IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

RADIATION PROTECTION IN
DIAGNOSTIC AND
INTERVENTIONAL RADIOLOGY

L 2: Radiation units and dose quantities

IAEA
International Atomic Energy Agency
Introduction

• Subject matter: the basic dosimetric

quantities
• Several quantities and units are needed in
the field of diagnostic radiology and related
dosimetry
• Some can be measured directly while others
can only be calculated

IAEA 2: Radiation units and dose quantities 2

Topics

• Exposure and exposure rate

• Absorbed dose and KERMA
• Mean Absorbed Dose in a tissue
• Equivalent dose H
• Effective Dose
• Related dosimetry quantities (surface and depth
dose, backscatter factor…..)
• Specific dosimetry quantities (Mammography, CT,
…)
IAEA 2: Radiation units and dose quantities 3
Objective

• To become familiar with dosimetric

quantities and units, and to perform related
calculations.

IAEA 2: Radiation units and dose quantities 4

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 2: Radiation units and dose

quantities

Topic 1: Exposure and exposure rate

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International Atomic Energy Agency
Exposure

• Exposure is a dosimetric quantity for ionizing

radiation, based on the ability of the
radiation to produce ionization in air.
• This quantity is only defined for radiation
producing interactions in air.

IAEA 2: Radiation units and dose quantities 6

Exposure

• Before interacting with the patient

(direct beam) or with the staff (scattered
radiation), X Rays interact with air
• The quantity “exposure” gives an
indication of the capacity of X Rays to
produce a certain effect in air
• The effect in tissue will be, in general,
proportional to this effect in air

IAEA 2: Radiation units and dose quantities 7

Exposure

• The exposure is the absolute value of the

total charge of the ions of one sign produced
in air when all the electrons liberated by
photons per unit mass of air are completely
stopped in air.

X = dQ/dm

IAEA 2: Radiation units and dose quantities 8

Exposure: X

• The SI unit of exposure is Coulomb per

kilogram [C kg-1]
• The former special unit of exposure was
Roentgen [R]
• 1 R = 2.58 x 10-4 C kg-1
• C kg-1 = 3876 R

IAEA 2: Radiation units and dose quantities 9

Exposure rate: X/t

• Exposure rate (and later, dose rate) is the

exposure produced per unit of time.
• The SI unit of exposure rate is the C/kg per
second or R/s.
• In radiation protection it is common to
indicate these rate values
“per hour” (e.g. R/h).

IAEA 2: Radiation units and dose quantities 10

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 2: Radiation units and dose

quantities

Topic 2: Absorbed dose and KERMA

IAEA
International Atomic Energy Agency
Patient dosimetry quantities

IAEA 2: Radiation units and dose quantities 12

Absorbed dose, D

• The absorbed dose D, is the energy

absorbed per unit mass. This quantity is
defined for all ionizing radiation (not only for
electromagnetic radiation, as in the case of
the “exposure”), and for any material.
• D = dE/dm. The SI unit of D is the Gray [Gy].
• 1 Gy = 1 J/kg.
• The former unit was the “rad”. 1 Gy = 100
rad.
IAEA 2: Radiation units and dose quantities 13
Absorbed dose, D and KERMA

• The KERMA (kinetic energy released in a mass)

K = dEtrans/dm
• where dEtrans is the sum of the initial kinetic energies of
all charged ionizing particles liberated by uncharged
ionizing particles in a material of mass dm
• The SI unit of kerma is the joule per kilogram
(J/kg), termed Gray (Gy).
• In diagnostic radiology, Kerma and D are equal.

IAEA 2: Radiation units and dose quantities 14

Relation between absorbed dose and
exposure

• It is possible to calculate the absorbed dose

in a material if the exposure is known
• D [Gy]. = f . X [C kg-1]
• f = conversion coefficient depending on medium
• The absorbed energy in a quantity of air
exposed to 1 [C kg-1] of X Rays is 0.869 [Gy]
• f(air) = 0.869

IAEA 2: Radiation units and dose quantities 15

Example of conversion coefficient: f

f values ([Gy] / Ckg-1])

Photon energy Water Bone Muscle

10 keV 0.91 3.5 0.93

100 keV 0.95 1.5 0.95

IAEA 2: Radiation units and dose quantities 16

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 2: Radiation units and dose

quantities

Topic 3: Mean Absorbed Dose in a tissue

IAEA
International Atomic Energy Agency
Mean absorbed dose in a tissue or
organ

• The mean absorbed dose in a tissue or

organ DT is the energy deposited in the
organ divided by the mass of that organ.

IAEA 2: Radiation units and dose quantities 18

Exposure and absorbed dose or
KERMA

• Exposure can be linked to air dose or kerma

by suitable conversion coefficients.
• For example, 100 kV X Rays that produce
an exposure of 1 R at a point will also give
an air kerma of about 8.7 mGy (0.87 rad)
and a tissue kerma of about 9.5 mGy (0.95
rad) at that point.

IAEA 2: Radiation units and dose quantities 19

Ratio of absorbed dose in soft tissue
to that in air

• Values of absorbed dose to tissue will vary

by a few percent depending on the exact
composition of the medium that is taken to
represent soft tissue.
• The following value is usually used for 80 kV
and 2.5 mm Al:
Dose in soft tissue = 1.06 Dose in air

IAEA 2: Radiation units and dose quantities 20

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 2: Radiation units and dose

quantities

Topic 4: Equivalent dose H

IAEA
International Atomic Energy Agency
Equivalent dose: H

• The equivalent dose H is the absorbed dose

multiplied by a dimensionless radiation
weighting factor, wR which expresses the
biological effectiveness of a given type of
radiation
• To avoid confusion with the absorbed dose,
the SI unit of equivalent dose is called the
sievert (Sv). The old unit was the “rem”
• 1 Sv = 100 rem
IAEA 2: Radiation units and dose quantities 22
Radiation weighting factor, wR

• For most of the radiation used in medicine

(X Rays, , e-) wR is = 1, so the absorbed
dose and the equivalent dose are
numerically equal
• The exceptions are:
• alpha particles (wR = 20)
• neutrons (wR = 5 - 20).

IAEA 2: Radiation units and dose quantities 23

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 2: Radiation units and dose

quantities

Topic 5: Effective Dose

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International Atomic Energy Agency
Detriment

• Radiation exposure of the different organs

and tissues in the body results in different
probabilities of harm and different severity
• The combination of probability and severity
of harm is called “detriment”.

IAEA 2: Radiation units and dose quantities 25

Tissue weighting factor

• To reflect the combined detriment from

stochastic effects due to the equivalent
doses in all the organs and tissues of the
body, the equivalent dose in each organ and
tissue is multiplied by a tissue weighting
factor, WT, and the results are summed over
the whole body to give the effective dose E

IAEA 2: Radiation units and dose quantities 26

Tissue weighting factors, wT

WT
Organ/Tissue WT Organ/Tissue

Bone marrow 0.12 Lung 0.12

Bladder 0.04 Liver 0.04
Bone surface 0.01 Oesophagus 0.04
Salivary
Brain 0.01 0.01
Glands
Breast 0.12 Skin 0.01
Colon 0.12 Stomach 0.12
Gonads 0.08 Thyroid 0.04
Liver 0.05 Remainder 0.12

IAEA 2: Radiation units and dose quantities 27

Effective dose, E

• E = T wT.HT
• E: effective dose
• wT: weighting factor for organ or tissue T
• HT: equivalent dose in organ or tissue T

IAEA 2: Radiation units and dose quantities 28

 IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 2: Radiation units and dose

quantities

Topic 6: Related dosimetry quantities (surface

and depth dose, backscatter factor…..)

IAEA
International Atomic Energy Agency
Entrance surface dose (ESD)

• Absorbed dose is a property of the absorbing

medium as well as the radiation field, and the
exact composition of the medium should be
clearly stated.
• Usually ESD refers to soft tissue (muscle) or
water
• Absorbed dose in muscle is related to absorbed
dose in air by the ratio of the mass energy
coefficients

IAEA 2: Radiation units and dose quantities 30

Entrance surface dose (ESD)

• The obtained value for all typical diagnostic X Ray

qualities can be assumed to be 1.06 (± 1%)

  µ en   µ en  
• F =       1.06
  
   water  air 
• where (µen/) are the mass energy coefficients of
water and air, respectively.

IAEA 2: Radiation units and dose quantities 31

Entrance surface dose (ESD)

• On the other hand, the ESD measured on the

surface of the patient or phantom includes a
contribution from photons scattered back from
deeper tissues, which is not present for free air
measurements
• For this reason, correction factor (backscatter
factor) must be introduced
• If measurements are made at other distances than
the true focus-to-skin distance, doses must be
corrected by the inverse square law
IAEA 2: Radiation units and dose quantities 32
Backscatter factors (water)

HVL Field size (cm x cm)

mm Al 10 x 10 15 x 15 20 x 20 25 x 25 30 x 30

2.0 1.26 1.28 1.29 1.30 1.30

2.5 1.28 1.31 1.32 1.33 1.34

3.0 1.30 1.33 1.35 1.36 1.37

4.0 1.32 1.37 1.39 1.40 1.41

IAEA 2: Radiation units and dose quantities 33

Dose area product (I)

• The dose-area product (DAP) quantity is defined

as the dose in air in a plane, integrated over the
area of interest
• The DAP (cGy·cm2) is constant with distance since
the cross section of the beam is a quadratic
function which cancels the inverse quadratic
dependence on dose
• This is true neglecting absorption and scattering of
radiation in air and even for X Ray housing near
the couch table
IAEA 2: Radiation units and dose quantities 34
Inverse square law

3
2
1 2
4 1 6
5
3 4 9
D
8
7
2D

3D

IAEA 2: Radiation units and dose quantities 35

DAP-meter (Diamentor ®)

IAEA 2: Radiation units and dose quantities 36

Dose-area product meter

IAEA 2: Radiation units and dose quantities 37

Dose area product (II)

• It is always necessary to calibrate and to check the

transmission chamber for the X Ray installation in
use
• In some European countries, it is compulsory that
new equipment is equipped with an integrated
ionization transmission chamber or with automatic
calculation methods
• It is convenient, in this case, also to check the
read-out as some systems overestimate the real
DAP value
IAEA 2: Radiation units and dose quantities 38
IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 2: Radiation units and dose

quantities

Topic 7: Specific dosimetry quantities

(Mammography, CT,…)

IAEA
International Atomic Energy Agency
The average glandular dose (AGD)

• The Average Glandular Dose (AGD) is the

dosimetry quantity generally recommended
for risk assessment
• The use of AGD is recommended by the
ICRP, the British Institute of Physical
Sciences in Medicine, the NCRP, the BSS
and the Netherlands Commission on
Radiation Dosimetry (NCS)

IAEA 2: Radiation units and dose quantities 40

The average glandular dose AGD
(mammography)

• The AGD cannot be measured directly but it is

derived from measurements with the standard
phantom for the actual technique set-up of the
mammographic equipment
• The Entrance Surface Air Kerma (ESAK) free-in-air
(i.e., without backscatter) has become the most
frequently used quantity for patient dosimetry in
mammography
• For other purposes (compliance with reference
dose level) one may refer to ESD which includes
backscatter
IAEA 2: Radiation units and dose quantities 41
The ESAK (mammography)

• ESAK can be determined by:

• a TLD dosimeter calibrated in terms of air kerma free-in-
air at a HVL as close as possible to 0.4 mm Al with a
standard phantom
• a TLD dosimeter calibrated in terms of air kerma free-in-
air at a HVL as close as possible to 0.4 mm Al stuck to
the patient skin (appropriate backscatter factor should
be applied to Entrance Surface Dose measured with the
TLD to express ESAK)
• Note: due to low kV used the TLD is seen on the image
• a radiation dosimeter with a dynamic range covering at
least 0.5 to 100 mGy (better than  10% accuracy)

IAEA 2: Radiation units and dose quantities 42

Dosimetric quantity for C.T.

• CTDI (Computed Tomography Dose Index)

• DLP (Dose-Length Product)

• MSAD (Multiple Scan Average Dose)

IAEA 2: Radiation units and dose quantities 43

Computed tomography dose index
(CTDI)

• The CTDI is the integral along a line parallel to the axis of

rotation (z) of the dose profile (D(z)) for a single slice,
divided by the nominal slice thickness T
+
1
CTDI = T  -
D(z)dz
• In practice, a convenient assessment of CTDI can be made
using a pencil ionization chamber with an active length of
100 mm so as to provide a measurement of CTDI100
expressed in terms of absorbed dose to air (mGy).

IAEA 2: Radiation units and dose quantities 44

Computed tomography dose index
(CTDI)

• measurements of CTDI may be

carried out free-in-air in parallel with
the axis of rotation of the scanner
(CTDI100, air)
• or at the centre (CTDI100, c)
• and 10 mm below the surface
(CTDI100, p) of standard CT
CTDI  1s D( x)dx dosimetry phantoms
• the subscript ‘n’ (nCTDI) is used to
denote when these measurements
have been normalised to unit mAs.
IAEA 2: Radiation units and dose quantities 45
Computed tomography dose index
(CTDI)
• On the
the assumption
assumptionthat
thatdose
doseininaaparticular
particularphantom
phantom
decreases
decreases linearly
linearly with
withradial
radialposition
positionfrom
fromthe
thesurface
surfacetotothe
centre, thenthen
the centre, the normalised average
the normalised dosedose
average to thetoslice
the is
slice is
approximated
approximated by by the
the(normalised)
(normalised)weighted
weightedCTDI:
CTDI:
[mGy(mAs)
[mGy(mAs)-1]-1
]

n CTDI w =
1
C
( 1
3
2
CTDI100,c + CTDI100,p
3
)
•• where:
where:
•• C
C is
is the
the tube
tube current
currentxxthe
theexposure
exposuretime
time(mAs)
(mAs)
•• CTDI100,p
CTDI100,p represents
representsananaverage
averageofofmeasurements
measurementsatat
four
four different
different locations
locationsaround
aroundthe
theperiphery
peripheryofofthe
the
phantom
phantom
IAEA 2: Radiation units and dose quantities 46
Reference dose quantities
• Two reference dose quantities are proposed for CT in order to
promote the use of good technique:
• CTDIw in the standard head or body CT dosimetry phantom for a
single slice in serial scanning or per rotation in helical scanning:
[mGy]

CTDI w = n CTDI w C
• where:
• nCTDIw is the normalised weighted CTDI in the head or body
phantom for the settings of nominal slice thickness and applied
potential used for an examination

• C is the tube current x the exposure time (mAs) for a single slice in
serial scanning or per rotation in helical scanning.

IAEA 2: Radiation units and dose quantities 47

Reference dose quantities

• DLP Dose-length product for a complete examination: [mGy •

cm]
DLP =  n CTDI w T N C
i
where:
• i represents each serial scan sequence forming part of an
examination
• N is the number of slices, each of thickness T (cm) and
radiographic exposure C (mAs), in a particular sequence.
N.B.: Any variations in applied potential setting during
the examination will require corresponding changes in the
value of nCTDIw used.

IAEA 2: Radiation units and dose quantities 48

Reference dose quantities

• In the case of helical (spiral) scanning [mGy • cm]:

DLP =  n CTDI w T At
i
• where, for each of i helical sequences forming part of
an examination:
• T is the nominal irradiated slice thickness (cm)
• A is the tube current (mA)
• t is the total acquisition time (s) for the sequence.

• N.B.: nCTDIw is determined for a single slice as in serial

scanning.

IAEA 2: Radiation units and dose quantities 49

Reference dose quantities

• Multiple Scan Average Dose (MSAD): The average

dose across the central slice from a series of N
slices (each of thickness T) when there is a
constant increment between successive slices:
I
+
1

2
MSAD = I D N, I (z)dz
I -
2
• where:
• DN,I(z) is the multiple scan dose profile along a line
parallel to the axis of rotation (z).

IAEA 2: Radiation units and dose quantities 50

Summary

• Dosimetric quantities are useful to know the

potential hazard from radiation and to
determine radiation protection measures to
be taken.
• The old, non-S.I. quantities and units are
mentioned, since these are still used in
some countries, notably the United States of
America.

IAEA 2: Radiation units and dose quantities 51

Where to Get More Information

• Gregg EC. Effects of ionizing radiation on humans.

In Waggener RG and Kereikas JG., editors.
Handbook of medical physics, Volume II. Boca
Raton, CRC Press Inc., 1984.
• Radiation Dosimetry. Volume 1. Ed: Attix F.H. and
Roesch W.C. New York, Academic Press, 1968.
• Radiation exposure in Computed Tomography; 4th
revised Edition, December 2002, H.D.Nagel, CTB
Publications, D-21073 Hamburg

IAEA 2: Radiation units and dose quantities 52

References

• Protection against ionizing radiation from external

sources used in medicine. ICRP Publication 33.
Pergamon Press 1982.
• Radiological protection and safety in medicine.
ICRP Publication 73. Pergamon 1996.
• Quality Criteria for Computed Tomography. EUR
16262. Office for Official Publications of the
European Communities. Luxembourg 1999

IAEA 2: Radiation units and dose quantities 53

References

• Avoidance of radiation injuries from medical

interventional procedures. ICRP Publication
85. Ann ICRP 2000;30 (2). Pergamon.
• Quantities and Units in Radiation Protection
Dosimetry. ICRU report 51. Bethesda, USA,
1993.

IAEA 2: Radiation units and dose quantities 54