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  1. 1. Online-only Data Supplement to Radiation Dose to Patients from Cardiac Diagnostic Imaging Andrew J. Einstein, M.D., Ph.D. Kevin W. Moser, Ph.D. Randall C. Thompson, M.D. Manuel D. Cerqueira, M.D. Milena J. Henzlova, M.D. Circulation 2007;116:1290-1305 ©2007 Contents of this Document: Table I: Common Terminology Used in Radiation Dosimetry Table II: ICRP and Manufacturers' Data on Effective Doses, Total Body Doses, and Absorbed Doses per Unit Activity of 99mTc Sestamibi and Tetrofosmin Table III: ICRP and Manufacturers' Data on Effective Doses, Total Body Doses, and Absorbed Doses per Unit Activity of Other Radiopharmaceuticals Table IV: Highest Equivalent Doses to Individual Organs (mSv) for Selected Nuclear Cardiology Protocols Corresponding Author: Andrew J. Einstein, M.D., Ph.D. Department of Medicine, Cardiology Division Columbia University Medical Center 622 West 168th Street, PH 10-408 New York, NY 10032 Email:
  2. 2. Table I: Common Terminology Used in Radiation Dosimetry Absorbed dose: mean energy imparted to the matter in a volume by ionizing radiation, divided by the mass of the matter in the volume. Gray (Gy): special name for 1 Joule / kg, the SI unit of absorbed dose Rad (radiation absorbed dose): 0.01 Gy, traditional unit of absorbed dose Activity (A): average number of spontaneous nuclear decays in a given period of time Bequerel (Bq): 1 decay per second, the SI unit of activity Curie (Ci) : 3.7 × 1010 Bq, traditional unit of activity Air kerma: sum of the kinetic energy of all charged particles liberated per unit mass in air, measured in Gy or rad. Cumulative dose (CD): total air kerma during a procedure, commonly measured at the interventional reference point. Measured in Gy, also called cumulative air kerma. Deterministic effect: an effect that occurs predictably when a dose exceeds a threshold, e.g. skin injury and posterior subcapsular cataracts. Dose-area product (DAP): air kerma multiplied by x-ray beam cross-sectional area, commonly measured in mGy × cm2. Dose coefficient: a measure of dose per unit activity, estimated from mathematical biokinetic models. May reflect equivalent dose per unit activity to an individual tissue (DT /A), or effective dose per unit activity to a person (E/A). Dose-length product (DLP): integrated radiation dose for an entire CT examination, measured in units of mGy × cm and calculated by multiplying the CTDIvol by the length irradiated. Effective dose (E): sum of the weighted equivalent doses for all tissues, and also measured in Sv or rem. Similar to the older term effective dose equivalent. Entrance skin dose (ESD): absorbed dose to skin at a particular location on the entrance surface of the x-ray beam, measured in Gy. Measures both incident and backscattered radiation. Equivalent dose: product of the absorbed dose and the radiation weighting factor. Sievert (Sv): special name for 1 Joule/kg, the SI unit of equivalent dose Rem (roentgen equivalent man): 0.01 Sv, traditional unit of equivalent dose Exposure: the total charge of ions of one sign produced in a unit of dry air by a given amount of x-ray or γ-ray radiation; SI unit is Coulombs / kg. Roentgen (R): conventional unit of exposure, equal to 2.58 × 10-4 C/kg. Incident dose (ID): air kerma along the x-ray beam axis at the level of the skin surface, measured in Gy. In comparison with ESD at the same point, ID does not measure backscattered radiation. Interventional reference point (IRP): the point on the x-ray beam axis lying 15 cm from the imaging system’s isocenter on the x-ray tube side. Kerma-area product (KAP): synonym for dose-area product. Peak skin dose (PSD): the highest absorbed dose received by any location of a patient’s skin, measured in Gy. Also called maximum skin dose (MSD). Radiation weighting factor (wR): factor quantifying the biological effect of a given absorbed dose, reflecting the type and quality of radiation emitted by a radionuclide or external radiation field. Dimensionless, ranging from 1 for photons and electrons to 20 for alpha particles. Stochastic effect: an effect that occurs with a probability that increases with dose, e.g. malignancy and germ cell mutations. Tissue weighting factor (wT): factor reflecting the relative probability of stochastic effects, such as cancer incidence, in a given organ or tissue. Dimensionless, the sum of wT over all tissues is 1. Weighted equivalent dose: product of the equivalent dose and the tissue weighting factor. Also measured in Sv or rem. Volume computed tomography dose index (CTDIvol): average radiation dose over the volume scanned in a helical sequence, commonly measured in mGy.
  3. 3. Table II: ICRP and Manufacturers' Data on Effective Doses, Total Body Doses, and Absorbed Doses per Unit Activity of 99mTc Sestamibi and Tetrofosmin 99m 99m Radiopharmaceutical Tc Sestamibi Tc Tetrofosmin Data Source ICRP 80 PI ICRP 80 PI Stress (2h Stress (4.8h Rest/stress (void time) Rest Stress Rest (2h) Rest (4.8h) ) ) Rest Stress Rest Stress Effective Dose (E/A in mSv/MBq) 9.0E-03 7.9E-03 - - - - 7.6E-03 7.0E-03 1.1E-02 8.6E-03 Total Body Dose (in mGy/MBq) - - 4.3E-03 4.3E-03 3.8E-03 3.8E-03 - - - - Organ Absorbed Doses (DT/A in mGy/MBq) Adrenals 7.5E-03 6.6E-03 3.4E-03 3.3E-03 4.1E-03 4.3E-03 Bladder 1.1E-02 9.8E-03 1.8E-02 3.7E-02 1.4E-02 2.7E-02 1.7E-02 2.6E-02 1.9E-02 1.6E-02 Bone 8.2E-03 7.8E-03 6.1E-03 5.8E-03 5.6E-03 5.4E-03 4.5E-03 4.8E-03 5.6E-03 6.2E-03 Bone Marrow 5.5E-03 5.0E-03 4.6E-03 4.5E-03 4.1E-03 4.0E-03 2.9E-03 2.9E-03 4.0E-03 4.1E-03 Brain 5.2E-03 4.4E-03 3.9E-04 4.6E-04 2.2E-03 2.7E-03 Breasts 3.8E-03 3.4E-03 1.8E-03 1.7E-03 1.8E-03 1.6E-03 9.0E-04 1.0E-03 1.8E-03 2.2E-03 Colon 2.4E-02 1.9E-02 2.4E-02 1.8E-02 Colon (lower large intestine) 1.9E-02 1.6E-02 3.6E-02 3.7E-02 2.9E-02 2.9E-02 2.0E-02 1.5E-02 2.2E-02 1.5E-02 Colon (upper large intestine) 2.7E-02 2.2E-02 5.0E-02 5.0E-02 4.0E-02 4.0E-02 2.7E-02 2.0E-02 3.0E-02 2.0E-02 Esophagus 4.1E-03 4.0E-03 2.1E-03 2.4E-03 Gallbladder 3.9E-02 3.3E-02 1.8E-02 1.8E-02 2.6E-02 2.5E-02 3.6E-02 2.7E-02 4.9E-02 3.3E-02 Heart 6.3E-03 7.2E-03 4.6E-03 4.4E-03 5.0E-03 4.8E-03 4.4E-03 4.8E-03 3.9E-03 4.1E-03 Kidneys 3.6E-02 2.6E-02 1.8E-02 1.8E-02 1.5E-02 1.5E-02 1.4E-02 1.1E-02 1.3E-02 1.0E-02 Liver 1.1E-02 9.2E-03 5.2E-03 5.1E-03 3.8E-03 3.7E-03 4.0E-03 3.3E-03 4.2E-03 3.2E-03 Lungs 4.6E-03 4.4E-03 2.5E-03 2.4E-03 2.3E-03 2.2E-03 2.0E-03 2.2E-03 2.1E-03 2.3E-03 Muscles 2.9E-03 3.2E-03 3.7E-03 4.1E-03 3.3E-03 3.5E-03 Ovaries 9.1E-03 8.1E-03 1.4E-02 1.4E-02 1.1E-02 1.2E-02 8.4E-03 7.6E-03 9.6E-03 7.9E-03 Pancreas 7.7E-03 6.9E-03 4.1E-03 3.9E-03 5.0E-03 5.0E-03 Remaining Organs 3.1E-03 3.3E-03 3.9E-03 4.1E-03 Salivary Glands 1.4E-02 9.2E-03 1.4E-02 9.3E-03 1.2E-02 8.0E-03 Skin 3.1E-03 2.9E-03 1.3E-03 1.4E-03 1.9E-03 2.2E-03 Small Intestine 1.5E-02 1.2E-02 2.7E-02 2.7E-02 2.2E-02 2.2E-02 1.5E-02 1.1E-02 1.7E-02 1.2E-02 Spleen 6.5E-03 5.8E-03 3.0E-03 3.0E-03 3.8E-03 4.1E-03 Stomach 6.5E-03 5.9E-03 5.5E-03 5.2E-03 4.8E-03 4.7E-03 3.7E-03 3.5E-03 4.6E-03 4.6E-03 Testes 3.8E-03 3.7E-03 3.1E-03 3.5E-03 2.8E-03 3.1E-03 2.4E-03 2.9E-03 3.1E-03 3.4E-03 Thalamus Thymus 4.1E-03 4.0E-03 2.1E-03 2.4E-03 2.5E-03 3.1E-03 Thyroid 5.3E-03 4.4E-03 6.3E-03 6.3E-03 2.4E-03 2.2E-03 5.7E-03 4.8E-03 5.8E-03 4.3E-03 Uterus 7.8E-03 7.2E-03 7.2E-03 7.6E-03 8.4E-03 7.3E-03
  4. 4. Table III: ICRP and Manufacturers' Data on Effective Doses, Total Body Doses, and Absorbed Doses per Unit Activity of Other Radiopharmaceuticals 201 99m 82 13 15 18 Radiopharmaceutical Tl Tc labeled erythrocytes Rb N-ammonia O-water F-FDG Data Source ICRP 53A5 PI 1 PI 2 PI 3 ICRP 80 PI ICRP 80 PI ICRP 80 ICRP 53A5 ICRP 80 Effective Dose (E/A in mSv/MBq) 1.7E-01 3.6E-01 - 3.6E-01 7.0E-03 - 3.4E-03 - 2.0E-03 1.1E-03 1.9E-02 Total Body Dose (in mGy/MBq) - - 5.9E-02 - - 4.1E-03 - 4.3E-04 - - - Data Source ICRP 53A5 PI 1 PI 2 PI 3 ICRP 80 PI ICRP 53 PI ICRP 53 ICRP 53A5 ICRP 80 Organ Absorbed Doses (DT/A in mGy/MBq) Adrenals 5.8E-02 6.2E-02 6.5E-02 9.9E-03 2.0E-02 9.7E-04 2.3E-03 1.4E-03 1.2E-02 Bladder 4.1E-02 5.2E-02 5.3E-02 8.5E-03 6.5E-03 1.7E-04 8.1E-03 2.6E-04 1.6E-01 Bone 3.8E-01 8.8E-02 8.9E-02 7.4E-03 6.5E-03 6.7E-04 6.6E-06 1.6E-03 6.3E-04 1.1E-02 Bone Marrow 1.1E-01 5.5E-02 5.6E-02 6.1E-03 4.1E-03 9.9E-04 3.8E-04 1.7E-03 8.9E-04 1.1E-02 Brain 2.3E-02 5.9E-02 6.1E-02 3.6E-03 4.2E-03 1.3E-03 2.8E-02 Breasts 2.5E-02 3.6E-02 3.6E-02 3.5E-03 1.9E-04 1.8E-03 2.8E-04 8.6E-03 Colon 2.5E-01 3.7E-03 1.6E-03 1.3E-02 Colon (lower large intestine) 3.4E-01 3.4E-01 5.9E-02 3.4E-01 3.4E-03 3.9E-03 8.6E-04 1.9E-03 1.6E-03 1.5E-02 Colon (upper large intestine) 1.8E-01 3.3E-01 7.0E-02 3.3E-01 4.0E-03 3.9E-03 8.6E-04 1.8E-03 1.6E-03 1.2E-02 Esophagus 3.6E-02 6.1E-03 3.3E-04 1.1E-02 Gallbladder 6.6E-02 8.3E-02 8.4E-02 6.5E-03 4.5E-04 1.2E-02 Heart 1.9E-01 2.8E-01 1.4E-01 2.8E-01 2.3E-02 2.7E-02 3.3E-03 1.9E-03 2.1E-03 1.9E-03 6.2E-02 Kidneys 4.8E-01 4.6E-01 3.2E-01 4.6E-01 1.8E-02 1.8E-02 8.7E-03 4.6E-03 1.7E-03 2.1E-02 Liver 1.5E-01 9.9E-02 1.6E-01 9.9E-02 1.3E-02 7.8E-03 9.7E-04 8.7E-04 4.0E-03 1.6E-03 1.1E-02 Lungs 1.1E-01 4.7E-02 4.8E-02 1.8E-02 2.4E-03 1.7E-03 2.5E-03 1.6E-03 1.0E-02 Muscles 5.2E-02 4.6E-02 4.7E-02 3.3E-03 2.9E-04 1.1E-02 Ovaries 1.2E-01 1.0E-01 1.3E-01 1.0E-01 3.7E-03 4.3E-03 2.4E-04 3.8E-04 1.7E-03 8.5E-04 1.5E-02 Pancreas 5.8E-02 7.4E-02 7.5E-02 6.6E-03 4.5E-03 6.3E-04 1.9E-03 1.4E-03 1.2E-02 Remaining Organs 5.4E-02 3.5E-03 1.1E-02 2.3E-04 1.6E-03 4.0E-04 1.1E-02 Salivary Glands Skin 2.2E-02 3.3E-01 3.4E-02 2.0E-03 2.5E-04 8.0E-03 Small Intestine 1.4E-01 4.5E-01 1.1E-01 4.5E-01 3.9E-03 3.9E-03 1.4E-03 1.8E-03 1.3E-03 1.3E-02 Spleen 1.2E-01 1.8E-01 1.8E-01 1.4E-02 3.0E-02 5.0E-03 2.5E-03 1.6E-03 1.1E-02 Stomach 1.2E-01 1.9E-01 1.1E-01 1.9E-01 4.6E-03 3.8E-03 8.6E-04 1.7E-03 1.7E-03 1.1E-02 Testes 4.5E-01 8.2E-01 1.5E-01 8.3E-01 2.3E-03 3.0E-03 1.3E-04 3.0E-04 1.8E-03 7.4E-04 1.2E-02 Thalamus 4.7E-02 Thymus 3.6E-02 4.6E-02 6.1E-03 3.3E-04 1.1E-02 Thyroid 2.2E-01 6.2E-01 1.3E-01 6.2E-01 5.7E-03 3.8E-02 1.7E-03 1.5E-03 1.0E-02 Uterus 5.1E-02 8.5E-02 8.6E-02 3.9E-03 2.1E-04 1.9E-03 3.5E-04 2.1E-02 ICRP 53A5 denotes ICRP Publication 53 Addendum 5. Three manufacturers currently produce 201Tl for medical use in the United States; their PIs are referred to as PI 1, PI 2, and PI 3.
  5. 5. Table IV: Highest Equivalent Doses to Individual Organs (mSv) for Selected Nuclear Cardiology Protocols 99m 99m 99m 99m 201 201 201 201 Tc Sestamibi Tc Sestamibi Tc Tetrofosmin Tc Tetrofosmin Tl Tl Tl Tl Rest-Stress ICRP Rest-Stress PI Rest-Stress ICRP Rest-Stress PI ICRP PI 1 PI 2 PI 3 Gallbladder (48) ULI (59) Gallbladder (41) Gallbladder (52) Kidneys (62) Testes (106) Kidneys (42) Testes (107) Kidneys (40) LLI (43) Bladder (33) ULI (32) Testes (58) Thyroid (80) Liver (21) Thyroid (80) ULI (32) Bladder (41) ULI (30) LLI (24) Bone (49) Kidneys (60) Testes (19) Kidneys (60) Colon (28) SI (32) Colon (27) Bladder (23) LLI (44) SI (58) Heart (18) SI (58) LLI (23) Gallbladder (32) LLI (23) SI (19) Colon (32) LLI (44) Thyroid (17) LLI (44) SI (18) Kidneys (22) SI (17) Kidneys (15) Thyroid (28) ULI (43) Ovaries (17) ULI (43) 99m 99m 82 82 15 13 18 Dual Isotope Tc RBCs Tc RBCs Rb Rb O water N ammonia F FDG ICRP ICRP PI ICRP PI ICRP ICRP ICRP Kidneys (86) Heart (19) Spleen (25) Thyroid (141) Kidneys (32) Heart (4) Bladder (9) Bladder (59) Testes (62) Kidneys (15) Heart (22) Adrenals (74) Heart (7) Kidneys (4) Kidneys (5) Heart (23) LLI (59) Lungs (15) Blood (9) Kidneys (67) Lungs (6) Stomach (4) Brain (5) Brain (10) Bone (56) Spleen (12) Liver (7) Spleen (19) SI (5) Colon (4) Liver (4) Kidneys (8) Colon (50) Liver (11) Bladder (5) Pancreas (17) Adrenals (4) ULI (4) Lungs (3) Uterus* (8) ULI (44) Adrenals (8) Bone (5) SI (14) Liver (3) LLI (4) Spleen* (3) LLI (6) ULI = upper large intestine, LLI = lower large intestine, SI = small intestine, RBCs = erythrocytes