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European Commission
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1998
Directorate-General
Environment, Nuclear Safety
and Civil Protection
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A comprehensive culture of radiation protection and safety in medicine has been progressively
developing throughout the European Union with regard to the medical use of ionising
radiation and has been integrated into the various branches of diagnosis and treatment.
The European Commission has contributed to this evolution with the establishment of legal
requirements for the radiation protection of persons undergoing medical examinations or
treatment.
Since 1984, the use of ionising radiation in medical practice has continued to develop, the
number of installations to increase and the application to diversify. This together with the
scientific and technical progress, urged the European Commission to revise Directive
84/466/EURATOM. The revised Medical Exposure Directive (MED97) 97/43/EURATOM
was approved by the Council on 30 June 1997.
It is the aim of the Commission to give some guidance to member states on the instructions
and treatment needed for pregnant and breast-feeding women who can be considered as a
particular subgroup of patients
For this reason the Commission consulted the group of health experts established by the
Article 31 of the Euratom Treaty. This group of experts created a working party with a
mandate to develop such a guidance in order to facilitate the application of the MED.
The present guidance was approved by the group of Article 31 experts during its session of 8
& 9 June 1998, taking into account comments made at the international workshop on the
implementation of the MED in Madrid on 27 April 1998.
Therefore this guidance has by definition a limited scope and certainly does not claim to be an
exhaustive scientific report dealing with every aspect of the protection of the offspring.
4
The document is structured as follows:
A chapter entitled ‘Biological effects of ionising radiation in unborn children and infants’
gives general information on the risk of exposure to ionising radiation and how to put it into
perspective. The second chapter called ‘Options for the medical practitioner concerning
female patients’ provides guidance on how to avoid or to minimise detriment to the unborn
child and to the breast-fed child. Three annexes and a schematic overview summarising
different steps to be followed in the case of exposure of a female of childbearing age complete
the guide. The first annex summarises a number of typical questions from mothers or mothers-
to-be and gives examples of informative posters, the second gives dosimetric quantities and
the third presents a number of typical absorbed doses to the unborn child. Finally, reference
documents are listed.
This document will be made available in all official languages of the European Union.
Suzanne FRIGREN
Director Nuclear Safety and Civil
Protection
5
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(1) As the radiological protection of an unborn child (from conception to birth) is required
by the MED, and as their protection is of particular concern, the present
recommendations are made to:
(2) Article 1 of the MED states that the directive applies to the following medical
exposures:
The directive shall also apply to exposure of individuals knowingly and willingly
helping (other than as part of their occupation) in the support and comfort of patients
undergoing medical examination or treatment.
(3) Article 3 of the MED states that all individual medical exposures shall be justified
taking into account the specific objectives of the exposure, the availability of previous
diagnostic information, when appropriate, and the efficacy and availability of alternative
techniques. Special attention shall be given for those exposures where there is no direct
health benefit for the person undergoing the exposure.
(4) Concerning optimisation, Article 4 (1) of the MED specifies that all medical exposures
for radiodiagnostic purposes shall be kept as low as reasonably achievable consistent
with obtaining the required diagnostic information, and taking into account economic
and social factors. For radiotherapeutic purposes, exposures of target tissue shall be
individually planned; exposures of non-target tissues shall be as low as reasonably
achievable, without underexposing the target tissue.
(5) If pregnancy cannot be excluded, article 10 (1) of the MED states that depending on the
type of medical exposures, special attention shall be given to the justification,
particularly the urgency, and to the optimisation of the medical exposure taking into
account the exposure both of the expectant mother and the unborn child.
6
(6) Article 10 (2) requires that in nuclear medicine for breast-feeding women, depending on
the type of medical examination or treatment, special attention shall be given to the
justification, particularly the urgency, and to the optimisation of the medical exposure,
taking into account the exposure both for the mother and the child.
(7) If the prescriber and the practionner justify the examination or treatment, taking into
account pregnancy or breast feeding, it is the ultimate responsibility of the mother to
decide if the treatment or examination should be performed after being informed on
possible consequences for the unborn child or the breast-fed child.
7
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(8) There are two categories of biological effects of ionising radiation: deterministic effects
and stochastic effects. Deterministic effects are these caused by the decrease in or loss
of organ function due to cell damage or cell killing. For these effects threshold doses
exist: the function of many organs and tissues is not affected by small reductions in the
number of available healthy cells. Only if the decrease is large enough will there be
clinically observable pathological effects.
(9) Stochastic effects are those that result from radiation changes in cells that retain their
ability to divide. These modified cells may sometimes initiate a malignant
transformation of a cell, leading to the development of a malignant clone and eventually
to a clinically overt cancer. The period between the initiation and the manifestation of
the disease may extend from a few years (e.g. leukaemia, thyroid cancer) to several
decades (e.g. colon and liver cancer). In addition genetic effects may be initiated due to
the irradiation of germ cells.
(10) For stochastic effects no threshold dose is assumed and the probability of their
occurrence is believed to be proportional to the dose (linear dose-effect relationship in
the low dose, low dose-rate range). Therefore the probability of their induction should
be reduced by keeping the dose as low as possible.
(11) The probability of a fatal radiation induced cancer has been estimated (ICR91) at
approximately 5 per cent per sievert effective dose1 for the low dose, low dose rate and
1% for serious genetic diseases, for the whole population with its normal age
distribution. Also curable cancers can be induced depending on the organ. For elderly
people (older than about 60 years of age) the probability seems to be about 5 - 10 times
lower, because their future life span may not be long enough to express the cancer and
they would be unlikely to pass genetic damage to offspring. For children up to the age of
10 years, the probability of fatal cancer induction is maybe 2-3 times higher. For
pregnant women the risk is the same as for the average population, however the unborn
child is assumed to have the same risk as young children to develop a fatal cancer, about
15 per cent per sievert (ICR91).
(12) When the medical profession communicates risks from exposure to ionising radiation to
patients these risks should be explained and put in context so that they can be easily
understood. For example, use of phrases such as " one out of 10,000 might get a
radiation induced cancer " is preferable to the use of risk estimates in the form 10-4. To
help the patient to evaluate the figure given she should be informed about comparable
risks for adults at the same time (see Fig. 1). Another possibility is to use the baseline
values for serious genetic effects and for fatal childhood cancer. Congenital anomalies
visible at birth are observed with as many as 6 per cent of all new-born children
(UNS86), and the number of fatal childhood cancer is in the order of 1 out of 1000 in
the time period from birth to the age of ten.
1 Some examples of doses and eventual effects are: if 100.000 persons are exposed to 1 mSv it is assumed that 5
persons will have a fatal cancer. Equally if the exposure to those 100.000 is 5 mSv, it is assumed that 25
individuals will get a fatal cancer
8
)LJXUH. Loss of life expectancy: Comparison of risks (based on Coh91)
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(13) A stochastic risk for radiation induced cancer is believed to be present during the entire
pregnancy, with a probability of maybe 2-3 times higher than that for the whole
population.
(14) The development of the unborn child may be divided approximately into three major
phases:
• the phase of major organogenesis, which extends to approximately the 8th week
post-ovulatory
• the phase of fetal development, lasting from about 9 weeks until birth, which
includes the phase of major formation of the central nervous system from the 8th
to 15th (25th) week (UNS93)
The type of effect on the unborn child depends on the period of the pregnancy when the
irradiation is applied. Tissues with developing cells are relatively more radiosensitive.
(15) In the early period of pregnancy when the number of cells is small the radiation effect
may be in the form of a failure to implant or of the death of the unborn child. It is,
however, difficult to study in man events taking place in the unborn child before
implantation. Based on animal data it is anticipated that at relatively high doses this
failure to implant is more likely to take place than any radiation effect in the live-born,
although the stochastic risks for radiation induced effects cannot be entirely dismissed.
Taking into consideration the frequency of embryonic death and the low probability that
the radiation will affect the live-born, this early period of pregnancy is generally
regarded as a period with relatively low radiation risks.
9
(16) In the period from the 3rd to the 8th week there is a potential for malformation of
organs. The risk of malformation will depend on the period of organogenesis at the time
of irradiation and is probably especially high during the most active phase of cell
multiplication and differentiation of the structures being developed. As dose thresholds
may apply to these effects, they appear to be deterministic in nature. Thresholds have
been observed in animal experiments and on this basis the threshold in man has been
estimated to be of the order of 100 mSv. In the diagnostic field the dose to the unborn
child will only in very rare cases reach this level. Hence malformation of organs is very
unlikely to be caused by diagnostic exposure of the mother. For comparison purposes
the spontaneous incidence of such effects in live-born can be taken as a few per cent
(ICR92).
(17) Values of intelligence quotient (IQ) lower than expected have been reported in some
children exposed LQ XWHUR at Hiroshima and Nagasaki. The data are consistent with a
general downward shift in the distribution of IQ with increasing dose. It is assumed that
this shift is proportional to dose. A figure of about 30 IQ points per sievert relates to the
dose to the unborn child in the period from 8 to 15 weeks after conception. On this
basis, the change in the IQ of an individual that can be caused by a dose as large as 100
mSv will be no more than three IQ points. Small shifts in IQ cannot be identified
clinically. The effects on IQ are less marked following exposure in the period from 16 to
25 weeks after conception and have not been observed for other periods. All
observations on IQ relate to high doses and high dose rates. (ICR96).
(18) A second finding is the dose-related increase in the frequency of children classified as
“severely retarded”. The number is small, but the data indicate an excess probability of
severe mental retardation of 0,4 at 1 sievert. The effect was observed following
exposures in the 8th to 15th week after conception, is less marked following exposures in
the period from the 16th to 25th week and has not been observed for other periods.
(19) For comparison purposes the normal incidence in live-born of severe mental retardation
can be assumed to be around 1 in 200 (ICR92).
(20) Particularly in the later phase of pregnancy there is a risk of growth disturbance without
malformation for children irradiated LQ XWHUR, although this may occur at all stages of
pregnancy. However, with present knowledge this risk is assumed to be small but cannot
be quantified.
(21) The risk of induction of cancers either in childhood or in adult life following LQXWHUR
irradiation throughout pregnancy is considered to be the same as for children up to the
age of 10, i.e. it may be a factor of two to three times higher than that for the average
population (see previous section).
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(22) A new-born child may be exposed to ionising radiation if the mother has undergone a
nuclear medicine examination or treatment. This is due to the fact that the radionuclide
administered to the mother will remain in her body for a certain time depending on the
type of radionuclide and on biological factors. If the radionuclide at the same time emits
penetrating radiation, the new-born child will be exposed to the external radiation from
10
the mother when close to her, i.e. during feeding or cuddling. The dose will depend on
the time the child is held, the distance from the mother’s body etc.
(24) Patients with radioactive substances in their body may present a contamination problem
in that they excrete radioactivity, via perspiration, saliva, breath and urine, which can be
inhaled or ingested by a new-born child. Great care and attention to hygiene will in
general mean that the dose to the child will be small.
(25) The principal risk for a new-born child from ionising radiation will be induction of
cancers and is considered to be of the same order as for small children i.e. a factor of
two to three times higher than for the average population (see previous section).
11
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(26) As laid down in article 5.1 of the MED the prescriber as well as the practitioner shall be
involved as specified by Member States in the justification process at the appropriate
level. This is also applicable for the situation addressed in article 10 involving pregnant
or breast-feeding women..
(27) In this section general guidance is given, both for the prescriber and the practitioner, on
how detriment for the unborn and breast-fed child can be avoided or minimised. For
special aspects of this situation concerning justification and optimisation see e. g. MED
articles 3 and 4.
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(28) The recommendations in paragraphs §28-48 are intended to be applied for treatment or
examination that might cause a considerable dose (above 10 mSv) to the unborn child.
Therefore, they are not to be applied for low dose examinations, ie. below 1 mSv,
equivalent dose to the unborn child. This includes X-ray examinations where the uterus
is not in the primary beam.
(29) Having regard to the exceptions in paragraph 28, the presence of pregnancy should be
evaluated when an examination or treatment involving ionising radiation is considered.
The patient should be explicitly asked, orally or in writing, whether she might be
pregnant or may have missed a period. The MED says in article 10.1.a: “In the case of a
female of child bearing age, the prescriber and the practioner shall inquire as specified
by Member States whether she is pregnant, or breast feeding, if relevant;”. These
inquiries may be made on behalf of the prescriber or the practitioner by other members
of the staff. The outcome of the questioning should be recorded. In addition, a notice
requesting the patient to inform the staff about pregnancy should be displayed
prominently (example see annex I).
(30) If the woman answers that she has regular periods, did not miss a period and neither the
woman or the prescriber or the practitioner have otherwise a reason to assume
pregnancy, the examination or treatment can be performed as planned.
It must be stressed that the use of contraceptives like the contraceptive pill or coil does
not necessarily guarantee non-pregnancy.
(31) If there is any uncertainty concerning pregnancy, expressed either by the patient, the
prescriber or the practioner because of a missed period, the period is known to be
12
irregular or for other reasons, pregnancy should be considered. The planned exposure
should be posponed until after the next period or a pregnancy test may be performed.
If there remains any doubt about pregnancy, in particular when the period is late, the
woman should be treated as pregnant, according to paragraph 32. However, in the case
that pregnancy is not likely (for example no sexual intercourse) or it concerns low dose
to the uterus, these precautions are not necessary.
(32) In the case the prescriber or the practioner suspects a patient not to tell the truth about a
possible pregnancy, for whatever reason, he or she should explain to the patient why
there is a need to know and, at the same time, point out to her that she too has a
responsibility in this procedure. If doubt remains, the practitioner should proceed with
common sense.
(33) There is no need to apply the so called ten-day-rule routinely (exposure only during the
first ten days after the beginning of the last period). However, if a diagnostic
examination or treatment is planned which involves a high dose to the uterus, the ten-
day-rule should be applied or a pregnancy test performed
(34) If pregnancy is confirmed, or if the woman is to be treated as pregnant, one of the three
following alternative procedures is recommended. It must be stressed, however, that
these provisions are examples on what measures may be appropriate, there might be
others.
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(35) In the decision-making process the possible radiation risks at high dose as described in
the previous chapters, such as failure to implant or early death of the unborn child,
should be given due attention. The increased risk of radiation induced malformation and
of reduction in IQ must be taken into account, especially for pregnancies between week
eight and fifteen.
13
considerations. Recording of all technical parameters is strongly recommended to
facilitate this estimation.
(37) More detailed recommendations about how to act when the patient is pregnant or is
treated as such are given below for the various types of medical procedures.
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(39) For such diagnostic and interventional procedures involving the lower abdomen or
pelvis action should be taken as outlined in the next paragraph, if the examination
cannot be postponed until after delivery.
(40) Reduction of the dose to the unborn child might be achieved in a number of ways. These
include the following: taking a reduced number of images, selection of projections,
limitation of fluoroscopic time to a minimum, shielding, and careful collimation of the
radiation beam. A protocol should be available for various x-ray examinations of the
abdomen to ensure that the radiation dose to the unborn child is as low as reasonably
achievable, whilst taking due attention to the outcome for the patient herself. This is
particularly important for certain interventional procedures and examinations using
computed tomography where doses to an unborn child might be considerable.
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(41) Irradiation of the unborn child results from placental transfer with distribution of
radiopharmaceuticals in the fetal tissues, and from external irradiation from the
radiopharmaceuticals present in the mother’s organs (e. g. the bladder) and tissues. The
chemical and biological properties of the radiopharmaceuticals are the critical factors in
possible placental transfer. For dose estimations to the unborn child these factors must
be taken into account. Today such data are limited - for examinations where data are
lacking general precautionary measures should be taken.
(42) Possible means for dose reduction could for example include careful selection of
radiopharmaceutical and radionuclide to minimise the dose to the unborn child.
(43) In nuclear medicine, unlike x-ray procedures, the mother may still be a source of
radiation for some time after the examination or treatment has been performed.
Therefore, in certain circumstances, advice should be given to avoid pregnancy for an
appropriate period of time after administration of the radionuclides.
(44) The basic safety standard (BSS96) states that the protection of the unborn child of
exposed workers shall be comparable with that provided for members of the public and
that it shall be most unlikely that the dose exceeds 1 mSv. This value was chosen as a
dose constraint for the unborn child and can be considered a reasonable basis for
14
constraining medical exposures. For most diagnostic procedures it will not be necessary
to advise women to avoid pregnancy for a period following the administration of
radiopharmaceuticals, because the dose to the unborn child would be below the value
mentioned. However, in some cases the dose to the unborn child could exceed 1 mSv.
Examples for such procedures are given in Table 1 together with an indication of the
period of time during which pregnancy should be avoided (from Tho98).
7DEOH Nuclear medicine examinations where pregnancy within the indicated period
of time may result in radiation doses to the unborn child from the time of
implantation in excess of 1 mSv (Tho98)
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Note 1: The calculations are based on doses to the uterus by external radiation,
and for the examinations with 59-Fe and with 131-I possible placenta
transfer has also been taken into account.
Note 2: If the administered activity differs considerably from the above
mentioned values, a medical physics expert should be consulted for
advice.
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(45) In order to minimise the risk of radiation treatment of patients with unrecognised
pregnancy, radiation therapy treatment should, if such a delay is justifiable, be scheduled
to the first ten days after the onset of menstruation.
(46) Before making a decision about radiation treatment of the mother to be, the dose to the
unborn child should be carefully estimated. This dose will normally be high, but
generally the treatment of the mother will have preference over these high doses to the
unborn child. The mother to be must be involved in the discussion and decision about
treatment.
(47) The individual dose planning should be done in such a way as to minimise the dose to
the unborn child without jeopardising the treatment of the mother to be, if the treatment
cannot be postponed until after birth . If the dose to the unborn child would result in
severe deterministic effects or lead to a high probability of stochastic detriment, the
termination of pregnancy should be considered.
(48) After treatment with radiopharmaceuticals the patient should be advised to avoid
pregnancy for a period of time as indicated below. This will ensure that the dose to the
gametes and/or to the unborn child will probably not exceed 1 mSv. In Table 2 (Tho98)
15
recommendations for some common procedures are given. As the spermatozoa could be
damaged in a male patient, he should be advised not to father children for four months
after treatment with 131-I.
7DEOH Advice for time period after treatment with radionuclides during which
pregnancy should be avoided in order to ensure that the radiation dose to the
unborn child is below 1 mSv (Tho98).
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* The calculations are based on doses to the uterus by external radiation, but for
the treatments with 131-I possible placenta transfer has also been taken into
account.
Note: It must be stressed that the relation between activity and dose to the unborn
child is not linear, therefore advice from the medical physics expert
concerning the dose to be expected should be sought for activities
considerably higher than those listed in Table 2.
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(49) After a pregnant woman has been examinated or treated with ionising radiation -either
as outlined in these recommendations or when pregnancy was not known when the
examination or treatment was performed - the dose to the unborn child should be
evaluated by a medical physics expert or by the practitioner. If the uterus was not in the
X-ray beam or the dose is estimated to be below 1 mSv, this evaluation is not necessary.
(50) The dose and the time of pregnancy when the exposure occurred should be taken into
account when discussing possible actions with the patient. The risk of everyday life
compared with the risk due to the exposure should be discussed with the mother to be
(see also § 12 up to § 21).
16
It must be emphasised that abortion is a very drastic decision that should not be taken
without very serious reasons. Below 100 mSv (BIR73), abortion on the ground of
radiation alone should not be considered. Above 100 mSv individual circumstances
should be taken into account. However, even a dose to the unborn child as high as
several hundreds of milligray may not in all circumstances lead to advice for abortion.
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(51) If the planned procedure for a woman of fertile age is a nuclear medicine examination or
therapy with radionuclides, the woman should be asked, orally or in writing, whether
she is breast-feeding a child. A notice requesting the patient to inform the staff about
breast-feeding should also be prominently displayed in the waiting area. If the answer is
yes, advice about restriction of breast-feeding dependent on the diagnostic or therapeutic
procedure should be given to the patient. For diagnostic procedures with some of the
most common radiopharmaceuticals, Table 3 can serve as guidance. This advice will
ensure that the infant will receive an effective dose below 1 mSv, which corresponds to
the dose limit for the public. In the case of therapy with unsealed radionuclides breast-
feeding will normally have to be stopped.
17
7DEOH Recommendations for interrupting breast-feeding after administration of
radiopharmaceuticals in routine use (Mou97)
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(53) The dose from external radiation originating from diagnostic nuclear medicine
examinations of the mother will generally be low. However, even the small doses that
might be received can be avoided by minimising prolonged close contact between the
patient and the nursed child during the first few hours after administration of
radiopharmaceuticals. Care in this respect should also be observed if the child is bottle-
fed. The mother should be informed about the possible radiation risks to the child.
19
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Α. It is important for you, and also for the baby that the mother is well. To ensure
this is the case your consultant has asked us to do the investigation.
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Α. The radiation dose you and your baby will receive is very small. In fact, the
variation of the dose from natural radiation within a whole country is even
greater than that. (Pregnant technicians are allowed to work in this department,
and those living in certain parts of the country receive greater doses than that
naturally.)
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Α. The naturally occurring incidence of abnormalities is 3 - 6 %. Under the most
unfavourable circumstances the dose to your unborn child would add to this
risk x % (x = dose to the fetus in mSv according to Table 3 annex III times
0,042), which is much lower/a factor of hundred lower/less than half compared
to the natural incidence.
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Α. Some of the radioactive substance which we have given you will come out in
your milk. We want to ensure that your child will receive a radiation dose from
your milk less than he/she would receive naturally during the course of a year.
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Α. The milk which you expressed before the test can be given to the baby in a
bottle. All milk expressed during the interruption period should be thrown
away down the sink.
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Α. Yes. The times we have given you are based on information which has been
gathered from all over the world.
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Α. Cuddling your baby is most important, but you should try to avoid doing so for
long periods (greater than 1 hour at a time). However by tomorrow (for
technetium diagnostic tests) you need take no special precautions. 'HSHQGLQJ
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The highest quoted risk figure is that for severe mental retardation during the most unfavourable period of pregnancy
20
21
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The basic physical quantity used in radiological protection is the DEVRUEHGGRVH, 'T, averaged
over an organ or defined tissue, T, where 'T is the energy deposited in the organ divided by
the mass of that organ. The unit of absorbed dose is called the gray (Gy).
Some radiations are more effective than others in causing stochastic effects. To allow for this,
a further quantity has been introduced. This is the HTXLYDOHQWGRVH+Twhich is the average
absorbed dose in an organ or tissue multiplied by a dimensionless radiation weighting factor,
ZR. For almost all the radiation used in medicine, the radiation weighting factor is unity, so
the absorbed dose and the equivalent dose are numerically equal. The exceptions are alpha
particles, for which the radiation weighting factor is 20, and neutrons, for which the radiation
weighting factor is between 5 and 20, depending on the energy of the neutrons. To avoid
confusion with the absorbed dose, the unit of equivalent dose is called the sievert (Sv).
Radiation exposure of the different organs and tissues in the body results in different
probabilities of harm and different seventies. The combination of probability and severity of
harm is called here
GHWULPHQW
meaning health detriment. To reflect the combined detriment
from stochastic effects in all the organs and tissues of the body, the equivalent dose in each
organ and tissue is multiplied by a WLVVXHZHLJKWLQJIDFWRU :T, and the results are summed
over the whole body to give the HIIHFWLYHGRVH( It is given by the expression
Absorbed doses in organs and effective doses cannot be measured directly. They are derived
from other, measurable quantities. These include simple quantities such as absorbed dose in a
tissue equivalent material at the surface of a body or in a phantom.
Tissue
SOURCE Absorbed Radiation Equivalent weighting Effective
inside or Emission doses, 'T, weighting doses, +T factors :T dose, E
outside the (Gy) factors :R (Sv) and (Sv)
body ⇒
summation
ORGANS ⇒ ORGANS ⇒
)LJ The relationship between absorbed dose, 'T, equivalent dose, +T, and effective dose, E.
23
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The following table shows examples of absorbed doses to the unborn child from common
diagnostic procedures taken from NRPB surveys of diagnostic radiology and nuclear medicine
procedures (NRP98). The doses can vary considerably depending on the physiology and
pathology of the patient, the technique and procedure used. Thus, the figures are only given a
rough indication of the absorbed doses.
24
7DEOH ,Q XWHUR doses following common diagnostic procedures; taken from NRPB
surveys of diagnostic radiology and nuclear medicine (NRP98)
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Abdomen (AP only) 1.4 4.2
Barium enema 6.8 24
Barium meal 1.1 5.8
Chest < 0.01 < 0.01
Intravenous urography 1.7 10
Lumbar spine 1.7 10
Pelvis 1.1 4
Skull < 0.01 < 0.01
Thoracic spine < 0.01 < 0.01
&RPSXWHGWRPRJUDSK\
Abdomen 8 49
Chest 0.06 0.96
Head < 0.005 < 0.005
Pelvis 25 79
Pelvimetry 0.2 0.4
1XFOHDUPHGLFLQH
99m 3.3 4.6
Tc bone scan (phosphate)
99m 0.2 0.4
Tc lung perfusion (MAA)
99m 0.3 1.2
Tc lung ventilation (aerosol)
99m 1.5 4.0
Tc kidney scan (DTPA)
99m 0.7 1.6
Tc thyroid scan (pertechnetate)
99m 3.4 3.7
Tc dynamic cardiac scan (RBC)
51 < 0.01 0.01
Cr glomerular filtration (EDTA)
201 3.7 4.0
Tl myocardial perfusion (thallium)
99m 4.3 6.5
Tc brain scan (pertechnetate)
75 - 14.0
Seleno-cholesterol
67 - 12.0
Ga tumours and abscesses
131 - 22.0
I thyroid metastases
25
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The assistance of a medical physics expert will be needed for the calculation of doses to the
unborn child from X-ray examinations. However, the figures below can be used for an
estimation of the dose if the tube voltage (kV). and the current-time product (mAs) are known.
&RQYHQWLRQDO;UD\V
The figures represent a rough estimation and are applicable for a focus-film-distance of
approximately 1 m and for AP/PA projections of colon, pelvis, lumbar spine etc., where the
unborn child is in the primary beam.
70 1 0.04
90 1 0.1
110 1 0.2
The absorbed dose will increase proportionally with the current-time product.
If the current-time product is not known due to the use of an automatic exposure control it can
be estimated from an exposure table, if the sensitivity of the film-screen system is known.
The figures are also valid for fluoroscopy with the elapsed time being converted from minutes
to seconds.
26
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The figures are representing a rough estimate and apply for CT-examinations with non-
overlapping consecutive scans where the unborn child is in the primary beam . The absorbed
dose is an average value for different makes and types scanners. Most examinations are
performed with a tube voltage in the indicated range.
120-130 1 0.1
The absorbed dose will increase proportionally to the current-time product at a certain tube
voltage; the mAs-values used are typically in the range 100 to 300 which will give a dose to
the unborn child of the order of one to several tens of mSv.
27
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BIR73 BIR Diagnostic Radiology in early pregnancy and grounds for recommending
abortion. Statement of Radiation Protection committee, BIR London, 1973.
BSS96 &RXQFLO GLUHFWLYH (85$720 RI 0D\ OD\LQJ GRZQ EDVLF VDIHW\
VWDQGDUGV IRU WKH SURWHFWLRQ RI WKH KHDOWK RI ZRUNHUV DQG WKH JHQHUDO SXEOLF
DJDLQVW WKH GDQJHUV DULVLQJ IURP LRQL]LQJ UDGLDWLRQ Official Journal of the
European Communities L 159, 1-28, 1996.
Coh91 Cohen B L; &DWDORJ RI ULVNVH[WHQGHGDQGXSGDWHG. Health Phys. 61: 317-335,
1991.
ICR91 International Commission on Radiological Protection.
5HFRPPHQGDWLRQV RI WKH ,QWHUQDWLRQDO &RPPLVVLRQ RQ 5DGLRORJLFDO
3URWHFWLRQ, ICRP Publication 60. Oxford: Pergamon Press, 1991
ICR92 International Commission on Radiological Protection.
5DGLRORJLFDO3URWHFWLRQLQ%LRPHGLFDO5HVHDUFK, ICRP Publication 62. Oxford:
Pergamon Press, 1992
ICR96 International Commission on Radiological Protection.
5DGLRORJLFDO 3URWHFWLRQ DQG 6DIHW\ LQ 0HGLFLQH, ICRP Publication 73. Oxford:
Pergamon Press, 1996
Iod98 European Commission; Radiation Protection following I-131 therapy (exposures
due to out-patients or discharged in-patients).
5DGLDWLRQ3URWHFWLRQ, 1998 – OPOCE Luxembourg
MED97 &RXQFLO GLUHFWLYH (85$720 RI -XQH RQ KHDOWK SURWHFWLRQ RI
LQGLYLGXDOV DJDLQVW WKH GDQJHUV RI LRQL]LQJ UDGLDWLRQ LQ UHODWLRQ WR PHGLFDO
H[SRVXUH DQG UHSHDOLQJ 'LUHFWLYH (85$720 Official Journal of the
European Communities L 180, 22-27, 1997.
Mou97 Mountford PJ; 5LVN DVVHVVPHQW RI WKH QXFOHDU PHGLFLQH SDWLHQW.
Br J Radiol 70 (1997), 671-684
NRP98 National Radiological Protection Board. ,QXWHURDGYLFHGRFXPHQW.
PAD84 &RXQFLO GLUHFWLYH (85$720 RI 6HSWHPEHU OD\LQJ GRZQ EDVLF
PHDVXUHV IRU WKH UDGLDWLRQ SURWHFWLRQ RI SHUVRQV XQGHUJRLQJ PHGLFDO
H[DPLQDWLRQRUWUHDWPHQW. Official Journal of the European Communities L 265,
1-3, 1984.
Tho98 Thomson WH; 3ULYDWHFRPPXQLFDWLRQ, 1998
UNS86 United Nations. ,RQLVLQJ UDGLDWLRQ *HQHWLF DQG 6RPDWLF (IIHFWV RI ,RQL]LQJ
5DGLDWLRQ United Nations Scientific Committee on the Effects of Atomic
Radiation, 1986. Report to the General Assembly, with annexes. United Nations
sales publication E.86.IX.9. United Nations, New York, 1986.
UNS93 United Nations. 6RXUFHV DQG (IIHFWV RI ,RQL]LQJ 5DGLDWLRQ United Nations
Scientific Committee on the Effects of Atomic Radiation, 1993. Report to the
General Assembly, with annexes. United Nations sales publication E.94.IX.2.
United Nations, New York, 1993.
29
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The Medical Exposure Directive (97/43/EURATOM) requires special attention for the
protection of offspring of pregnant and breastfeeding patients exposed to ionising radiation for
medical purposes. The prescriber of the exposure and the practitioner are obliged to ask the
woman in childbearing age if she might be pregnant or missed a period. This guide includes a
schematic overview of the procedure to be followed in such situation. It also gives
information on the risk of exposure of unborn children and infants and also provides ways to
avoid or to minimise possible detriment to them. Three practical annexes allow the
practitioner to better respond to frequent questions from pregnant and breastfeeding women
based on knowledge about dosimetric quantities and typical doses to the unborn child from
common examinations and treatments. A number of reference documents are included.
30