Radiation exposure of the Italian population from diagnostic radiology and nuclear medicine examinations

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Workshop on European Population Doses from Medical Exposure 24-26 April 2012, Athens, Greece Radiation exposure of the Italian population from diagnostic radiology and nuclear medicine examinations

1 Workshop on European Population Doses from Medical Exposure April 2012, Athens, Greece Radiation exposure of the Italian population from diagnostic radiology and nuclear medicine examinations Gaetano Compagnone 1, Faustino Bonutti 2, Stefano De Crescenzo 3, Anna Dipilato 4, Daniele Giansanti 5, Alessandro Lazzari 6, Paola Angelini 7, Sara Domenichelli 1, Renato Padovani 2 1 Medical Physics Department, S. Orsola Malpighi University Hospital, Bologna (I), 2 Medical Physics Department, S. Maria della Misericordia University Hospital, Udine (I), 3 Medical Physics Department, Niguarda Cà Granda Hospital, Milano (I), 4 Medical Physics Department, University of Perugia (I), 5 Istituto Superiore di Sanità, Roma (I), 6 Medical Physics Department, USL2 Hospital, Lucca (I), 7 Regional Health Service Emilia-Romagna, Bologna (I)

2 INTRODUCTION In the European Union many studies have been implemented to quantify the contribution of medical procedures to the ionizing radiation exposure of the population In spite of the fact that the Italian health level is similar to that of other European countries where the population radiation dose from medical exposure was already estimated, in Italy this evaluation was not performed yet The present study was carried out by collecting data related to both the dose and the frequency of the main diagnostic radiology and nuclear medicine procedures in Italy for estimating: frequency of procedures collective effective dose per caput dose to the Italian population

3 Regional Health Autorities every 5 years (2001, 2006, 2011) should evaluate doses to the population from medical exposures and send them to the Ministry of Health

5 MATERIALS AND METHODS The survey included 5 Italian regions: Emilia-Romagna, Friuli Venezia Giulia, Lombardia, Toscana, Umbria (accounting for approximately 30% of the Italian population) The included radiology procedures in 2006 (reference year) covered several broad categories: PROJECTION RADIOGRAPHY: Chest/Thorax; Cervical, Thoracic and Lumbar spine; Mammography; Abdomen; Pelvis and hip RADIOGRAPHY AND FLUOROSCOPY: Ba meal and Ba enema; Intravenous urography INTERVENTIONAL RADIOLOGY: Cardiac angiography; Percutaneous Transluminal Coronary Angioplasty COMPUTED TOMOGRAPHY: CT head; CT neck; CT chest; CT spine; CT abdomen; CT pelvis + 33 examinations in NUCLEAR MEDICINE

6 For each procedure were requested to each region both the frequency and the dose. The metric of the latter was selected depending on the type of examination: Entrance Skin Dose in projection radiography Kerma Area Product in interventional radiology Entrance Skin Air Kerma and Average Glandular Dose in mammography Dose Length Product in computed tomography Administered Activity in nuclear medicine If a region was not able to provide data for a specific examination, the results were interpolated on the basis of the other regions data (weighted mean by the number of examinations) Effective doses per examination were estimated using appropriate conversion coefficients and, finally, data linearly extrapolated to the whole Italian population, to assess collective effective dose and per caput effective dose

7 Variations in the terminology adopted by the Hospitals for describing the different types of examinations: CT abdomen what is exactly?

8 RESULTS AND DISCUSSION Country: Italy Number of inhabitants: (in millions) Year: 2006 The "TOP 20 list" RP154 Specific exams included in exam types *) Total number per year annual frequency per 1000 pop 1 Chest/Thorax ,942, Cervical spine ,809, Thoracic spine , Lumbar spine (inc.lsj) ,774, Mammography ,534, Abdomen ,612, Pelvis & hip 4,189, Ba meal , Ba enema , Ba follow-through na na IVU , Cardiac angiography 263, CT head ,934, CT neck 155, CT chest ,273, CT spine , CT abdomen ,809, CT pelvis , CT trunk na na 20 PTCA 149, Ba follow-through examinations are included in Ba meal CT trunk examinations are included in CT Chest and CT abdomen because this examination is counted as 2 examinations (chest and abdomen)

9 Mean E/exam (msv) Annual collective effective dose per 1000 pop (msv) 1 Chest/Thorax Cervical spine Thoracic spine Lumbar spine (inc.lsj) Mammography Abdomen Pelvis & hip Ba meal Ba enema IVU Cardiac angiography CT head CT neck CT chest CT spine CT abdomen CT pelvis PTCA For Radiology, the highest dose/procedure was found in Percutaneous Transluminal Coronary Angioplasty (20.9 msv). The annual collective effective dose received by the whole Italian population amounted to 53,021 man Sv from Radiology

10 For the PET/CT examination the dose contribution from the CT part is omitted. For Nuclear Medicine, the highest dose/procedure was found in I-131 Adrenal cortical scintigraphy (59.4 msv). The annual collective effective dose received by the whole Italian population amounted to 4,246 man Sv from Nuclear Medicine

11 The most frequent procedures are Chest/Thorax (11,942,928 examinations/year) in radiology and Tc-99m Bone imaging (280,509 examinations/year) in nuclear medicine. As far as the examinations under consideration are concerned, the estimated total number of examinations in Italy was 35,954,900 and 874,696 for radiology and nuclear medicine, respectively. The annual collective effective dose received by the whole Italian population amounted to 57,267 man Sv The per caput dose was 0.94 msv per inhabitant in 2006, (Italy population was million) The uncertainties at 95% confidence level were calculated according to the Dose DataMed2 criteria: in radiology procedures, the total relative uncertainties were 9.3% and 11.4% for frequency and collective dose, respectively.

13 CONCLUSIONS This study collected different regional surveys and made homogeneous the available data according to the DoseDataMed2 criteria with an acceptable statistical significance. In Italy, this evaluation represents the first national estimation of frequency and population dose from diagnostic radiology and nuclear medicine examinations. The next step could be to extend the same methodology to other regions and to increase the number of examinations, in order to reduce the uncertainties both in frequency and in dose.

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

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