Attention. Therefore, all the data and statements made in this presentation are preliminary and might change in the future.

Transcription

1 Attention The aim of the Dose Datamed II workshop in Athens was to present preliminary data, collect feedback from the audience and to work towards final results and conclusions. Therefore, all the data and statements made in this presentation are preliminary and might change in the future. Please use the data with care and indicate its preliminary character! We would appreciate any feedback made based on the data presented with an at:

2 Summary of the population dose for X-ray procedures Hannu Järvinen Radiation and Nuclear Safety Authority (STUK), Finland

3 By definition For a given x-ray procedure: Annual population dose = Annual collective effective dose to population = Mean (typical) effective dose of the procedure x Frequency (number/year) of the procedure

4 Mean (typical) effective dose 3 possible methods for dose determination: (1) measurement, i.e. measurement of a practical quantity (KAP, DLP etc) and conversion to effective dose by published conversion factors, (2) calculation, i.e. calculation of effective dose by Monte Carlo (e.g. using a commercial software PCXMC, CTEXPO) or other software (3) literature, i.e. taking the effective dose from published literature.

5 0,300 0,250 0,200 0,150 0,100 0,050 Mean (typical) effective dose 0,014 0,26 msv Stdev 0,0763 Max/min 18,6 Chest/Thorax 0,000 AL AT BY BE HR BG CR CY CZ DK EE FI FR DE GR HU IS IR IT LV LC LI LU MA MT MD ME NL NO PL PT RO SP SK SI ES SE CH TR UA UK

6 3,000 2,500 2,000 1,500 1,000 0,500 Mean (typical) effective dose 0,289 3,15 msv Stdev 0,766 Max/min 3,500 10,9 Mean effective dose, msv Lumbar spine (inc.lsj) 0,000 AL AT BY BE HR BG CR CY CZ DK EE FI FR DE GR HU IS IR IT LV LC LI LU MA MT MD ME NL NO PL PT RO SP SK SI ES SE CH TR UA UK

7 Mean (typical) effective dose 0,017 2,095 msv Stdev 0,344 Max/min 2, ,2 Mean effective dose, msv 2,000 1,500 1,000 0,500 Mammography Medio-lateral oblique &/or Cranio-caudal radiographs on one or oth breasts 0,000 AL AT BY BE HR BG CR CY CZ DK EE FI FR DE GR HU IS IR IT LV LC LI LU MA MT MD ME NL NO PL PT RO SP SK SI ES SE CH TR UA UK

8 Mean (typical) effective dose 3,25 11,25 msv Stdev 3,78 Max/min 3,5 12,000 Cardiac angio-graphy Mean effective dose, msv 10,000 8,000 6,000 4,000 2,000 0,000 AL AT BY BE HR BG CR CY CZ DK EE FI FR DE GR HU IS IR IT LV LC LI LU MA MT MD ME NL NO PL PT RO SP SK SI ES SE CH TR UA UK

9 180, , , , ,000 80,000 60,000 40,000 20,000 0,000 Mean (typical) effective dose CT spine AL AT BY BE HR BG CR CY CZ DK EE FI FR DE GR HU IS IR IT LV LC LI LU MA MT MD ME NL NO PL PT RO SP SK SI ES SE CH TR UA UK Mean effective dose, msv

10 TOP 20 Group Mean effective dose, msv Range, msv Max/min Mean (typical) effective dose Chest/Thorax 0,105 0,014-0,260 18,6 Cervical spine 0,190 0,02-0,7 35,0 Thoracic spine 0,679 0,141-2,0 14,2 Lumbar spine (inc.lsj) 1,204 0,289-3,15 10,9 Mammography 0,313 0,017-2, ,2 Abdomen 0,888 0,105-2,927 27,9 Pelvis & hip 0,718 0, ,7 Ba meal 5,943 0, ,8 Ba enema 8,411 2,2-25,2 11,5 Ba follow-through 6,653 0,63-24,5 38,9 IVU 2,827 0,434-5,634 13,0 Cardiac angio-graphy 7,560 3,25-11,25 3,5 CT head 1,855 0,279-3,924 14,1 CT neck 2,161 0,415-5,38 13,0 CT chest 6,293 2,033-20,35 10,0 CT spine 11,164 2, ,89 68,5 CT abdomen 11,053 2,612-28,65 11,0 CT pelvis 5,954 0,8-14,48 18,1 CT trunk 10,673 2, ,5 PTCA 14,553 6, ,4

11 Mean (typical) effective dose: comparison with earlier data 2,5 2 Mean E, msv 1,5 1 0,5 0 Chest/Thorax Cervical spine Thoracic spine Lumbar spine (inc.lsj) Mammography Abdomen Pelvis & hip Average of European countries (this survey) Average for 10 countries (RP 154) UNSCEAR HCL1

12 Mean (typical) effective dose: comparison with earlier data Mean E, msv Average of European countries (this survey) Average for 10 countries (RP 154) UNSCEAR HCL1

13 Overall total collective effective dose 34 countries (21 April 2012): mansv mansv per 1000 of population resulting in a mean effective dose of 0,99 msv per caput.

14 Overall total collective effective dose Overall total collective effective dose per 1000 of population, msv 2500,0 2000,0 1500,0 1000,0 500,0 Real overall data for BG, CH, DE, FI, FR, UK Calculated from TOP 20 data for other countries 0,0 EE LU BE HU DE IS NO FR PT IT CZ CH PL LI GR ES ME DK IR AT SP SE SK MA CR MT UA SI NL FI BG MD UK RO AL BY Plain radiography Fluoroscopy Computed tomography Interventional radiology

15 Overall total E/TOP 20 total E Overall total collective effective dose 4,50 4,00 3,50 3,00 2,50 2,00 1,50 1,00 0,50 Correction factors Overall total/top20 total Plain radiography Fluoroscopy CT IR 1,12 1,55 1,18 2,61 BG FI FR DE CH UK Mean 0,00 Total Plain Fluoroscopy CT IR radiography

16 Overall total collective effective dose Overall total collective effective dose per 1000 of population, msv 2500,0 2000,0 1500,0 1000,0 500,0 Real overall data for BG, CH, DE, FI, FR, UK Calculated from TOP 20 data for other countries 0,0 EE LU BE HU DE IS NO FR PT IT CZ CH PL LI GR ES ME DK IR AT SP SE SK MA CR MT UA SI NL FI BG MD UK RO AL BY Plain radiography Fluoroscopy Computed tomography Interventional radiology

17 Overall total collective effective dose 100 % 90 % 80 % 70 % 60 % CT 56,4 % Range 8,6.84,2% 50 % 40 % 30 % 20 % 10 % 0 % HU EE LU BE IS DE FR NO PT CH IT CZ GR PL LI DK AT IR SK SE SP MA CR MT UA SI NL FI MD BG UK ME RO AL BY HR CY LV LC ES TR Plain radiography Fluoroscopy Computed tomography Interventional radiology Relative contribution to overall collective effective dose %

18 TOP 20 total collective effective dose 34 countries (21 April 2012): mansv 0,776 mansv per 1000 of population resulting in a mean effective dose of 0,78 msv per caput.

19 Group Collective effective dose: comparison of overall and TOP 20 Overall total mansv TOP 20 total mansv Overall total per 1000 population, man-msv TOP 20 total per 1000 population, man-msv DDM1: % % of TOP 20 from overall TOTAL ,4 775,5 78 % 78,0 Plain radiography ,5 181,7 87,1 Fluoroscopy ,8 109,2 66,7 Computed tomography ,1 455,8 82,3 Interventional radiology ,0 28,9 42,5

20 Collective effective dose: Percentage of TOP 20 collective E from overall collective E

21 Impact of real national TOP 20 list on New TOP 20/ collective effective dose Country New TOP 20 groups Annual collective E per 1000 population, msv Bulgaria Finland Germany Switzerland Dropped out from TOP 20 of RP 154 Annual collective E per 1000 population, msv RP 154 TOP 20 New national TOP 20 Kidneys&Ureters&Bladde 8,87 Mammography 2,74 Fluoroscopy of chest 6,13 CT trunk 3,24 CT Percentage guided bolting of of TOP 20 nerve-roots 6,95 Ba meal 0,10 Contrast coll fluoroscopy E from of Overall Ba followthrough coll 0,51 lower limb arteries 5,07 Double E contrast (on exam the of average): large intestine 3,21 Ba enema 0,56 CT About guided biobsy of 80 % % lung 2,06 IVU 0,91 CT guided intervention 1,26 (puncture, spinal Ba followthrough injections etc.) 79,28 Ba followthrough CT angiography 97,247 1,23 CT interventional 56,221 IVU 2,40 Total collective E per 1000, TOP 20 of RP 154 RP 154 TOP 20 Total collective E per 1000, New national TOP 20 New TOP 20/ RP 154 TOP 20 1,03 % of RP 154 TOP 20 of overall E % of New TOP 20 of overall E 321,18 330,19 1,03 78,7 80,9 1,04 349,90 365,12 1,04 1,07 77,0 80,3 1121, ,33 1,07 67,0 71,7 1,17 880, ,58 1,17 86,3 101,0

22 Major uncertainties of present overall European collective E Source of uncertainty 1. Countries missing all frequencies (no data) 2. Countries missing data for one or more examinations 3. Countries missing data for mean (typical) E 4. Accuracy of TOP 20 approximation/correction 5. Uncertainties of national methods (frequencies, dose, ) Possible solution to overcome European mean collective E/ population number x population number of the country Estimates based on the European mean ratio of examination in question to the total number of all examinations Estimated by using the European mean E National TOP 20 lists Improved interpretations of TOP 20 National efforts, European guidance,

23 THANK YOU!