapy procedure

Indonesia

Sri Lanka

Millions of population in 1978
33
146.9
14.2
Externa 1 beam
Cobalt-GO teletherapy
x-ray therapy 100-150 kV
Brachytherapy
lnterstiti a 1
Gold-198 seeds
Radium-226 needles
Intracavi ty
Radium-226 tubes
Applicators
Radium-226 moulds
Strontium-90 eye applicators
Radiopharmaceuticals
4 (0.1)Thyroid cancer: iodine-131
165 (5)Thyreotoxicosis: iodine-131
Polycythaemia vera: phosphorus-32

Tab 1 e955 (6.5)4454 (314)171 ( 12)6 (0.4)118 (8.3)

148 (1.0)

221 (15.6)
31 (2 .2)
11 (0.77)
22 (1.6)
2 (0.1)

24

Data on the annual freguenc~ of brachytherapY in Japan

r 9J

1971

1979

female
Male
Total

400
54,5
454.5

217
16.2
233.2

226Ra
Radiation source(relative frequency,%) 222Rn
137cs
60co
90
90Sr

50.3
2.3
7.2
28.5
11. 7

38.5
a/
lb.0
38.5
6.0
1.0

Mouth
Source position(relative frequency, %) Maxilla
Neck
BreastCervix
Femur
Other

12.0
1.6
0.6
0.7
60.0
0.2
24.9

4.1

Treatments(number per million)

y

3.2
85.5
7.2

~/ Radon-222 has not been used for brachytherapy inJapan since 1976 be:ause production has been
stopped due to radiation protection problems.

359

Ta b 1e25

Annual number of treatments and relative fre9uencti of various treatments
witn radio narmaceuticals in ~weden durin tie ears 1971-1978

Radiopharmaceutical
131 I
32p
198Au
32p, 90y
198Au, 90y
90y
90y
32p
32p
198Au

Annual number of treatments per million population(relative frequency in per cent of all treatments in brackets)

Diseaseor site treated

1971

1972

Thyroid diseases

249.8(82.5)
Polycythemia vera
40.6
(13.4)
2.4
Pleura and abdomen(0.8)
Rheumatic arthritis
3.1
(1.0)
Knees and joints
1.8
(0.6)
Pleural and perime3.9
diastinal carcinoma( 1. 3)
Cystic craniopharyngeoma 1. 3
(0.4)
Mycos is fungoi des
Metastasis, generalized
carcinoma
Spina 1 cord cyst

1973

271.0
297.3
(85. 3)(84.1)
36.0
38.8( 11.1)(11.2)
1. 9(0. 57)4.0
0.3(1.23)(0.07)
3.5
4.4,(1.07) (91.2)
4.9
0.5( 1.53)(0.14)
0.4(0.11)
0.5(0.15)
0.13(0.04)
0.1(0.03)

T a b 1e

1974

1975

1976

1977

300.1
(88.0)
31.5(9.22)

298.4(87 .8)
31.5
(9.3)

387.1
(90.1)
31.0(7 .2)
0.4(0.09)

357.6 350.3(88.58) (89.6)
33.8
32. 3
(9.38) (8.3)
1.44
0.96
(0. 36) (0.24)

0.1(0.04)
3.3(0.97)
4.6(1. 36)1.5(0.43)

0.3(0.07)
5.0( 1.47)
3.8(1.11)
0.6(0.18)

6.9(1.56)

1.0(0.23)

0.24(0.06)

26

Percentage of absorbed dose in ovaries and testes
of tne total treatment dose at maximum build-up
at two different field locations[N9)(The Last tTJO coZwnns give the gonad doses resuLtir19 from45 Gy maximum absorbed dose in the treatment region)

Percentage dose
Treatment region!1edi as ti num 2
10 x 10 cm
Paraaorta 1 lymph
nodes
10 x 10 cm2

360

Type of radiation

45 MV x ray
10 MV x ray
45 MeV electron
18 tleV e 1ectron
45 MV x ray
10 MV x ray
45 MeV electron
18 MeV electron

9 .1(2.08)
1.08(0.27)
1.08(0. 27)

Absorbed dose (rrxiy)with 45 Gy at maximumin treatment region

Ovaries

TestesOvaries

Testes

0.15
0.2
0.3
0.05
0.4
0.6
0.15
0.03

0.2
0.24
0.2
0.09
0 .1
0.4
0.07
0.02

68
90
135
23
180
270
68
14

90
110
90
41
45
180
32
9

1978

5.9
( 1.50)0.36(0.09)
1.2(0.31)

Ta b l e

27

Average eercentage gonadal doses for various treatments
using colia lt-60

INS]

Type oftreatment
Head fields

Average CGO a/(cm) field sTze

Site orcondition

Mante fields

Nose, middle ear,sinuses, paratoid,
brain. CNS,
pituitary, antrum
Pharynx, larynx,
thyroid,
upper oesophagus,
upper postcricoid
Bronchus, 1ung
Lower oesophagus
BreastShoulderHodgkin's disease

Abdominal
fields

Stomach, bowel
Lymphoma

Neck fields

Thorax fieldsa/Percentage dose
ea lcul ated

Measured

(cm)

M

F

M

F

M

F

50

70

60

0.085

0.115

0.096

0.128

100

60

50

0.130

0.200

0.195

0.254

150
130
120
200
850
850
120
220

40
50

30
40
40'
50
30
40
20
20

0.445
0.252

0.900
o. 395
0.345
0.225
3.250
1.200
2.200
3,400

0.468
0.220

0.850
0.382
0.377
0.210
3.300
1.010
2.410
3.280

60
40
50
30
30

0.150
1.200
0.450
0.850
1.150

0.170
1.150
0.550
0.915
1.250

CGO a centre-of-the-field to gonad distance.

Ta b l eer 1 Gan

28

and females
lus scatter radiation
1at1onram genera

Ma l eIrradiation
position

Head
Neck
Chest
AbdomenOvaries
PelvisThigh
TestesLower leg
Foot

60cc
gamma rays

200 kVx rays

!I

!I

~/

b/

0.043
0.21
0. 35
0.075
0.475 0.0025 0.068 0.01
0.382 0.006 0.06 0.018

10 MV
x rays

a/
0.487
0.54
0.44
0.29

b/

10 fleV
electrons

50 kV
x rays

!I

!I

~I

0.25
0.385
0.0015 0.5
0.0026 0.414

~/

0.005
0.015
0.016
0.015

0.638 0.129 0.062 0.104 0.16 0.0043 0.657 0.002 0.015 0.028
0.483 0.135 0.06 0.06 0.067 0.0274 0.507 0.0017 1.68 0.041
495
796
0.265 785
845
0.37 808
0.1
0.18
0.23
0.015
0.2
0.05 0.01 0.22
0.23
0.18
0.01
0.15
0.05

FemaleIrradiation
position

Head
Neck
Chest
AbdomenOvaries
PelvisThigh
TestesLower leg
Foot

Goco
ga= rays

200 kVx rays

a/

!I

~I

y

10 MV
x rays10 MeV
electrons

!I

~I
0.001
0.006
0.023
0.48
0.05
0.005

0.18
o. 34
0.42
0.32
460
0.38
0.384

0.027
0.003 0.03 0.01
0.009 0. 33 0.027
0.032 0.02 0.067
0.64
165
1.11
0.075 0.03 0.2
0.0072 0.026 0.022

0.302
0.34
0.228
0.08
607
0.05
0.096

0.16
0.075

0.02
0.02

0.175
0.11

!I

b/

50 kV
x rays

!I

£/

0.218
0.38
0.44
0.32
0.002 0.001
1.8
30.6
0.37 0.005 0.01
0.4
0.001 0.01
0.065
0.045

!I Gonad dose due to primary plus scatter radiation, in ntiy per Gy at thesurface of beam entrance.
b/ Gonad dose due to generalized leakage radiation, in mGy per Gy and cm 2of the beam entrance surface.

361

Tab 1 e

29

Absorbed dose in various or ans outside the treatment area
er unit a,n t e sur ace oe earn en ranee
x ray ra , ot erapy
Absorbed dose from scatter radiation in
Irradiation
position

Head
Neck
Thoral\AbdomenPe 1visThighThyroid

BreastStomachLungs
Bladder(mGy Gy - l cm - 2 )

0.05

0.004
0.009
0.02
0.03
0.003
0.001

0.00040.0035
0.03
0.17
0.07
0.01

0.015
0.1
0.09
0.11
0.005
0.001

Table

30

0.04
0.004
0.001

0.00020.0008
0.007
0.16
0.25

TestesOvaries

0.1
0.002
0.004
0.03
0.12

0.001
0.006
0.023
0.31
0.005

Absorbed dose in various organs outside the treatment area
er unit administered activ,t in radio harrnaceutical thera

Absorbed dose
per unit
administeredactivity(mGy/MBq)

Organ

Administeredradiopharrnaceutical

Type of disease

131 1-iodide

GonadsBone marrow
GonadsPolycythemia vera
Malignant intraperitoneal Gonads
and intrapleural infusions Bone marrowLung
t1a 1i gnan t lymphoma
Hyperthyroidism

0.08
0.19
0.14
0.08
1.62
22.9

198Au

Joint diseases

90y

Joint diseases

Regional lymph
nodes
176
Lymphocytes
2.7
Liver
0.14
Total body
0.35
Regional lymph
nodes
246
Liver
0.14
Total body
0;3s

32 P-phospha te
198Au-co 11 oi ds
32 P-lipiodol F(with 1-131 forscintigraphi c
localization oflymph nodes)

31

T a b 1 e

Geneticall si nificant dose e uivalent values µSv
or ra ,ation t erapy reporte at , erent times
from various countries
Year
Country
Australia
Germany, Fed.Rep.of
Japan
United States

362

1970

1971

1973

1978

6-t2

8+3
0:1

23
7

23-!:lRef.
[S21][S2,S3,S4J(H5, H19)[Tl)

Tab l e

32

Berlin (West} ( 1973

tlunich (1971)

Type of disease

PrivateGS0cl.7

C1l ni cGS0c6.5

Total
GS0c8,2

PrivateGS0al.9

ClinicGS0=4.1

Total
GS0=6.0

Haemangioma
Arthros is andarthritis
Ke loi d
Spleen or kidneytransplants
Anal region
Other benign
conditions
Malignant diseases

1.6
9.0
71.0

41. 5
8.0
7.0
10.5
31.0
2.0
0

10.0
8.6
57.7

2.9
72 .1

83.7
2.3
6.0

57.5
30. l
4.5

0.1
7.7
0

7.9
0

13.0
4.0
0

17.7

23. 7
7.3
0

0

T a b l e

33

Annual geneticall) significant dose equivalent from external beam therapy
1n a an 6 a e and sex of the at1ents
and byte nature o t e con 1t1ons regu1r1ng radiotherapy
Annual genetically significant
dose equivalent (µSv)
Age class
Ma 1 eRef.

F e ma 1 e

BenignMalignBenignMalign

0-14
15-29
30-44
> 45

0.41
0.06
0.01
0

0.39
0.97
0.29
0

3.10
3.40
0.02
0

0.61
0.22
0.11
0

Total 1971

0.48

1.65

6.52

0.94

fH5]

Total 1978

0.03

0.36

0.08

0.58

fH19]

363

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A3

A6
B1
82
B3

85

86

89

BIO

B13

814
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816

818
B19

B20
B21
B23

B24

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