TRACKING RADIATION
EXPOSURE FROM
MEDICAL DIAGNOSTIC
PROCEDURES

 

WORKSHOP REPORT

 

Committee on Tracking Radiation Doses from
Medical Diagnostic Procedures

Nuclear and Radiation Studies Board

Division on Earth and Life Studies

NATIONAL RESEARCH COUNCIL
                       Of THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
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TRACKING RADIATION EXPOSURE FROM MEDICAL DIAGNOSTIC PROCEDURES WORKSHOP REPORT Committee on Tracking Radiation Doses from Medical Diagnostic Procedures Nuclear and Radiation Studies Board Division on Earth and Life Studies

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This study was supported by the following government agencies: Contract No. 200-2005-13434, TO 26 Centers for Disease Control and Prevention Contract No. HHSF2232008100201, TO 19/HHSF22301017T Food and Drug Administration Contract No. IOMHP060002-01-00 Department of Health and Human Services Any opinions, findings, conclusions, or recommendations expressed in this publica- tion are those of the author(s) and do not necessarily reflect the views of the agencies that provided support for the project. International Standard Book Number-13: 978-0-309-25766-4 International Standard Book Number-10: 0-309-25766-2 Cover: Image titled “Drop in the Bucket,” courtesy of Dr. Aaron Sodickson (Brigham and Women’s Hospital). Drops signify the exposure of patients who undergo medi- cal imaging exams that utilize ionizing radiation; exposure may vary by amount and frequency. The workshop explores how tracking radiation exposure from medical diagnostic procedures can improve health care. Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu/. Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engi- neers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON TRACKING RADIATION DOSES FROM MEDICAL DIAGNOSTIC PROCEDURES BARBARA J. MCNEIL (Chair), Harvard Medical School, Boston, Massachusetts HEDVIG HRICAK (Vice Chair), Memorial Sloan-Kettering Cancer Center, New York AMY BERRINGTON DE GONZÁLEZ, National Cancer Institute, Bethesda, MD WALTER HUDA, Medical University of South Carolina, Charleston FRED A. METTLER, JR., New Mexico VA Healthcare System, Albuquerque RICHARD L. MORIN, Mayo Clinic, Florida, Jacksonville Staff OURANIA KOSTI, Study Director, Nuclear and Radiation Studies Board TONI GREENLEAF, Administrative and Financial Associate SHAUNTEÉ WHETSTONE, Senior Program Assistant JAMES YATES, JR., Office Assistant v

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NUCLEAR AND RADIATION STUDIES BOARD JAY DAVIS (Chair), Hertz Foundation, Livermore, California BARBARA J. MCNEIL (Vice Chair), Harvard Medical School, Boston, Massachusetts JOONHONG AHN, University of California, Berkeley JOHN S. APPLEGATE, Indiana University, Bloomington MICHAEL L. CORRADINI, University of Wisconsin, Madison PATRICIA J. CULLIGAN, Columbia University, New York ROBERT C. DYNES, University of California, San Diego JOE GRAY, Oregon Health and Science University, Portland DAVID G. HOEL, Medical University of South Carolina, Charleston HEDVIG HRICAK, Memorial Sloan-Kettering Cancer Center, New York THOMAS H. ISAACS, Stanford University, Palo Alto, California ANNIE B. KERSTING, Glenn T. Seaborg Institute, Lawrence Livermore National Laboratory, Livermore, California MARTHA S. LINET, National Institutes of Health, Bethesda, Maryland FRED A. METTLER, JR., New Mexico VA Health Care System, Albuquerque BORIS F. MYASOEDOV, Russian Academy of Sciences, Moscow RICHARD J. VETTER, Mayo Clinic, Rochester, Minnesota RAYMOND G. WYMER, Oak Ridge National Laboratory, Oak Ridge, Tennessee (retired) Staff KEVIN D. CROWLEY, Senior Board Director JENNIFER A. HEIMBERG, Senior Program Officer OURANIA KOSTI, Program Officer TONI GREENLEAF, Administrative and Financial Associate LAURA D. LLANOS, Administrative and Financial Associate SHAUNTEÉ WHETSTONE, Senior Program Assistant ERIN WINGO, Senior Program Assistant JAMES YATES, JR., Office Assistant vi

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Reviewers T his report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that will assist the National Research Council in making its published report as sound as possible and will ensure that this report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manu- script remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their participation in the review of this report: • David Brenner, Columbia University • James Brink, Yale University • Cynthia McCollough, Mayo Clinic • Orhan Suleiman, U.S. Food and Drug Administration Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the contents of this report, nor did they see the final draft of the report before its release. The review of this report was overseen by Theodore Phillips, Professor Emeri- tus, University of California, San Francisco. Appointed by the National Research Council, Dr. Phillips was responsible for making certain that an vii

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viii REVIEWERS independent examination of this report was carried out in accordance with institutional procedures and that all review comments were considered care- fully. Responsibility for the final content of this report rests entirely with the authorizing committee and the institution.

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Contents OVERVIEW 1 1 INTRODUCTION 3 2 BACKGROUND 5 2.1 Trends in Diagnostic Imaging, 5 2.2 Potential Health Risks from Diagnostic Imaging, 7 2.3 Appropriateness of Diagnostic Imaging, 10 2.4 Reduction in Radiation Doses, 11 2.5 Recent Progress in Radiation Safety in Medicine, 13 3 WORKSHOP SUMMARY 17 3.1 Opening Comments, 17 3.2 Population Utilization of Imaging, 20 3.3 National and International Efforts in Dose Tracking, 27 3.4 From Dose Indices to Dose Estimates, 30 3.5 From Dose to Risk Estimates, 33 3.6 Why Track Doses?, 38 3.7 Lessons Learned from Pediatrics, 49 3.8 Some Possible Next Steps Suggested at the Workshop, 51 APPENDIXES A Project Statement of Task 59 B Workshop Agenda 61 C Committee and Staff Biographical Sketches 65 D Workshop Speakers Biographical Sketches 71 ix

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