Medical diagnostic imaging: radiation safety issues. Review

«Radiation and Risk», 2018, vol. 27, No. 4, pp.49-64

DOI: 10.21870/0131-3878-2018-27-4-49-64


Kashcheev V.V. – Head of Lab., C. Sc., Biol.
Pryakhin E.A. – Researcher. Contacts: 4 Korolyov str., Obninsk, Kaluga region, Russia, 249036. Tel.: (484) 399-32-81; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .

A. Tsyb MRRC, Obninsk


Development of radiological technologies and their use not only for military but for civilian purposes, especially in medicine, necessitates scientifically substantiated assessment of safety of radiological medical procedures for patients. IAEA International safety standards published in 2011 considers three types of radiation exposure situations: planned, emergency and existing, and three categories of radiation exposures: occupational, public and medical. Medical radiological exposure refers to the planned exposure situation, however, it is considered separately. The paper presents the review of published studies of possible health risks from medical radiological procedures, as well as available methods for assessment of health risk from radiological imaging. Fluorography, Xray radiography, computed tomography (CT). PET, PETCT are common radiological procedures. CT and radionuclide imaging are the main contributors to the collective dose from radiological procedures; though the annual percent of CT and radionuclide diagnostics is 3.3%, their contribution to the annual radiation dose from all radiological imaging procedures is 47.8%. To date, no unified approach to the assessment of health risks from medical imaging is available. The known methods have their specific limits and assumptions, unsuitable for the assessment of individual health risks, or the methods difficult for practical use. At the same time, in accordance with the international safety standards a patient should be informed of possible adverse effects of radiological procedures and health risks from exposure to radiation. The development of the easytouse method for evaluating individual health risk associated with medical imaging is a matter of great importance for radiation protection of a patient. It has to be addressed in the nearest future.

Key words
Medical radiation, nuclear medicine, radionuclide diagnosis, computed tomography (CT), positron emission tomography (PET), lifetime attributable risk (LAR), excess relative risk (ERR), multiple and single exposure, cancer incidence, radiation risk, effective dose.


1. Ponomareva T.V., Kalnitsky S.A., Vishnyakova N.M. Medical exposure and strategy for its prevention. Radiatsionnaya gigiyena – Radiation Hygiene, 2008, vol. 1, no. 1, pp. 63-68. (In Russian).

2. Kalistratova V.S. The role of dose rate in the appearance of stochastic effects and reduction of life expectancy under the action of incorporated radionuclides and sources of external radiation. Meditsinskaya radiologiya i radiatsionnaya bezopasnost’ – Medical Radiology and Radiation Safety, 2004, vol. 49, no. 3, pp. 5-27. (In Russian).

3. Tsyb A.F., Ivanov V.K., Biryukov A.P. Possibilities of radiation epidemiology in solving problems of radiation safety of medical exposure. Radiatsiya i risk – Radiation and Risk, 2008, vol. 17, no. 2, pp. 50-62. (In Russian).

4. The radiation doses to the Russian population in 2016: information collection. St. Petersburg, Ramzaev’s NIIRG Publ., 2017. 125 p. (In Russian).

5. Radiation Safety Standards (RSS-99/2009). Sanitary-epidemiological rules and standards. Moscow, Federal Center of Hygiene and Epidemiology of Rospotrebnadzor, 2009. 100 p. (In Russian).

6. Basic Sanitary Rules for Radiation Safety (OSPORB-99/2010). Health regulations, SP Moscow, Center for Sanitary and Epidemiological Rationing, Hygienic Certification of Russian Ministry of Health, 2010. (In Russian).

7. Dubinkin D.O. The development of nuclear medicine in the Russian Federation. Meditsina: tselevyye proyekty – Medicine: Targeted Projects, 2013, no. 16, pp. 71-74. (In Russian).

8. Information about the medical organization for 2013. In Russia: Statistical form N 30: approved 01.14.13. Moscow, Rosstat, №13. 22 p. (In Russian).

9. Bratylova A.A., Golikov V.Yu., Kalnitsky S.A. Patient irradiation levels during X-ray computed tomography in medical organizations in St. Petersburg and Leningrad oblast. Radiatsionnaya gigiyena – Radiation Hygiene, 2014, vol. 7, no. 3, pp. 33-38. (In Russian).

10. Balonov M., Golikov V., Zvonova I., Chipiga L., Kalnitsky S., Sarycheva S., Vodovato A. Patient doses from medical examinations in Russia: 2009-2015. J. Radiol. Prot., 2017, vol. 38, no.1, pp. 121-139. DOI: 10.1088/1361-6498/aa9b99.

11. Methodical recommendations. Completing the forms of the federal state statistical observation N 3-DOZ. Moscow, Rospotrebnadzor, 2007. 23 p. (In Russian).

12. Radiation doses to the population of the Russian Federation according to the results of the functioning of ESKID in 2002-2015: information collection. St. Petersburg, Ramzaev’s NIIRG Publ., 2015. 40 p.

13. Barkovsky A.N., Akhmatdinov R.R., Baryshkov N.K., Bratilova A.A., Kormanovskaya T.A., Kuvshinnikov S.I., Repin L.V., Stamat I.P., Tutelyan O.E. Results of the functioning of the Unified State System of Control and Accounting for Individual Doses of Exposure of Citizens of the Russian Federation according to the 2015 data. Radiatsionnaya gigiyena – Radiation Hygiene, 2016, vol. 9, no. 4, pp. 47-73. (In Russian).

14. Zimatkina T.I., Malevich R.O., Volf S.B. Medical exposure of children and ways to optimize it. Novosti mediko-biologicheskikh nauk – News of Medical and Biological Sciences, 2017, vol. 15, no. 1, pp. 14-19. (In Russian).

15. Radiation diagnosis and radiation therapy on the threshold of the third millennium. Ed.: M.M. Vlasova. St. Petersburg, Norma, 2003. 468 p. (In Russian).

16. Belavina E.A. Organizational and methodological support of radiation diagnosis and prevention of breast cancer in women in St. Petersburg: Author's abstract dis. med. sciences. St. Petersburg, 2006. 20 p. (In Russian).

17. Vishniakova N.M. Exposure frequency and levels due to the examination methods using ionizing sources for the patients and population of Russia. Radiatsionnaya gigiyena – Radiation Hygiene, 2010, vol. 3, no. 3, pp. 17-22. (In Russian).

18. Polsky O.G. Medical exposure: a necessary risk. Bezopasnost’ okruzhayushchey sredy – Environmental Safety, 2007, no. 1, pp. 24-27. (In Russian).

19. Brenner D.J. We can do better than effective dose for estimating or comparing low-dose radiation risks. Ann. ICRP, 2012, vol. 41, no. 3-4, pp. 124-128. DOI: 10.1016/j.icrp.2012.07.001.

20. Igisheva A.L., Litvinenko V.V. The effect of effective radiation dose during radiological examinations on the human body. Non-destructive control: a collection of works of the Vth All-Russian scientific-practical conference of students, graduate students and young scientists "Non-destructive control: electronic instrumentation, technology, security". In 2 vol., Tomsk, May 26-30, 2014. Tomsk, TPU, 2014, vol. 2, pp. 132-134. (In Russian).

21. International Commission on Radiological Protection. 2007 recommendations of the ICRP. Publication 103.Ann. ICR, 2007, vol. 37, no. 24.

22. Radiological protection in medicine. ICRP Publication 105. Ann. ICRP, 2007, vol. 37, no. 8. Elsevier, 2007. 63 p.

23. Balonov M.I., Shrimpton P.C. Effective dose and risks from medical x-ray procedures. ICRP Publication, 2012, vol. 41, no. 3-4, pp. 129-141. DOI: 10.1016/j.icrp.2012.06.002.

24. McCollough C.H., Christner J.A., Kofler J.M. How effective is effective dose as a predictor of radiation risk? Am. J. Roentgenol., 2010, vol. 194, pp. 890-896. DOI: 10.2214/AJR.09.4179.

25. Ivanov V.K., Kashcheev V.V., Chekin S.Yu., Menyajlo A.N., Pryakhin E.A., Tsyb A.F., Mettler F.A. Limiting the use of an effective dose in assessing the risk of medical exposure. ANRI, 2012, no. 3(70), pp. 35-44. (In Russian).

26. Ivanov V.K., Kashcheev V.V., Chekin S.Yu., Menyajlo A.N., Pryakhin E.A., Tsyb A.F., Mettler F.A. Radiation risk assessment of medical exposure in terms of effective and organ doses. Radiatsiya i risk – Radiation and Risk, 2012, vol. 21, no. 4, pp. 7-23. (In Russian).

27. Ivanov V.K., Kashcheev V.V., Chekin S.Yu., Menyaylo A.N., Pryakhin E.A., Tsyb A.F., Mettler F.A. Estimation of risk from medical radiation exposure based on effective and organ dose: how much difference is there? Radiat. Prot. Dosim., 2013, vol. 155, no. 3, pp. 317-328. DOI: 10.1093/rpd/nct008.

28. Martin C.J. Effective dose: how should it be applied to medical exposures? Br. J. Radiol., 2007, vol. 80, no. 956, pp. 639-647.

29. Shrimpton P.C., Wall B.F., Yoshizumi T.T., Hurwitz L.M., Goodman P.C. Effective dose and dose-length product in CT. Radiology, 2009, vol. 250, no. 2, pp. 604-605.

30. Kashcheev V.V., Pryakhin E.A., Menyaylo A.N., Chekin S.Yu., Ivanov V.K. Calculation of equivalent doses to organs and tissues, as well as lifetime attributable risk from typical computed tomography imaging. Radiatsiya i risk – Radiation and Risk, 2013, vol. 22, no. 3, pp. 8-20. (In Russian).

31. Fujii K., Aoyama T., Koyama S., Kawaura C. Comparative evaluation of organ and effective doses for paediatric patients with those for adults in chest and abdominal CT examinations. Br. J. Radiol., 2007, vol. 80, no. 956, pp. 657-667.

32. Kritsaneepaiboon S., Jutiyon A., Krisanachinda A. Cumulative radiation exposure and estimated lifetime cancer risk in multiple-injury adult patients undergoing repeated or multiple CTs. Eur. J. Trauma Emerg. Surg., 2018, vol. 44, no. 1, pp. 19-27. DOI: 10.1007/s00068-016-0665-6.

33. Furtado C.D., Aguirre D.A., Sirlin C.B., Dang D., Stamato S.K., Lee P., Sani F., Brown M.A., Levin D.L., Casola G. Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology, 2005, vol. 237, no. 2, pp. 385-394.

34. Nuclear Regulatory Commission. Health effects of exposure to low levels of ionizing radiation: BEIR V. Washington, DC, National Academy Press, 1990.

35. International Commission on Radiological Protection. 1990 Recommendations of the ICRP. Publication 60. Oxford, England, Pergamon, 1991.

36. Brenner D.J., Elliston C.D. Estimated radiation risks potentially associated with full-body CT screening. Radiology, 2004, vol. 232, no. 3, pp. 735-738.

37. Pierce D.A., Preston D.L. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat. Res., 2000, vol. 154, no. 2, pp. 178-186.

38. Ivanov V.K., Menyaylo A.N., Kashcheev V.V., Chekin S.Yu., Gorsky A.I., Maksyutov M.A., Tumanov K.A. Comparative analysis of modern models of radiation risk assessment of the ICRP and UNSCEAR. ANRI, 2011, no. 3(66), pp. 18-29. (In Russian).

39. Ivanov V.K., Kashcheev V.V., Chekin S.Yu., Menyaylo A.N., Pryakhin E.A., Tsyb A.F., Mettler F.A. Estimating the lifetime risk of cancer associated with multiple CT scans. J. Radiol. Prot., 2014, vol. 34, no. 4, pp. 825-841. DOI: 10.1088/0952-4746/34/4/825.

40. Slovis B.H., Shah K.H., Yeh D.D., Seethala R., Kaafarani H.M., Eikermann M., Raja A.S., Lee J. Significant but reasonable radiation exposure from computed tomography-related medical imaging in the ICU. Emerg. Radiol., 2016, vol. 23, no. 2, pp. 141-146. DOI: 10.1007/s10140-015-1373-y.

41. Sodickson A., Baeyens P.F., Andriole K.P., Prevedello L.M., Nawfel R.D., Hanson R., Khorasani R. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology, 2009, vol. 251, no. 1, pp. 175-184. DOI: 10.1148/radiol.2511081296.

42. Lahham A., ALMasri H., Kameel S. Estimation of female radiation doses and breast cancer risk from chest ct examinations. Radiat. Prot. Dosimetry, 2018, vol. 179, no. 4, pp. 303-309. DOI: 10.1093/rpd/ncx283.

43. Dijkstra H., Groen J.M., Bongaerts F.A., van der Jagt E.J., de Bock T.G., Greuter M.J. The cumulative risk of multiple CT exposures using two different methods. Health Phys., 2014, vol. 106, no. 4, pp. 475-483. DOI: 10.1097/HP.0000000000000083.

44. Parisi M.T., Bermo M.S., Alessio A.M., Sharp S.E., Gelfand M.J., Shulkin B.L. Optimization of pediatric PET/CT. Semin. Nucl. Med., 2017, vol. 47, no. 3, pp. 258-274. DOI: 10.1053/j.semnuclmed.2017.01.002.

45. Rudas M.S., Nasnikova I.Yu., Matyakin G.G. Positron-emission tomography in clinical practice. Teaching manual. Moscow, 2007. 53 p. (In Russian).

46. Quinn B., Dauer Z., Pandit-Taskar N., Schoder H., Dauer L.T. Radiation dosimetry of 18F-FDG PET/CT: incorporating exam-specific parameters in dose estimates. BMC Med. Imaging, 2016, vol. 16, no. 1, pp. 41. DOI: 10.1186/s12880-016-0143-y.

47. Pryakhin E.A., Kashcheev V.V., Menyajlo A.N., Ivanov V.K. Radiation risk assessment in a single PET/CT scan. Radiatsiya i risk – Radiation and Risk, 2017, vol. 26, no. 2, pp. 41-48. (In Russian).

48. Andersson M., Eckerman K., Mattsson S. Lifetime attributable risk as an alternative to effective dose to describe the risk of cancer for patients in diagnostic and therapeutic nuclear medicine. Phys. Med. Biol., 2017, vol. 62, no. 24, pp. 9177-9188. DOI: 10.1088/1361-6560/aa959c.

49. Jadvar H., Connolly L.P., Fahey F.H., Shulkin B.L. PET and PET/CT in pediatric oncology. Semin. Nucl. Med., 2007, vol. 37, no. 5, pp. 316-131.

50. Nievelstein R.A., Quarles van Ufford H.M., Kwee T.C., Bierings M.B., Ludwig I., Beek F.J., de Klerk J.M., Mali W.P., de Bruin P.W., Geleijns J. Radiation exposure and mortality risk from CT and PET imaging of patients with malignant lymphoma. Eur. Radiol., 2012, vol. 22, no. 9, pp. 1946-1954. DOI: 10.1007/s00330-012-2447-9.

51. Fahey F.H., Treves S.T., Adelstein S.J. Minimizing and communicating radiation risk in pediatric nuclear medicine. J. Nucl. Med., 2011, vol. 52, no. 8, pp. 1240-1251. DOI: 10.2967/jnumed.109.069609.

52. Chawla S.C., Federman N., Zhang D., Nagata K., Nuthakki S., McNitt-Gray M., Boechat M.I. Estimated cumulative radiation dose from PET/CT in children with malignancies: a 5-year retrospective review. Pediatr. Radiol., 2010, vol. 40, no. 5, pp. 681-686. DOI: 10.1007/s00247-009-1434-z.

53. Methodical recommendations. Radiation risk assessment in patients during radiological examinations (MR Moscow, Rospotrebnadzor, 2015. (In Russian).

54. Fahey F.H., Goodkind A.B., Plyku D., Khamwan K., O'Reilly S.E., Cao X., Frey E.C., Li Y., Bolch W.E., Sgouros G., Treves S.T. Dose estimation in pediatric nuclear medicine. Semin. Nucl. Med., 2017, vol. 47, no. 2, pp. 118-125. DOI: 10.1053/j.semnuclmed.2016.10.006.

55. Rehani M.M. Looking into future: challenges in radiation protection in medicine. Radiat. Prot. Dosimetry, 2015, vol. 165, no. 1-4, pp. 3-6. DOI: 10.1093/rpd/ncv071.

Full-text article (in Russian)