Effective Doses in Radiology and Diagnostic Nuclear Medicine: A Catalog 1

Department of Radiology and Nuclear Medicine, New Mexico Veterans Administration Healthcare System, 1501 San Pedro Blvd, Albuquerque, NM 87108, USA.
Radiology (Impact Factor: 6.87). 08/2008; 248(1):254-63. DOI: 10.1148/radiol.2481071451
Source: PubMed


Medical uses of radiation have grown very rapidly over the past decade, and, as of 2007, medical uses represent the largest source of exposure to the U.S. population. Most physicians have difficulty assessing the magnitude of exposure or potential risk. Effective dose provides an approximate indicator of potential detriment from ionizing radiation and should be used as one parameter in evaluating the appropriateness of examinations involving ionizing radiation. The purpose of this review is to provide a compilation of effective doses for radiologic and nuclear medicine procedures. Standard radiographic examinations have average effective doses that vary by over a factor of 1000 (0.01-10 mSv). Computed tomographic examinations tend to be in a more narrow range but have relatively high average effective doses (approximately 2-20 mSv), and average effective doses for interventional procedures usually range from 5-70 mSv. Average effective dose for most nuclear medicine procedures varies between 0.3 and 20 mSv. These doses can be compared with the average annual effective dose from background radiation of about 3 mSv.

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    • "Although no well-controlled human studies have been conducted to evaluate the teratogenic effect of gadolinium in pregnant women, no harmful effects have been reported for human fetuses exposed to gadolinium in utero. Different studies have demonstrated that the fetus can excrete, swallow, and reabsorb gadolinium into the gastrointestinal tract, which persists in the amniotic fluid (Mettler et al., 2008). Therefore, in clinical practice, it is wise to consider the use of gadolinium-based contrast media in pregnant women only when the "
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    ABSTRACT: Background: Traditionally, pregnancy was considered to have a positive effect on endometriosis and its painful symptoms due not only to blockage of ovulation preventing bleeding of endometriotic tissue but also to different metabolic, hormonal, immune and angiogenesis changes related to pregnancy. However, a growing literature is emerging on the role of endometriosis in affecting the development of pregnancy and its outcomes and also on the impact of pregnancy on endometriosis. The present article aims to underline the difficulty in diagnosing endometriotic lesions during pregnancy and discuss the options for the treatment of decidualized endometriosis in relation to imaging and symptomatology; to describe all the possible acute complications of pregnancy caused by pre-existing endometriosis and evaluate potential treatments of these complications; to assess whether endometriosis affects pregnancy outcome and hypothesize mechanisms to explain the underlying relationships. Methods: This systematic review is based on material searched and obtained via Pubmed and Medline between January 1950 and March 2015. Peer-reviewed, English-language journal articles examining the impact of endometriosis on pregnancy and vice versa were included in this article. Results: Changes of the endometriotic lesions may occur during pregnancy caused by the modifications of the hormonal milieu, posing a clinical dilemma due to their atypical appearance. The management of these events is actually challenging as only few cases have been described and the review of available literature evidenced a lack of formal estimates of their incidence. Acute complications of endometriosis during pregnancy, such as spontaneous hemoperitoneum, bowel and ovarian complications, represent rare but life-threatening conditions that require, in most of the cases, surgical operations to be managed. Due to the unpredictability of these complications, no specific recommendation for additional interventions to the routinely monitoring of pregnancy of women with known history of endometriosis is advisable. Even if the results of the published studies are controversial, some evidence is suggestive of an association of endometriosis with spontaneous miscarriage, preterm birth and small for gestational age babies. A correlation of endometriosis with placenta previa (odds ratio from 1.67 to 15.1 according to various studies) has been demonstrated, possibly linked to the abnormal frequency and amplitude of uterine contractions observed in women affected. Finally, there is no evidence that prophylactic surgery would prevent the negative impact of endometriosis itself on pregnancy outcome. Conclusions: Complications of endometriosis during pregnancy are rare and there is no evidence that the disease has a major detrimental effect on pregnancy outcome. Therefore, pregnant women with endometriosis can be reassured on the course of their pregnancies although the physicians should be aware of the potential increased risk of placenta previa. Current evidence does not support any modification of conventional monitoring of pregnancy in patients with endometriosis.
    Human Reproduction Update 10/2015; DOI:10.1093/humupd/dmv045 · 10.17 Impact Factor
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    • "Information on the doses of CT scans in children has been published in recent years. The children and adolescents observed in these studies underwent investigations with CT at doses from 0.3 to 20 mSv, which were performed for medical reasons (Mettler et al. 2008). These studies all agree that after a number of years a significantly increased incidence of malignant tumors can be found in these children compared to nonexposed controls (Brenner et al. 2001, Chodick et al. 2007, Pearce et al. 2012, Mathews et al. 2013, Miglioretti et al. 2013). "
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    ABSTRACT: In 2011, the first consensus conference on guidelines for the use of cone-beam computed tomography (CBCT) was convened by the Swiss Society of Dentomaxillofacial Radiology (SGDMFR). This conference covered topics of oral and maxillofacial surgery, temporomandibular joint dysfunctions and disorders, and orthodontics. In 2014, a second consensus conference was convened on guidelines for the use of CBCT in endodontics, periodontology, reconstructive dentistry and pediatric dentistry. The guidelines are intended for all dentists in order to facilitate the decision as to when the use of CBCT is justified. As a rule, the use of CBCT is considered restrictive, since radiation protection reasons do not allow its routine use. CBCT should therefore be reserved for complex cases where its application can be expected to provide further information that is relevant to the choice of therapy. In periodontology, sufficient information is usually available from clinical examination and periapical radiographs; in endodontics alternative methods can often be used instead of CBCT; and for implant patients undergoing reconstructive dentistry, CT is of interest for the workflow from implant planning to the superstructure. For pediatric dentistry no application of CBCT is seen for caries diagnosis.
    Swiss Dental Journal 09/2015; 125(9):945-953.
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    • "Onepossibleexplanationfortheamountofpatients exposedtoaCEDR>50mSvisthefactthattheywere treatedatatertiaryreferencecenter,whichmore frequentlydealswithsevereandrefractorypatients. Evenso,themajorityofpatientswereexposedtoa CEDR<50mSvofionizationradiationduringthe totalfollow-upperiodand4%wereexposedto >100mSv.Theeffectsofionizingradiationshould notbeunderestimated,consideringtheLNTmodel andtheevidenceforanincreaseinsomecancerrisks atdosesabove~5mSv[19] [21]. Brenneretal.showedthatradiation-inducedcan- "
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    ABSTRACT: Crohn's disease (CD) patients undergo many radiological studies employing ionizing radiation for diagnosis and management purposes. Our aim was to assess the total radiation exposure of our patients over the years, to estimate the risk factors for exposure to high doses, and to correlate radiation exposure to immunosuppression. The cumulative effective dose of radiation (CEDR) was calculated multiplying the number of imaging studies by the effective dose of each examination. A total of 451 patients with CD (226 female) were followed during 11.0 years (interquartile range [IQR]: 6.0-16.0), with 52.1% of the patients being classified with penetrating (B3) and 38.6% being steroid-dependent. About 16% were exposed to high-radiation dose levels (CEDR >50 mSv) and 4% were exposed to CEDR >100 mSv. The mean CEDR between age 26 and 35 years was 12.539 mSv and a significant dose of radiation (over 50 mSv) was achieved at a median age of 40 (IQR: 29.0-47.0). Abdominal-pelvic computed tomography scan was the examination that contributed the most for CEDR. Patients with B3 phenotype, previous surgery, azathioprine, and anti-tumor necrosis factor (TNF)-α therapy were exposed earlier on the course of the disease to CEDR >50 mSv (p < 0.001). The value of CEDR in the patients under immunosuppression mainly increased in the first year of immunosuppression. Penetrating phenotype, abdominal surgery, steroid resistance or steroid dependence, and treatment with anti-TNF-α and azathioprine were predictive factors for high CEDR. It was also demonstrated that immunosuppression and anti-TNF-α treatment were followed by a sustained increment of radiation exposure and that a significant dose of radiation was achieved <40 years of age.
    Scandinavian Journal of Gastroenterology 04/2015; 50(10):1-12. DOI:10.3109/00365521.2015.1037344 · 2.36 Impact Factor
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