Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

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

email at:

contact@ddmed.eu

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Summary of national DRLs for

x-ray procedures in Europe

Hannu Järvinen

Radiation and Nuclear Safety

Authority (STUK), Finland

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

DRLs for adult x-ray examinations are established in 54 % of

the European countries (22 % no DRLs, 24 % no reply)

75 %

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

DRLs for paediatric x-ray examinations are established in 27

% of the countries (49 % no DRLs, 24 % no reply)

76 %

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Plain radiography

Anatomical

region Projections

Most

common

value Range Max/min

Countries with

the most

common DRL

Countries with

higher DRL

Countries with

lower DRL

Head, skull,

cranium AP or PA 5,0 2,5-5 2

CZ, IT, MO,

RO, SK -

BE, BG, LI, CH,

UK

LAT 3,0 1-3 3

CZ, IT, LI, MO,

RO, SK - BE, CH, UK

Chest, thorax PA 0,4 0,15-0,6 4,0 CR,CZ, IT, SK BG, MD

BE, FI, FR, LI,

RO, CH, UK

LAT 1,5 0,75-2 2,7

CR, CZ, IT,

RO, SK LI, MD

BE, FI, FR, CH,

UK

Thoracic spine AP 7 3,5-7 2

CR, CZ, MO,

SK - LI, UK

LAT 20 10-20 2

CR, CZ, MO,

SK - LI, UK

Abdomen AP or PA 5 1-10 10 FI, LI FR, IT, SK, UK BE, SI

Lumbar spine AP 10 5-10 2

CR,CZ, IT, LI,

MO, RO, SK -

BE, BG, DK, FI,

CH, UK

LAT 30 10-30 3

CR, CZ, IT,

MO, SK -

BE, BG, FI, LI,

CH, UK

LSJ 40 26-40 1,5 CZ, IT, MO, RO - UK

Pelvis AP 10 3,5-10 2,9

CZ, IT, MO,

RO, SK -

BE, BG, FI, LI,

CH, UK

Mammography

CC, MLO or

LAT 10 7-12 1,7

DK, FI, IT, LU,

RO BG GR

One

projection 3 1,5-4 2,7

CR, MO, NO,

SK SE, UK

AT, CZ, FR,

DE,LI, NL

ESD,

mGy

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Plain radiography

DAP, mGy cm2

Anatomical

region Projections

Most

common

value Range Max/min

Countries with

the most

common DRL

Countries with

higher DRL

Countries with

lower DRL

Head, skull,

cranium AP or PA 650 600-1000 1,7 DE, LU, CH AT BE, SI

LAT 600 500-1000 2 BE, DE, LU, SI AT CH

Dental Panoramic 120 120-200 1,7 FI FR -

Chest, thorax PA 150 120-1000 8,3 SI, CH

AT, BE, BG,

CZ, FR, DE, UK

LAT 600 250-1000 4 LU, CH AT, CZ, FR BE, DE, SI

Thoracic spine AP 1300 1250-1750 1,4 DE, LU, SI FR -

LAT 1700 1200-2750 2,3 DE, LU FR SI

Abdomen AP or PA 3000 2000-8000 4

AT, FI, DE, LU,

NL, UK BE, CZ, FR SI

Lumbar spine AP 2300 1500-10000 6,7 DE

BE, BG, CZ,

FR, LU, CH SI, UK

LAT 4000 2750-8000 2,9 AT

BE, FR, DE,

CH SI, UK

LSJ 3000 3000 1 SI, UK - -

Pelvis AP 2500 2500-7000 2,8 DE, NO, CH

AT, BE, BG,

CZ, FI, FR, DE,

LU, SI, SE, UK -

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

0,25

0,50,4 0,4

0,20,3

0,40,3

0,6

0,30,4

0,15 0,2

1,2

1,5 1,5

0,8

1,2

1,5

1,7

2

1,5 1,5

0,75

1

0

0,5

1

1,5

2

2,5A

L

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

ES

D,

mG

y

Thorax PA Thorax LAT

Chest/thorax, ESD

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

280350

400

1000

250

160 160 150 150 120

1000

250

1000 1000

550600

450

600

0

200

400

600

800

1000

1200

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

DA

P,

mG

y c

m2

Thorax PA Thorax LAT

Chest/thorax DAP

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Abdomen ESD

4,55

8

10

5

10

1

6

0

2

4

6

8

10

12A

L

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO

SP

SK SI

ES

SE

CH

TR

UA

UK

ES

D,

mG

y

Abdomen AP or PA

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Abdomen DAP

30003300

8000

3000

7000

3000 3000 3000

2000

3000

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

AL BY HR CR CZ EE FR GR IS IT LC LU MT ME NO PT SP SI SE TR UK

DA

P,

mG

y cm

2

Abdomen AP or PA

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Fluoroscopy

DAP, mGy cm2

Examination or

Anatomical

region

Most

common

value Range Max/min

Countries with

the most

common DRL

Countries

with higher

DRL

Countries

with lower

DRL

Barium meal 18 13-25 1,9 BG, LI CZ UK

Small intestine 44 44-65 1,5 DE, LU AT -

Barium enema 40 31-60 1,9 BG, NO CZ, SE

DK, DE, LI,

UK

Colon 37 37-50 1,4 LU FI -

ERCP 30 30-45 1,5 CH AT -

IVU 20 15-40 2,7 DK, FI, SE CZ NO., UK

Phlebography 5 5-5,5 1,1 DE, LU AT -

Coronary

angiography

(CA) 60 23-80 3,5 AT, FI SE, CH

BG, DE, LU,

NO, UK

Lower limb

arteriography

(LLA) 45 45-200 4,4 BG LU, CH -

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Fluoroscopy

Fluoroscopy time, min, and ESD, mSv (IVU)

Examination or

Anatomical

region

Most

common

value Range Max/min

Countries with

the most

common DRL

Countries

with higher

DRL

Countries

with lower

DRL

Barium meal 2,3 2,3-14,1 6,1 UK BG -

Barium enema 2,7 2,7-14,2 5,3 UK BG -

Coronary

angiography

(CA) 6 5,6-8 1,4 UK FI -

IVU 10 5-10 2,0

CZ, IT, LU,

MO, RO - BG, FI

Fluoroscopy time, min

ESD, mGy

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Barium enema DAP

40

60

30

3733

40

50

31

0

10

20

30

40

50

60

70A

L

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT

LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

DA

P,

Gy

cm

2

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Coronary Angiography, DAP

60

40

60

35

23

45

80

70

36

0

10

20

30

40

50

60

70

80

90

AL

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

DA

P,

Gy

cm

2

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Interventional radiology

DAP, Gy cm2

Procedure or

Anatomical

region

Quantity

and unit

Most

common

value

Range Max/min Countries

with the

most

common

DRL

Countries

with

higher

DRL

Countries

with lower

DRL

PTCA

DAP,

Gy cm2 100 44-130 3,0 FI, CH AT DE, LU

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

PTCA, DAP

130

100

60

44

100

0

20

40

60

80

100

120

140A

L

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

DA

P,

Gy

cm

2

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Computed tomography (CT)

DLP, mGy cmAnatomical

region

Most

common

value

Range Max/min Countries with

the most

common DRL

Countries

with higher

DRL

Countries with

lower DRL

Head, brain,

cranium

1000 760-1300 1,7 BU, FI, LU,

NO, CH

AT, BE, DK,

FR, IT, SI, SE

DE, LI, UK

Cervical spine 400 400-600 1,5 NO LU, CH -

Neck 500 440-500 1,1 DK, CH - LU

Chest normal 400 270-700 2,6 BE, DE, NO,

CH

AT, BG, DK,

FI, FR, IT, LI,

SI, SE, UK

LU

Chest HRCT 80 80 -300 3,8 UK DK -

Upper

abdomen

400 400-740 1,9 CH AT, DE -

Abdomen 800 460-1200 2,6 DK, IT, LU,

NO

AT, BE, DE,

LI

BG, FI, SI, UK

Pelvis 550 450-650 1,4 BG, LI AT, DK, IT DE, CH

Lumbar spine 500 300-870 2,9 FI, DE, LU,

NO

BE, FR, SE,

CH

LI

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Computed tomography (CT)

CTDIvol , mGy

Anatomical

region

Most

common

value

Range Max/min Countries with

the most

common DRL

Countries

with higher

DRL

Countries with

lower DRL

Head, brain,

cranium

65 50-75 1,5 FI, FR, CH,

UK

NO, SE BG, CR, CZ, IT,

MD, SI

Chest normal 10 10-30 3 CH, UK BG, FI, IT,

NO, SI, SE

-

Abdomen 25 13-35 2,7 CR, MO, SE BG, CZ, IT FI, NO, SI, CH,

UK

Lumbar spine 35 30-55 1,8 CR, CZ, MO FI, SE NO, CH

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

CT head, DLP

1300

1020 1000

1100

10001050

950 9501000 1000

1040

1200

1000

760

0

200

400

600

800

1000

1200

1400

AL

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT

LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

DL

P,

mG

y c

m

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

CT head, CTDIvol

60

50

60

65 65

50

70

62

75

65 65

0

10

20

30

40

50

60

70

80A

L

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO

SP

SK SI

ES

SE

CH

TR

UA

UK

CT

DI v

ol, m

Gy

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

CT chest, DLP

550

400

550

700

500475

400

650

270

400

475

600

400430

300

80

0

100

200

300

400

500

600

700

800A

L

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

DL

P,

mG

y c

m

Normal HRCT

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

CT lumbar spine, DLP

870

500

700

500

300

500 500

600

850

0

100

200

300

400

500

600

700

800

900

1000

AL

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT

LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

DL

P,

mG

y c

m

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Paediatric plain radiography

examinations

ESD, mGy

Anatomical region Projection Age Most

common

value

Range Max/min Countries

with the

most

common

DRL

Countries

with higher

DRL

Countries

with lower

DRL

Head AP/PA 5 years 2 1,5 1,0 IT. LU, RO - -

LAT 5 years 1 1 1,0 IT. LU, RO - -

Thorax AP Newborn 0,08 0,08 1,0 IT, LU, RO - -

AP 5 years 0,1 0,08-0,1 1,3 IT, RO - DK

PA 5 years 0,1 0,08-0,1 1,3

FR, IT, LU,

RO - DK

LAT 5 years 0,2 0,095-0,2 2,1

FR, IT, LU,

RO - DK

Abdomen 5 years 1 1 1,0 IT, LU, RO - -

Pelvis AP Infants 0,2 0,2 1,0 IT, LU, RO - -

AP 5 years 0,9 0,375-0,9 2,4 IT, LU, RO - DK

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Paediatric plain radiography

examinations

DAP, mGy cm2

Anatomical region Projection Age Most

common

value

Range Max/min Countries

with the

most

common

DRL

Countries

with higher

DRL

Countries

with lower

DRL

Head AP/PA 1 year 200 200-250 1,3 DE AT -

AP/PA 5 years 300 300-350 1,2 DE AT -

LAT 1 year 200 200 1,0 AT, DE - -

5 years 250 250 1,0 AT, DE - -

Thorax Newborn 10,0 10-15 1,5 FR NL -

5 years 50 50 1,0 FR, DE - -

LAT 5 years 40 40-60 1,5 DE FR -

LAT 10 years 60 60-80 1,3 DE FR -

Abdomen AP 1 year 90 90-200 2,2 AT DE, NL -

AP 5 years 250 200-300 1,5 DE, NL FR AT

AP 10 years 350 350-700 2,0 DE AT, FR -

Pelvis 5 years 150 150-200 1,3 DE FR -

10 years 250 250-400 1,6 DE FR -

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Paediatric thorax plain

radiography, ESD, 5 y

0,080,1 0,1

0,080,1 0,1 0,1 0,10,095

0,2 0,2 0,2 0,2

0

0,05

0,1

0,15

0,2

0,25

AL

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT

LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

ES

D,

mG

y

AP PA LAT

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Paediatric abdomen plain

radiography, ESD

0

100

200

300

400

500

600

700

800A

L

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT LV

LC LI

LU

MK

MT

MD

ME

NL

NO

PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

DA

P,

mG

y cm

2

1 years 5 years 10 years

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Paediatric micturating

cystourethography (MCU)

DAP, mGy cm2

Anatomical region Projection Age Most

common

value

Range Max/min Countries

with the

most

common

DRL

Countries

with higher

DRL

Countries

with lower

DRL

Micturating

Cystourethrography

(MCU) 0 years 0,3 0,1-0,5 5,0 DK, FI, NL AT, UK DE

1 year 0,9 0,3-1 3,3 DK, FI UK AT, DE, NL

5 years 0,9 0,3-1 3,3 DK, FI AT, UK DE, NL

10 years 0,6 0,6-2,1 3,5 DE AT, UK -

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Paediatric micturating

cystourethography, DAP

0

0,5

1

1,5

2

2,5

AL

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

DA

P,

Gy

cm

2

0 years 1 years 5 years 10 years

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Paediatric CT

examinations

DLP, mGy cmAnatomical region Projection Age Most

common

value

Range Max/min Countries

with the

most

common

DRL

Countries

with higher

DRL

Countries

with lower

DRL

CT brain 0 years 270 270-390 1,4 UK AT, CH -

1 year 270 270-520 1,9 UK AT, FR, CH -

5 years 470 470-600 1,3 AT, FR - CH, UK

10 years 620 620-900 1,5 UK AT, FR, CH -

15 years 50? 50-900 18,0 CH AT -

CT chest 0 years 12 12-200 16,7 CH AT, UK -

1 year 28 28-200 7,1 CH AT, FR, UK -

5 years 55 55-650 11,8 CH AT, FR, UK -

10 years 105 105-370 3,5 CH AT, FR, UK -

15 years 200 200-205 1,03 AT CH -

CT abdomen 1 year 70 70-80 1,1 CH FR -

10 years 240 240-245 1,02 CH FR -

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Paediatric CT

examinations

CTDIvol , mGy

Anatomical region Projection Age Most

common

value

Range Max/min Countries

with the

most

common

DRL

Countries

with higher

DRL

Countries

with lower

DRL

CT Brain 0 years 20 20-27 1,4 NL CH -

1 year 25 25-33 1,3 NL CH -

5 years 35 35-40 1,1 NL CH -

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Paediatric brain CT, DLP

0

100

200

300

400

500

600

700

800

900

1000A

L

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

DL

P,

mG

y c

m

0 years 1 years 5 years 10 years 15 years

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Paediatric chest CT, DLP

0

100

200

300

400

500

600

700

AL

AT

BY

BE

HR

BG

CR

CY

CZ

DK

EE FI

FR

DE

GR

HU IS IR IT LV

LC LI

LU

MK

MT

MD

ME

NL

NO PL

PT

RO SP

SK SI

ES

SE

CH

TR

UA

UK

DL

P,

mG

y c

m

0 years 1 years 5 years 10 years 15 years

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Conclusion• A comprehensive review of DRLs have

been achieved

• Comparison of DRLs with population

dose levels to be made

• Basis for revised European DRLs? (to

be considered by DDM2 team)

Workshop on European Population Doses from Medical Exposure24-26 April 2012, Athens, Greece

Thank you for your attention!