NOTE The report of the Committee without its annexes appears as Official Records of the General Assembly, Sixty-third Session, Supplement No. 46. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the 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. The country names used in this document are, in most cases, those that were in use at the time the data were collected or the text prepared. In other cases, however, the names have been updated, where this was possible and appropriate, to reflect political changes. Scientific Annexes Annex A. Medical radiation exposures Annex B. Exposures of the public and workers from various sources of radiation INTROdUCTION 1. In the course of the research and development for and the application of atomic energy and nuclear technologies, a number of radiation accidents have occurred. Some of these accidents have resulted in significant health effects and occasionally in fatal outcomes. The application of technologies that make use of radiation is increasingly widespread around the world. Millions of people have occupations related to the use of radiation, and hundreds of millions of individuals benefit from these uses. Facilities using intense radiation sources for energy production and for purposes such as radiotherapy, sterilization of products, preservation of foodstuffs and gamma radiography require special care in the design and operation of equipment to avoid radiation injury to workers or to the public. Experience has shown that such technology is generally used safely, but on occasion controls have been circumvented and serious radiation accidents have ensued. 2. Reviews of radiation exposures from accidents have been presented in previous UNSCEAR reports. The last report containing an exclusive chapter on exposures from accidents was the UNSCEAR 1993 Report [U6]. 3. This annex is aimed at providing a sound basis for conclusions regarding the number of significant radiation accidents that have occurred, the corresponding levels of radiation exposures and numbers of deaths and injuries, and the general trends for various practices. Its conclusions are to be seen in the context of the Committee's overall evaluations of the levels and effects of exposure to ionizing radiation. 4. The Committee's evaluations of public, occupational and medical diagnostic exposures are mostly concerned with chronic exposures of …

sources and effects of ionizing radiation

Methods for patient dosimetry of x rays used in medical imaging have not been previously dealt with by the ICRU. Whereas some of the dosimetric concepts and techniques used in radiotherapy have been successfully employed for medical imaging using x rays, additional dosimetric quantities and measurement methods are required for patient dosimetry for procedures such as radiography, fluoroscopy and CT. This report presents specification of x-ray beams and quantities and units for dose measurement and calculation in medical x-ray imaging, including application specific quantities and new symbols. It addresses measurement methods for normalization quantities and for quantities recommended for the establishment and use of diagnostic reference levels. It presents methods of determining organ and tissue doses as well as doses in localized regions of organs and tissues, including detailed information on dose conversion coefficients. ___________ * Tentative Abstract of a forthcoming ICRU Report expected for the end of 2004.

Patient Dosimetry for x rays used in medical imaging

Wide variations in patient dose for the same type of X-ray examination have been evident from various international dose surveys. Reference dose levels provide a framework to reduce this variability and aid in the optimization of radiation protection. The aim of this study was to establish, for the first time, a baseline for national reference dose levels in Ireland for four of the most common X-ray examinations: chest, abdomen, pelvis and lumbar spine. Measurements of entrance surface dose using thermoluminescent dosemeters (TLDs) for these four X-ray examinations were performed on 10 patients in each of 16 randomly selected hospitals. This represented 42% of Irish hospitals applicable to this study. Results have shown wide variation of mean hospital doses, from a factor of 3 for an anteroposterior lumbar spine to a factor of 23 for the chest X-ray. The difference between maximum and minimum individual patient dose values varied up to a factor of 75. Reasons for these dose variations were complex but, in general, low tube potential, high mAs and low filtration were associated with high-dose hospitals. This study also demonstrated lower reference dose levels of up to 40% when compared with those established by the UK and the Commission of the European Communities for four out of six projections. Only the chest X-ray exhibited a similar reference level to those established elsewhere. This emphasizes the importance of each country establishing its own reference dose levels that are appropriate to their own radiographic techniques and practices in order to optimize patient protection.

Reference dose levels for patients undergoing common diagnostic X-ray examinations in Irish hospitals.

The composition of protective aprons worn by X-ray personnel to shield against secondary radiation is changing. Lead is being replaced by either lead-free or composite (lead with other high atomic numbered elements) materials. These newer aprons are categorised by manufacturers in terms of lead equivalent values, but it is unclear how these stated values compare with actual lead equivalent values. In this work, the actual lead equivalence of 41 protective aprons from four manufacturers, all specified as having 0.25 mm lead equivalence, were investigated with transmission experiments at 70 and 100 kVp. All aprons were in current use. The aprons were screened for defects, and age, weight and design was recorded along with details of associated quality assurance (QA). Out of the 41 protective aprons examined for actual lead equivalence, 73% were outside tolerance levels, with actual levels in some aprons demonstrating less than half of the nominal values. The lack of compatibility between actual and nominal lead equivalent values was demonstrated by aprons from three of the four manufacturers investigated. The area of the defects found on screening of the protective aprons were within recommendations. The results highlight the need for acceptancy and ongoing checks of protective aprons to ensure that radiation exposure of imaging personnel is kept to a minimum.

Protective aprons in imaging departments: manufacturer stated lead equivalence values require validation.

Specialised CT scan protocols for 3-D pre-operative planning of total hip replacement.

A collaborative national survey initiated by the University of Malaya and the Ministry of Health was conducted from 1993 to 1995 to establish baseline patient dose data for seven common types (12 projections) of X-ray examinations in Malaysia. A total of 12 randomly selected public hospitals and 867 patients were included in this survey. The entrance surface doses (ESD) received by the patients were measured using thermoluminescent dosemeters (TLDs) attached to the patient's skin. Histograms are presented showing wide, positively skewed distributions of measured entrance surface doses for each examination. Mean, median, first and third quartile values of ESD and median effective dose are reported. Survey results are generally comparable with those reported in the UK, USA and by the International Atomic Energy Agency (IAEA). The results also provide information on dose level for a lower weight population (mean weight 60 kg) compared with the international reference dose values based on a 70 kg standard. The findings support the importance of the on-going national quality assurance programme to ensure doses are kept to a level consistent with optimum image quality. The data will also be useful for the formulation of national guidance levels as recommended by the IAEA. Furthermore, this study provides patient dosimetry information on healthcare level II countries.

A S Hambali

Papers

Doses to patients in routine X-ray examinations in Malaysia.