Radiation Dosimetry and Safety
Thomas H. HauserMD, MMSc, MPH, FACC
Director of Nuclear CardiologyBeth Israel Deaconess Medical Center
Assistant Professor of MedicineHarvard Medical School
Boston, MA
• A study published in May by Yale University researchers found that radiologists and emergency room physicians were largely unaware of how much radiation the scans delivered, and now a study by Columbia University researchers highlights the risk of dying from radiation-induced cancer. A single full-body scan delivers a radiation dose nearly 100 times that of a screening mammogram and only slightly lower than the dose received by atomic bomb survivors a mile and a half from the burst sites. That's not a huge added risk (only a 1-in-1,250 risk of dying from cancer), but people worried about hidden disease would presumably want repeated, regular screenings. Full-body scans administered annually for 30 years starting at age 45 could cause one cancer death in every 50 patients, the new study estimates. That is a disturbingly high risk for a procedure of dubious benefit.
Annual Number of CTs in USA
Brenner and Hall, NEJM 357 (22): 2277
Outline
• Radiation dosimetry• Radiation safety
Outline
• Radiation dosimetry• Radiation safety
Measures of Radiation• Activity: Becquerel (= 2.7*10-11 Curie)• Absorbed dose: Gray (= 100 rad)
– 1 joule of energy deposited per kg of absorber
• Biologically effective dose: Sievert (= 100 rem)– Sievert = Gray * Q * N
• Q , quality factor– Photons, electrons, = 1– Alpha particles, = 20
• N , depends on type of body tissue– For most tissues, = 0.05– For gonads, = 0.2– For bone marrow, colon, lung, stomach, = 0.12
Example Radiation Exposures
http://hyperphysics.phy-astr.gsu.edu/Hbase/nucene/radexp.html
Your Exposure Increases by 0.01 mSv from…
• Three days of living in Atlanta • Two days of living in Denver • About seven hours in some spots in the
Espirito Santo State of Brazil. • An average year of TV watching (CRT) • A year of wearing a luminous dial watch • A coast-to-coast airline flight
http://hyperphysics.phy-astr.gsu.edu/Hbase/nucene/radexp.html
Radiation Biology (Radiobiology)
Radiation Biology (Radiobiology)
Radiation Dose Ranges for Medical Imaging
Stochastic Processes
• A stochastic process is one whose behavior is non-deterministic in that a state does not fully determine its next state. Stochastic crafts are complex systems whose practitioners, even if complete experts, cannot guarantee success. Classical examples of this are medicine: a doctor can administer the same treatment to multiple patients suffering from the same symptoms, however, the patients may not all react to the treatment the same way. This makes medicine a stochastic process.
www.wikipedia.org
Health Effects of Radiation• Stochastic health effects
– Long term, low level radiation exposure
– Increased exposure increases likelihood of the effect• Increased exposure does not affect severity
• Effects typically occur late after exposure
– Cancer, teratogenic effects, genetic (germ line) effects
• Non-stochastic health effects– Short term, high level radiation exposure
– Increased exposure increases both the likelihood and severity of the effect
• Effects typically occur shortly after exposure
– Burns, radiation sickness, organ failurewww.epa.gov
Health Effects of Radiation
• The health effects of radiation from medical imaging are stochastic– Low level radiation exposure– Typically multiple discrete exposures– Cancer is the main health effect of concern
Models to Determine Radiation Risk• Linear no threshold
– Risk from stochastic health effects decreases linearly with biologically effective absorbed dose
– Implies that there is risk to even low levels of radiation
– Most widely accepted model
• Linear with threshold– Risk from stochastic health effects decreases linearly with dose
until the radiation level crosses a threshold beyond which there is no risk
• Hormesis– The hypothesis that low doses of radiation are beneficial while high
doses are harmful
– Widely rejected
Cancer Risk Estimates
• Atomic weapon survivors– 25,000 survivors with exposures of <50 mSv– Significantly increased risk of cancer
• Nuclear power plant employees– 400,000 studied with mean dose of 20 m Sv– Significantly increased risk of cancer
• Information from both cohorts quantitatively similar
Brenner and Hall, NEJM 357 (22): 2277
Cancer Risk Estimates
Brenner and Hall, NEJM 357 (22): 2277
CT Radiation Doses
Nuclear Radiation Doses
Toohey et al, Radiographics. 2000;20:533-546
Coronary CT Radiation Dose
Einstein et al, JAMA. 2007;298:317-323.
Radiation Exposure
Einstein et al, JAMA. 2007;298:317-323.
Radiation Exposure
Einstein et al, JAMA. 2007;298:317-323.
LAR for 80 yo man with heart only ~1/5000
Outline
• Radiation dosimetry• Radiation safety
Radiation Safety
• Time• Distance • Shielding
Time
• Spend as little time as possible near radiation– Delivered dose is a function of time
Distance• The dose of radiation decreases as the square
of the distance between you and the source– Increases as the square of the distance as you get
closer
Shielding
• If you must spend a significant amount of time near a radiation source, use as much shielding as possible– Lead– Plastic
Lead Shielding
Plastic Shielding
• Best for β emitters– Prevents bremsstrahlung
Why is the Dose So High for Coronary CTA?
• Pitch– Typical pitch for helical/spiral acquisitions is 0.2
• Each part of body is irradiated 5 times
– Increases time of exposure
• kV, mA– Relatively high values to obtain high quality
images with high spatial resolution– Increases intensity of exposure
Retrospective Gating: Helical/Spiral
• Data acquired throughout the cardiac cycle– Reconstruction of entire dataset for evaluation of
LV function– Radiation dose of 15 to 21 mSv
Prospective Gating: Dose Modulation• Tube current is varied over the cardiac cycle to
produce high quality images during ventricular diastole (coronary quiescent period).
• Optimal image quality only during diastole– Evaluation of LV function still possible, but not optimal
• Radiation dose 7 to 12 mSv (40% reduction)
Prospective Gating: Step and Shoot• Tube voltage turned on prospectively only
during ventricular diastole• Data not acquired during systole
– Limited range of reconstruction– No assessment of LV function
• Radiation dose of 3 to 5 mSv (70% reduction)
Dual Source CT
McCollough, C. H. et al. Radiology 2007;243:775-784
Radiation Exposure
Hausleiter et al. Circulation, 113 (10): 1305. (2006)
Summary• Radiation dosimetry
– The sievert is the preferred measure of radiation exposure– Medical imaging results in low dose exposure with stochastic health
effects– The principle adverse outcome for low dose exposure is cancer– Coronary CTA delivers a relatively high dose of 15 to 21 mSv that
results in a non-trivial risk of cancer
• Radiation safety– Time, distance, shielding– For coronary CTA, pitch and exposure intensity are the primary
determinants of radiation dose– Employing dose modulation, prospective gating, dual source CT and
lower kV may reduce the radiation dose