National Diagnostic Reference Levels
in Japan (2020)- Japan DRLs 2020-

Japan Network for Research and Information on Medical Exposure (J-RIME)
Japan Association on Radiological Protection in Medicine
Japan Health Physics Society
Japan Pediatric Cardiac CT AllianceJapan Radiological Society
Japan Society of Medical Physics
Japanese Society for Oral and Maxillofacial Radiology
Japanese Society for Radiation Oncology
Japanese Society of Interventional Radiology
Japanese Society of Nuclear Medicine
Japanese Society of Pediatric Radiology
Japanese Society of Radiological Technology
The Japan Association of Radiological Technologists
The Japan Central Organization on Quality Assurance of Breast Cancer Screening
The Japanese College of Medical Physics
The Japanese Radiation Research Society
The Japanese Society for Neuroendovascular Therapy
The Japanese Society of Nuclear Medicine Technology

In cooperation with theJapan Medical Imaging and Radiological Systems Industries Association
National Institutes for Quantum and Radiological Science and Technology

Preface
Five years have passed since the Diagnostic Reference Levels (DRLs) were first publishedin Japan in June 2015.

With this revision of "Diagnostic Reference Levels in Japan (2020edition)" report (commonly referred to as the Japan DRLs 2020 or DRLs 2020), seven modalities
are being released.

This revision was prepared as per the results of a fact-finding survey

conducted by the Japan Network for Research and Information on Medical Exposure (J-RIME)in cooperation with related academic societies.
Japan DRLs 2015 was established for six modalities as a compiled "Setting of DRLs basedon the results of the latest domestic fact-finding survey" report in cooperation with related
academic societies under the activities of J-RIME.

Multiple experts, including physicians,

clinical radiologists, and medical physicists, discussed the data, and expert advice was obtained
from international organizations, including the United Nations Scientific Committee on the
Effects of Atomic Radiation (UNSCEAR), the International Commission on RadiologicalProtection (ICRP), the International Atomic Energy Agency (IAEA) and the World HealthOrganization (WHO). The establishment of national DRLs in Japan is ground-breaking, and has
had a major impact on radiation protection in medicine in Japan and has been reported on by the
media.
When initially published, the DRLs 2015 had not been included in laws and ordinances andwere positioned as one set by the academic societies in the framework of the J-RIME, but wererecognized and implemented in domestic radiation practice through the educational activities ofacademic societies. With the revision of the Medical Law Enforcement Regulations in March
2019, safety management systems for medical radiation have become an important part of the"Guidelines from relevant academic societies" in the dose management of medical exposure, andthe DRLs 2015 has been, in effect, incorporated into laws and ordinances.
Based on these circumstances, the DRLs 2020 have been developed in a timely mannerwith the cooperation of relevant academic societies in a similar manner as that of the DRLs 2015.
Radiation medicine has come into wide use in modern times and become an essential partof medical care. Continuous advances have been made by introducing new methods and devices.
While radiation medicine has brought great benefits to the general public, the medical exposureof patients has been increasing.

Note that medical exposure accounts for a considerable part of

the radiation exposure of the population in developed countries when combining natural andartificial radiations. Thus, it has been recognized domestically and internationally that radiation
protection efforts are crucial to allow patients to enjoy safe and effective radiation therapy.
‘Justification’, ‘Optimization’, and ‘Dose Limits’ are three principles in the protection against
various radiation exposures.

However, unlike occupational and public exposure, dose limits

have not been defined for protecting patients from medical exposure.

The medical exposure ofpatients differ from other types of exposure in that patients are exposed to radiation intentionallyand in that patients themselves receive benefits; thus, a uniform dose limit may limit medical careand lead to disadvantages to patients. Therefore, the principles of justification and optimizationmust be followed for the medical exposure of patients and, for optimization, the DRLs are an
important tool for optimizing radiological diagnosis and interventional radiology (IVR).
Currently, the international standard is to establish and implement DRLs for each individual
country.

In 2017, the ICRP released Publication 135, which comprehensively discusses DRLs.

This document provides historical information on the 20 years after the first introduction of theterm diagnostic reference level by the ICRP and guidance.

During the establishment of thecurrent DRLs 2020, ICRP Publication 135 was used as a reference.
While Japan has considerably contributed to the development of radiation medicine over
the years, knowledge about medical exposure has been accumulated but has not been systematizedfor protection against medical exposure.

Therefore, it was recognized that there was arequirement to gather and share domestic and overseas research information on medical exposure
with the cooperation of numerous experts in collaboration with academic societies and to establish
a medical exposure protection system that is appropriate for the situation in Japan.

In 2010, J-

RIME was established as a parent organization for these activities in cooperation with related
academic societies. The J-RIME’s objectives are to collect data on medical exposure such as
exposure dose and risk assessment in radiation medicine to gain an understanding of the actual
status of medical exposure in Japan and create an appropriate protection system for medical
exposure in Japan based on international trends.

As of 2020, J-RIME has expanded the scale ofits organization and activities with the participation and cooperation of academic societies,
institutions, universities, professional organizations, medical facilities, governmental agencies,
and associated industries related to radiation therapy and protection, and is also functioning as an
all-Japan network.
Finally, I would like to express its sincere gratitude to all of the relevant parties for theirtremendous efforts and support and for being accommodating during this revision of the DRLs.

July 3, 2020
Japan Network for Research and Information on Medical Exposure (J-RIME)
Representative

Makoto Hosono

Table of Contents
Table of Contents .............................................................................................................. 1
1.

Background of Establishment of Diagnostic Reference Levels(DRLs 2020) ...... 2

2.

Objective of Establishing new Diagnostic Reference Levels ................................... 4
2.1. Features of diagnostic reference levels (DRLs) .................................................... 4
2.2. Utilization of diagnostic reference levels in clinical settings ................................ 43.

National Diagnostic Reference Levels Established in 2020

(Japan DRLs 2020) . 6

3.1. Japan DRLs 2020 for Computed Tomography ...................................................... 6
3.1.1. Japan DRLs 2020 for Adult CT ...................................................................... 6
3.1.2. Japan DRLs 2020 for Pediatric CT ................................................................ 7
3.2. Japan DRLs 2020 for General Radiography.......................................................... 8
3.3. Japan DRLs 2020 for Mammography ................................................................... 8
3.4. Japan DRLs 2020 for Dental Radiography............................................................ 9
3.4.1. Japan DRLs 2020 for Intraoral Radiography ................................................. 9
3.4.2. Japan DRLs 2020 for Panoramic Radiography .............................................. 9
3.4.3. Japan DRLs 2020 for Dental Cone Beam CT ................................................ 93.5. Japan DRLs 2020 for IVR ................................................................................... 10
3.6. DRLs for Diagnostic Fluoroscopy....................................................................... 12
3.7 Japan DRLs 2020 for Nuclear Medicine .............................................................. 13
3.7.1. Japan DRLs 2020 for SPECT radiopharmaceuticals .................................... 13
3.7.2. DRLs for PET radiopharmaceuticals ............................................................ 15
3.7.3. DRLs for SPECT/CT hybrid CT .................................................................. 16
3.7.4. DRLs for PET/CT hybrid CT ....................................................................... 16
4.

Acknowledgement .................................................................................................. 17

1

1. Background of Establishment of Diagnostic Reference Levels(DRLs 2020)
International guidelines on international basic safety standards, such as the International
Commission on Radiological Protection (ICRP) and International Atomic Energy Agency (IAEA),
state that Diagnostic Reference Levels (DRLs) are tools for optimizing medical radiation
protection in the diagnostic field.

DRLs include determining which dose is defined as the doseto be used for DRL, how this dose is to be measured, how this accumulates and how these are to
be implemented. Moreover, DRLs are closely related to the quality assurance of equipment andmethods and play an important role in optimization.

Overseas, the European Union (EU)Council Directive 97/43/Euratom (June 1997) established a medical radiation protection
framework in Europe, in which the establishment of DRLs in the diagnostic field was required in
EU member countries and, in response, DRLs have been incorporated in various countries.
Moreover, in the United States, DRLs from the American College of Radiology (ACR), American
Association of Physicists in Medicine (AAPM), and National Council on Radiation Protection
and Measurements (NCRP) are considered to be the de facto standard.
In Japan, at first, various organizations, academic societies, organizations, and researchers
conducted a survey on diagnostic doses and proposed standard diagnostic doses. However, thesewere not necessarily conducted with sufficient cooperation of numerous related parties; therefore,
there were no widely accepted DRLs available. Therefore, as part of its activities, the Japan
Network for Research and Information on Medical Exposure (J-RIME), which was established as
an organization to share and collaborate on medical exposure research information, set up a DRL
working group of members assigned from each organization in August 2014 to create DRLs.
After defining diagnostic doses, the survey method were jointly evaluated in detail by constituent
organizations on one platform, a large-scale national survey was conducted, the results weretabulated and analyzed, and the work was performed with repeated discussions between
committee members considering comments from domestic and overseas experts.
was given to maintain transparency and objectivity during the process.

Consideration

In this manner, the firstnational DRLs were established for Japan (Japan DRLs 2015) and became widely recognized asa standard tool for promoting optimization in radiation protection within the country.
ICRP Publication 135, which defines the use of DRL in radiological diagnosis,
recommends DRL revisions at least every 3-5 years.

This is necessary to drive broader

optimization by implementing DRLs and to respond to changes in technical progress and clinicaldemands. The DRL Working Group of J-RIME set 2020, which is five years from the initial
version, as the time of revision, and a decision was made to establish the DRLs 2020 after a seriesof joint investigations and discussions by the constituent organizations.

By enforcing the partial

revision of the Enforcement Regulations of the Medical Care Law that includes the safety2management of radiation for medical use in April 2020, the optimization at each institution is
expected to be promoted using these new DRLs.

3

2. Objective of Establishing new Diagnostic Reference Levels
2.1. Features of diagnostic reference levels (DRLs)
The DRLs are a tool for institutions to become aware of using higher doses than otherinstitutions and to facilitate the process of dosing optimization.

The ICRP defines DRLs as "aform of investigation level used as a tool to aid in optimisation of protection in the medical
exposure of patients for diagnostic and Interventional procedures" 1).

The appropriate DRLs (acommon and easily measured or determined measure of the amount of ionizing radiation) for themodalities will be determined by referring to the distribution of the DRL (e.g., 75th percentile)obtained from such methods as dosimetry.
The most notable significance of this DRL is that it is not a dose limit and that it is not aboundary that separates right or wrong in terms of medical actions 1).
that should not be exceeded.

A dose limit is the dose

However, DRLs may be exceeded if clinically necessary 1).

Moreover, DRLs are used for patient groups or test groups and are not used to determine whether
an individual patient or test dose is too high.

Higher doses than those given to typical patients

may be required depending on the patient's weight and body shape.
DRLs are set per country, per region, or locally.

This is because equipment and procedural

protocols may vary from country to country and from region to region.

The DRLs 2020

represent national DRLs.
The DRLs are set in reference to the 75th percentile of the dose survey results and serve as
an index to identify examinations, equipment, and institutions that use high doses.

In addition

to the DRLs, this report includes the 75th percentile and median value results from dose surveys
for each modality included in the text of the report, as appropriate.

If the median of theinstitution is higher than the median for the country, the median for the country may be a target
for further optimization. However, if the median value at the institution is lower than the medianvalue for the country, an assessment of whether the image quality or diagnostic capability is
sufficient can be prioritized in the optimization process rather than dose 1).

2.2. Utilization of diagnostic reference levels in clinical settings
Typical doses used at the institution should be investigated and, if the median value exceeds
the DRLs, a review should be performed to determine if doses have been optimized, unless there
are clinical justifications.

In general, the capacity of the equipment used and protocols(procedures) will be evaluated to identify the cause of any high doses and measures taken to use
a more appropriate dose. After measures are implemented, the typical dose at the institution will
be evaluated again and compared in relation to the DRLs.

ICRP Publication 1351) recommends

annual dose surveys for computed tomography (CT) and IVR, and surveys every three years forother examinations unless there are changes in equipment.

4

Protocols for new equipment shouldbe evaluated before these are used to test patients and should be reassessed within 1 year of
introduction and when testing methods have been established.

Note that throughout all of theseprocedures, rather than seeking the best image quality, physicians attempt to achieve the sufficient
image quality required for each diagnosis.
The objective of DRLs is for optimization and not dose reduction.

If the necessary

diagnostic information cannot be obtained from a validated test, this will then result in
unnecessary exposure.

In particular, if the imaging conditions are changed, it is important toconfirm that the change in dose and image quality and diagnostic capability are ensured.
To promote optimization in the clinical setting, there is a requirement to compare the doseat one's own institution with the DRLs. However, it is difficult to compare the dose at one's own
institution with the DRLs if no dosimeter is available. As a countermeasure for the time being,
numerical values calculated using the numerical dose determination (NDD) method 2) or the useof existing software that can calculate the exposure dose or use of display values on the equipment
can be substituted.

Moreover, for dosimeters and phantoms, it may be useful to create amechanism by which the dosimeters and phantoms of affiliated organizations and otherinstitutions that own them can be used.
References:
1)

International Commission on Radiological Protection, 2017. Diagnostic Reference
Levels in Medical Imaging. ICRP Publication 135. Ann. ICRP 46 (1)2)

Mori T, Suzuki M, Sato H, et al. 1997 A Study of Creating Guidance Level in Medical
Exposure [in Japanese]. Research reports of Suzuka University of Medical Science andTechnology 4, 109-129.

5

3. National Diagnostic Reference Levels Established in 2020
(Japan DRLs 2020)
The following are recommended as national DRLs in Japan.

3.1. Japan DRLs 2020 for Computed Tomography
3.1.1. Japan DRLs 2020 for Adult CT
CTDIvol

DLP [mGy･

[mGy]

cm]

Routine brain

77

1350

Routine chest

13

510

Chest to pelvis

16

1200

Abdomen and pelvis

18

880

Liver, multi-phase

17

2100

Coronary CTA

66

1300

14

2600

n/a

5800

ProtocolAcutepulmonarythromboembolism

and

deep

thrombosis
Whole body CT for trauma

veinNote 1) Standard body weight is 50-70 kg
Note 2) Liver, multiphase does not include the chest or pelvis. CTDI and DLP are based on the average of allphases and the whole examinations, respectively.
Note 3) The CTDI and DLP of the coronary artery are based on a CTA scan and whole examinations,
respectively.
Note 4) The CTDI and DLP for acute pulmonary thromboembolism and deep vein thrombosis are based on thefirst phase and whole examinations, respectively.

6

3.1.2. Japan DRLs 2020 for Pediatric CT
Age grouping
<1 y

Head
Chest

Abdomen1- <5 y5- <10 y

10- <15 y

CTDIvol

DLP

CTDIvol

DLP

CTDIvol

DLP

CTDIvol

DLP

[mGy]

[mGy cm][mGy][mGy cm][mGy][mGy cm][mGy][mGy cm]

30

480

40

660

55

850

60

1000

6

140

8

190

13

350

13

460

(3)

(70)

(4)

(95)

(6.5)

(175)

(6.5)

(230)

10

220

12

380

15

530

18

900

(5)

(110)

(6)

(190)

(7.5)

(265)

(9)

(450)

Weight grouping
<5 kg

Chest

Abdomen

5 - <15 kg

15 - <30 kg

30 - <50 kg

CTDIvol

DLP

CTDIvol

DLP

CTDIvol

DLP

CTDIvol

DLP

[mGy]

[mGy cm][mGy][mGy cm][mGy][mGy cm][mGy][mGy cm]

5

76

9

122

11

310

13

450

(2.5)

(38)

(4.5)

(61)

(5.5)

(155)

(6.5)

(225)

5

130

12

330

13

610

16

720

(2.5)

(65)

(6)

(165)

(6.5)

(305)

(8)

(360)

Note 1) Doses refer to the 16 cm standard CT dosimetry phantom along with that refer to the 32 cm standard
CT dosimetry phantom in parentheses.
Note 2) The scan range for the abdomen is from the upper abdomen to the pelvis.

73.2. Japan DRLs 2020 for General Radiography
Examination

Entrance-surface air kerma [mGy]

Chest PA (<100 kV)

0.4

Chest PA (≥ 100 kV)

0.3

Chest PA (medical checkup) (≥ 100 kV)

0.2

Abdomen (AP supine)

2.5

Infant hip joint (0-1y)

0.2

Infant chest (0-1 y)

0.2Child chest (5 y)

0.2

Skull

2.5

Cervical spine

0.8

Thoracic spine

3.0

Thoracic spine LAT

5.0

Lumbar spine

3.5

Lumbar spine LAT

9.0

Pelvis2.5

3.3. Japan DRLs 2020 for Mammography
Mean glandular dose at 40 mm polymethylmethacrylate (PMMA) [mGy]2.4

2D mammography mean glandular dose based on clinical data [mGy]1.4

Digital breast tomosynthesis (DBT) mean glandular dose based on clinicaldata [mGy]8

1.5

3.4. Japan DRLs 2020 for Dental Radiography
3.4.1. Japan DRLs 2020 for Intraoral Radiography
Incident air kerma (Ka, i) [mGy]a)Examination site
Adultsb)

Pediatricc)

Incisor

1.1

0.9

Canine1.3

0.9

Premolar

1.6

1.0

Molar

2.0

1.2

Incisor

1.0

0.7

Canine1.1

0.8

Premolar

1.1

0.9

Molar

1.5

1.0

MaxillaMandible

As with DRLs2015, DRLs were set for the standard intraoral radiography using the bisecting or parallelingtechnique and did not include other oral procedures such as bite-wing or occlusal techniques (bisection, axial
projection).
a) Incident air kerma (Ka, i): Air kerma at the one-tip without patient backscatter1, 3, 4)b) Adult patients with standard body sizec) Ten-year-old pediatric patients

3.4.2. Japan DRLs 2020 for Panoramic Radiography
Air kerma-area product (PKA) [mGy cm2]

134

Dose-width product (DWP) [mGy mm]

89

3.4.3. Japan DRLs 2020 for Dental Cone Beam CT
Air kerma-area product (PKA)

Air kerma at the isocenter[mGy cm2](Kiso) [mGy]<40 cm2841

2440-100 cm2

1670

29

>100 cm2

1960

16

FOV

9

3.5. Japan DRLs 2020 for IVR
Head/neckKa,r [mGy]

PKA [Gy cm2]

Saccular aneurysm

590

89

Cerebral arteriovenous malformation

770

160

Cerebral dural arteriovenous fistula

1100

190

Cervical carotid artery stenosis/occlusion

560

120

Acute cerebral artery stenosis/occlusion

480

83

Intracranial tumor

720

140

Ka,r [mGy]

PKA [Gy cm2]

Saccular aneurysm

510

57

Cerebral arteriovenous malformation

470

77

Cerebral dural arteriovenous fistula

820

150

Cervical carotid artery stenosis/occlusion

390

72

Acute cerebral artery stenosis/occlusion

500

83

(1000)*(77)*

Ka,r [mGy]

PKA [Gy cm2]

Saccular aneurysm

3100

210

Cerebral arteriovenous malformation

4100

410

Cerebral dural arteriovenous fistula

4700

430

Cervical carotid artery stenosis/occlusion

820

150

Acute cerebral artery stenosis/occlusion

1400

230

Intracranial tumor

2500

320

Diagnosis Angiography (pre-op)

Diagnosis Angiography (post-op)

Intracranial tumor
Endovascular treatment (IVR)

Note 1) Ka, r: Incident air kerma at the patient entrance reference point (mGy) displayed on the equipment
Note 2) PKA: Air kerma-area product (Gy cm2) displayed on the equipment
Note 3) Cervical carotid artery stenosis/occlusion was in an elective case.
Note 4) *: Reference only because only few data are available

10

Cardiac Regions (Adult)
Ka,r [mGy]

PKA [Gy cm2]

Diagnostic catheterization

700

59

Non-CTO PCI

1800

130

CTO PCI

3900

280

Non-PVI RFCA

560

57

PVI RFCA

645

89

Note 1) PCI: Percutaneous Coronary Intervention
Note3) RFCA: Radiofrequency Catheter Ablation

Note 2) CTO: Chronic Total Occlusion
Note 4) PVI: Pulmonary Vein Isolation

Cardiac Regions (Pediatric, age grouping)Ka,r [mGy]

PKA [Gy cm2]

<1 y

100

7

1-<5y

130

12

5 - < 10 y

190

14

10 - < 15 y

350

47

<1 y

150

8

1-<5y

210

16

5 - < 10 y

210

16

10 - < 15 y

500

46

Diagnostic catheterization

Interventional radiography

Interventional radiography for chest and abdomenKa,r [mGy]

PKA [Gy cm2]

TACE

1400

270

TEVAR

830

200

EVAR

1000

210

Note 1) TACE: Transcatheter Arterial ChemoEmbolization
Note 2) TEVAR: Thoracic Endovascular Aortic Repair
Note 3) EVAR: Endovascular Aortic Repair

Entrance-surface air kerma rate in fluoroscopy
Entrance-surface air kerma rate in fluoroscopy (mGy min-1)

17Note 1) Phantom incident surface dose rate at the patient irradiation reference point (Entrance surface dose rate:
Incident surface dose rate including backscattered radiation from a phantom)

113.6. DRLs for Diagnostic Fluoroscopy
Ka, r
[mGy]

PKA
[Gy cm2]

Fluoroscopic
time [min]No. of images
per exam

30

17

5

5

110

45

6

27

230

61

13

45

89

29

6

21

Ileus tube insertion

150

47

28

6

Barium enema

130

46

11

27

ERCP (diagnostic)

93

26

14

12

ERCP (treatment)

170

36

17

13

Bronchoscopy

38

8

8

1

8

3

3

2

Lumbar nerve root block

49

9

3

2

Lumbar myelography

69

26

4

Barium swallow
Upper

gastrointestinal

fluoroscopy

with contrast
Upper

gastrointestinal

fluoroscopy

with contrast (detailed examination)
Upper

gastrointestinal

fluoroscopy

with contrast (medical checkup)

Total parenteral nutrition
catheterization(CV catheter-port insertion)

111)

Note 1) KAP (Air kerma-area product) was expressed as PKA in ICRP Publication 135 . The conventional
notation is DAP: Dose area product
Note 2) Incident air kerma at the patient entrance reference point (Ka,r) is the incident air kerma at the patient
entrance reference point for fluoroscopes specified in JIS Z 4751-2-54 2) (excluding backscatter)12

3.7 Japan DRLs 2020 for Nuclear Medicine
3.7.1. Japan DRLs 2020 for SPECT radiopharmaceuticals
Adult dose [MBq]Radiopharmaceutical
Bone: 99mTc-MDP

950

Bone: 99mTc-HMDP

950

Bone marrow: 111In-chloride

80

Cerebral blood flow: 99mTc-HMPAO (rest or stress)

800

Cerebral blood flow: 99mTc-HMPAO (rest and stress)

1200

Cerebral blood flow: 99mTc-ECD (rest or stress)

800

Cerebral blood flow: 99mTc-ECD (rest and stress)

1100

Cerebral blood flow: 123I-IMP (rest or stress)

200

Cerebral blood flow: 123I-IMP (rest and stress)

270

Brain receptors: 123I-iomazenil

200

Striatum: 123I-ioflupane

190

Cisternography: 111In-DTPA

40

Thyroid uptake: Na123I

10

Thyroid: 99mTcO4-

240

Parathyroid: 201Tl-chloride

120

Parathyroid: 99mTcO4-

300

Parathyroid: 99mTc-MIBI

800

Lung ventilation: 81mKr-gas

200

Pulmonary blood flow: 99mTc-MAA

260

Radionuclide venography: 99mTc-MAA

500

Liver/spleen: 99mTc-phytate

200

Hepatic function: 99mTc-GSA

260

Hepatobiliary: 99mTc-PMT

260

Liver and spleen: 99mTc-Sn colloid

180

Myocardial perfusion: 201Tl-chloride

120

Myocardial perfusion: 99mTc-tetrofosmin (rest or stress)

840

Myocardial perfusion: 99mTc-tetrofosmin (rest and stress)

1200

13

Myocardial blood flow: 99mTc-MIBI (rest or stress)

880

Myocardial blood flow: 99mTc-MIBI (rest and stress)

1200

Myocardial fatty acid metabolism: 123I-BMIPP

130

Cardiac sympathetic function: 123I-MIBG

130

Cardiac blood pool: 99mTc-HSA-D

970

Myocardial infarction: 99mTc-PYP

800

Salivary gland: 99mTcO4-

370

Meckel’s diverticulum: 99mTcO4-

440

Gastrointestinal bleeding: 99mTc-HSA-D

1040

Protein leakage: 99mTc-HSA-D

1040

Static renal imaging: 99mTc-DMSA

210

Dynamic renal imaging: 99mTc-MAG 3

380

Dynamic renal imaging: 99mTc-DTPA390

Adrenal cortex: 131I-adosterol

40

Adrenal medulla: 123I-MIBG

130

Tumor: 201Tl-chloride

120

Tumor and inflammation: 67Ga-citrate

120

Somatostatin receptor: 111In-pentetreotide

120

Lymphatic vessels: 99mTc-HSA-D

830

Sentinel lymph node (breast cancer): 99mTc-Sn colloid

120

Sentinel lymph node (breast cancer): 99mTc-phytate

120

Sentinel lymph node (melanoma): 99mTc-Sn colloid

120

Sentinel lymph node (melanoma): 99mTc-phytate

120

RI angiography: 99mTc-HSA-D

1000

14

3.7.2. DRLs for PET radiopharmaceuticals
Adult dose [MBq]Radiopharmaceutical
Brain function: C15O2-gas (2D acquisition)

8000

Brain function: 15O2-gas (2D acquisition)

6000

Brain function: C15O -gas (2D acquisition)

3000

Brain function: C15O2-gas (3D acquisition)

1800

Brain function: 15O2-gas (3D acquisition)

4500

Brain function: C15O-gas (3D acquisition)

3600

Amyloid: 18F -flutemetamol (in-house preparation)

260 1)

Amyloid: 18F -flutemetamol (delivery)

260 1)

Amyloid: 18F -florbetapir (in-house preparation)

370 1)

Amyloid: 18F -florbetapir (delivery)

370 1)

Amyloid: 18F -florbetaben (in-house preparation)

300 1)

Cerebral glucose metabolism: 18F -FDG (in-house preparation)

240

Cerebral glucose metabolism: 18F -FDG (delivery)

240

Cerebral glucose metabolism: 18F -FDG (dose per body weight)

4

Myocardial glucose metabolism: 18F -FDG (in-house preparation)

240

Myocardial glucose metabolism: 18F -FDG (delivery)

240

Myocardial glucose metabolism: 18F -FDG (dose per body weight)

5

Myocardial blood flow: 13NH3 (in-house preparation)

520

Tumor glucose metabolism: 18F -FDG (in-house preparation)

240

Tumor glucose metabolism: 18F -FDG (delivery)

240

Tumor glucose metabolism: 18F -FDG (dose per body weight)

4

Inflammation: 18F-FDG (in-house preparation)

240

Inflammation: 18F-FDG (delivery)

240

Inflammation: 18F-FDG (dose per body weight)

4

18

18

18

Note 1) This criterion was set for amyloid ( F-flutemetamol, F-florbetapir, F-florbetaben) by referring to
the package insert.

15

3.7.3. DRLs for SPECT/CT hybrid CT
CTDIvol [mGy]

DLP [mGy･cm]

Brain

13.0

330

Heart

4.1

85

CTDIvol [mGy]

DLP [mGy･cm]

Whole body

5.0

380

Brain

23.0

410

Head and neck

5.8

210

Chest

4.1

170

Heart

4.5

180

Abdomen, pelvis

5.0

210

Extremities

4.6

230

CTDIvol [mGy]

DLP [mGy･cm]

Whole body (medical examination)

6.1

600

Whole body (medical checkup)

5.5

550

Brain (medical examination)

31.0

640

Heart (medical examination)

9.1

380

SPECT/CT (Attenuation correction only)

SPECT/CT (Attenuation correction and image
fusion)3.7.4. DRLs for PET/CT hybrid CT
PET/CT (Attenuation correction and image fusion)16

4. Acknowledgement
Contributors to drafting, review and performing dose surveys
ABE, KOICHIROKANDA, REIKOOHBAYASHI, NAOTO

ABE, TOSHI

KATO HEDEYUKI

OHTANI, HIROKI

ABE, YUKINAO

KATO, MAMORUOKUDA, YASUOAKAHANE, KEIICHIKAWAUCHI, SATORUOKUMURA, YASUHIKOAKAHANE, MASAAKIKOBA, YUSUKEOHNO, KAZUKOASADA, YASUKI

KOBAYASHI, IKUOSAI, MASAHIROASAUMI, RIEKOKUBOTA, KAZUNORISAKAMOTO, HAJIME

AWAI, KAZUO

MATSUBARA, KOSUKESAKURAI, TAKASHICHANG, WEISHAN

MATSUMARU, YUJI

SATO, KENJI

ENDO, ATSUSHI

MATSUMOTO, KUNIHITOSHIRAGAMI, NOBUYUKI

FUJIBUCHI, TOSHIOH

MATSUMOTO, KAZUMASUGIHARA, YOSHITOFUKUNAGA, MASAAKIMISHIMA, AKIRASUZUKI, SHOICHI

GOTO, KENICHIMIYAJIMA, RYUICHISUZUKI, YOSHIAKIHARATA, YASUOMIYAZAKI, OSAMU

TAKEDA, KAZUYAHITOMI, GO

MORITAKE, TAKASHITAKEI, YASUTAKAHOSONO, MAKOTOMURAMATSU, YOSHIHISATAKESHITA, YOHEIIGARASHI, TAKAYUKI

NAGAHATA, TOMOMASATANAMI, YUTAKAIIMORI, TAKASHI

NAKADA, YOSHIHIROTSUKAMOTO, ATSUKOINNAMI, HISASHI

NAKAMAE, MITSUHIROTSUSHIMA, HIROYUKIISHIBASHI, TORUNEGISHI, TORU

UEMA, CHIAKIISHIGURO, MASANOBUNISHIDE, HIROKOWATANABE, HIROSHI

ITO, TERUONISHIKAWA, KEIICHIYOKOOKA, YUKIIZAWA, MAKI

NOTSU, MASAKAZUYONAI, SHUNSUKE

JINUSHI, AKIHIROODA, MASAFUMI

17