APPENDIX

Effective Doses, Organ Doses,

and Fetal Doses from Medical
Imaging Procedures
Estimates of effective dose and organ doses for a specific diagnostic procedure extend
over a range of values, and are dependent on many parameters such as image quality
(signal to noise and contrast to noise ratios), patient size, x-ray acquisition techniques,
and the application of dose reduction technologies. Methods to reduce radiation dose
include utilization of higher quantum detection efficiency digital radiographic detec-
tors and application of image processing algorithms to reduce noise. In CT, they
include implementation of automatic tube current modulation as a function of tube
angle and patient attenuation, and deployment of statistical iterative reconstruction
techniques. As technology advances and improves, a trend towards lower radiation
dose should occur, which for many procedures will result in lower effective doses
than the values listed in these tables. The numbers of days of typical background
radiation equal to the average effective dose of the examination are provided to help
to place the magnitude of the exposure into perspective.
Table E-1 lists typical adult effective doses for various diagnostic radiology proce-
dures. Table E-2 provides specific information for interventional examinations, Table
E-3 lists dose information for common CT procedures, and Table E-4 presents infor-
mation on dose from dental imaging procedures.
Table E-5 provides information on organ doses based on typical techniques for
radiography and CT procedures. Table E-6 lists organ doses determined from direct
measurements of a 6-year-old pediatric anthropomorphic phantom for “routine”
abdominal and chest CT examination techniques at seven different sites in Japan,
along with effective dose. Table E-7 lists effective dose estimates of various pediatric
examinations including the common chest radiograph as well as CT of the head and
abdomen as a function of age, from neonate to 15 years old. Table E-8 lists the con-
ceptus dose for various CT, radiography and fluoroscopy imaging procedures.

Table E-1 ADULT EFFECTIVE DOSES FOR VARIOUS DIAGNOSTIC ­RADIOLOGY

PROCEDURES (2008)
AVERAGE EFFECTIVE VALUES REPORTED DAYS OF EQUIVALENT
EXAMINATION DOSE (mSv) IN LITERATURE (mSv) BACKGROUND RADIATION
Skull 0.1 0.03–0.22 12
Cervical spine 0.2 0.07–0.3 24
Thoracic spine 1 0.6–1.4 118
Lumbar spine 1.5 0.5–1.8 177
Posteroanterior and 0.1 0.05–0.24 12
lateral study of chest
(Continued)
955
Table E-1 ADULT EFFECTIVE DOSES FOR VARIOUS DIAGNOSTIC ­RADIOLOGY
PROCEDURES (2008) (Continued)
AVERAGE EFFECTIVE VALUES REPORTED DAYS OF EQUIVALENT
EXAMINATION DOSE (mSv) IN LITERATURE (mSv) BACKGROUND RADIATION
Posteroanterior study 0.02 0.007–0.050 2
of chest
Two view digital 0.4 0.10–0.60 47
mammography
Abdomen 0.7 0.04–1.1 82
Pelvis 0.6 0.2–1.2 73
Hip 0.7 0.18–2.71 82
Shoulder 0.01 — 1
Knee 0.005 — 1
Other extremities 0.001 0.0002–0.1 <1
Dual x-ray absorpti- 0.001 0.001–0.035 <1
ometry (without CT)
Dual x-ray absorpti- 0.04 0.003–0.06 5
ometry (with CT)
Intravenous 3 0.7–3.7 350
­urography
Upper gastrointesti- 6 1.5–12 710
nal series
Small-bowel series 5 3.0–7.8 590
Barium enema 8 2.0–18.0 940

Source: Mettler FA, et al.: Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology
2008;248:254–263.

TABLE E-2 ADULT EFFECTIVE DOSES FOR VARIOUS INTERVENTIONAL

RADIOLOGY PROCEDURES (2008)
AVERAGE EFFECTIVE VALUES REPORTED DAYS OF EQUIVALENT
EXAMINATION DOSE (mSv)a IN LITERATURE (mSv) BACKGROUND RADIATION
Head and/or neck 5 0.8–19.6 590
angiography
Coronary angiography 7 2.0–15.8 820
(diagnostic)
Coronary percutaneous 15 6.9–57 1,770
transluminal angioplasty,
stent placement, or
radiofrequency ablation
Thoracic angiography of 5 4.1–9.0 590
pulmonary artery or aorta
Endoscopic retrograde 4 2.0–8.0 470
cholangiopancreatography
Abdominal angiography or 12 4.0–48.0 1,410
aortography
Transjugular intrahepatic 70 20–180 8,240
portosystemic shunt
placement
Pelvic vein embolization 60 44–78 7,060
a
Source: Mettler FA, et al.: Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology
2008;248:254–263.
 Appendix E • Organ Dose and Fetal Dose for Medical Imaging Procedures 957

TABLE E-3 ADULT EFFECTIVE DOSES FOR VARIOUS CT PROCEDURES (2008)

AVERAGE EFFECTIVE RANGE REPORTED IN DAYS OF EQUIVALENT
EXAMINATION DOSE (mSv) LITERATURE (mSv) BACKGROUND RADIATION
Head 2 0.9–4.0 240
Neck 3 — 350
Chest 7 4.0–18.0 820
Chest for pulmonary 15 13–40 1,770
embolism
Abdomen 8 3.5–25 940
Pelvis 6 3.3–10 710
Three-phase liver study 15 — 1,880
Spine 6 1.5–10 710
Coronary angiography 16 5.0–32 1,880
Calcium scoring 3 1.0–12 350
Virtual colonoscopy 10 4.0–13.2 1,180
Extremities <0.025 — <3

Source: Mettler FA, et al.: Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology
2008;248:254–263.

TABLE E-4 ADULT EFFECTIVE DOSE FOR VARIOUS DENTAL RADIOLOGY

PROCEDURES (2008)
AVERAGE EFFECTIVE VALUES REPORTED DAYS OF EQUIVALENT
EXAMINATION DOSE (mSv) IN LITERATURE (mSv) BACKGROUND RADIATION
Intraoral radiography 0.005 0.0002–0.010 1
Panoramic radiography 0.01 0.007–0.090 1
Dental CT 0.2 — 20

Source: Mettler FA, et al.: Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology
2008;248:254–263.

TABLE E-5 TYPICAL ORGAN-SPECIFIC RADIATION DOSES RESULTING FROM

VARIOUS RADIOLOGY PROCEDURES
EXAMINATION ORGAN ORGAN SPECIFIC RADIATION DOSE (mGy)
PA chest radiography Lung 0.01
Mammography Breast 3.5
CT chest Breast 21.4
CT coronary angiography Breast 51.0
Abdominal radiography Stomach 0.25
CT abdomen Stomach 10.0
Colon 4.0
Barium enema Colon 15.0

Source: Davies HE, Wathen CG, Gleeson FV. BMJ 2011;342:d947.

958 Section V • Appendices

TABLE E-6 ORGAN DOSE AVERAGES FOR A 6-YEAR-

OLD PEDIATRIC ANTHROPOMORPHIC
PHANTOM USING ROUTINE TECHNIQUES
AT SEVEN CT SCANNER SITES
ORGAN DOSE (mGy) 6 

TISSUE OR ORGAN PEDIATRIC ABDOMEN PEDIATRIC CHEST

Thyroid gland 0.3 6 0.2 10.5 6 6.6
Lung 4.2 6 2.1 9.1 6 4.2
Breast 2.3 6 1.8 8.4 6 4.7
Esophagus 4.2 6 2.0 9.0 6 4.4
Liver 8.8 6 3.5 8.0 6 3.7
Stomach 9.5 6 3.9 4.7 6 2.8
Kidneys 9.0 6 3.5 4.3 62.2
Colon 9.4 6 3.5 0.6 6 0.3
Ovary 9.0 6 3.1 0.1 6 0.1
Bladder 9.1 6 3.3 0.1 6 0.0
Testis 7.8 6 3.7 0.1 6 0.0
Bone surface 8.1 6 2.8 8.5 6 3.8

Source: Fujii K, Aoyama T, Koyama S, et al. Comparative evaluation of organ

and effective doses for paediatric patients with those for adults in chest and
abdominal CT examinations. Br J Radiol 2007;80:657–667.
, standard deivation

Table E-7 EFFECTIVE DOSE ESTIMATES FROM ­PEDIATRIC DIAGNOSTIC

­EXAMS AS A FUNCTION OF AGE
DAYS OF EQUIVALENT
EXAMINATION EFFECTIVE DOSE (mSv) BACKGROUND RADIATION
Chest (PA and Lat) 0.06 7
CT Heada
  neonate 4.2 490
  1y 3.6 420
  5y 2.4 280
  10 y 2.0 240
  15 y 1.4 160

CT Abdomena
  neonate 13.1 1,540
  1y 11.1 1,310
  5y 8.4 990
  10 y 8.9 1,050
  15 y 5.9 690
a
Data from Thomas KE, Wang B. Age specific effective doses for pediatric MSCT examinations at a
large ­children’s hospital using DLP conversion coefficients: a simple estimation method. Pediatr Radiol
2008;38(6):645–656.
 Appendix E • Organ Dose and Fetal Dose for Medical Imaging Procedures 959

TABLE E-8 ESTIMATED CONCEPTUS DOSES FROM COMMON

­RADIOGRAPHIC, FLUOROSCOPIC, AND CT EXAMINATIONS
ESTIMATED CONCEPTUS DOSES FROM SINGLE CT ACQUISITION

EXAMINATION DOSE LEVEL TYPICAL CONCEPTUS DOSE (mGy)

Extra-abdominal
  Head CT Standard 0
  Chest CT
   Routine Standard 0.2
   Pulmonary embolus Standard 0.2
CT angiography of coronary arteries Standard 0.1

Abdominal
  Abdomen, routine Standard 4
  Abdomen/pelvis, routine Standard 25
CT angiography of aorta (chest Standard 34
through pelvis)
Abdomen/pelvis, stone protocola Reduced 10
a
Anatomic coverage is the same as for routine abdominopelvic CT, but the tube current is decreased and the
pitch is increased because standard image quality is not necessary for detection of high-contrast stones.

ESTIMATED CONCEPTUS DOSES FROM RADIOGRAPHIC AND FLUOROSCOPIC

EXAMINATIONS

TYPICAL CONCEPTUS
EXAMINATION DOSE (mGy)
Cervical spine (AP, lat) <0.001
Extremities <0.001
Chest (PA, lat) 0.002
Thoracic spine (AP, lat) 0.003
Abdomen (AP)
  21-cm patient thickness 1
  33-cm patient thickness 3
Lumbar spine (AP, lat) 1
Limited IVPa 6
Small-bowel study b
7
Double-contrast barium enema studyc 7

AP, anteroposterior projection, lat, lateral projection, PA, posteroanterior projection.

a
Limited IVP is assumed to include four abdominopelvic images. A patient thickness of 21 cm is assumed.
b
A small-bowel study is assumed to include a 6-min fluoroscopic examination with the acquisition of 20 digital
spot images.
c
A double-contrast barium enema study is assumed to include a 4-min fluoroscopic examination with the
acquisition of 12 digital spot images.
Source: McCollough CH, Schueler BA, Atwell TD, et al. Radiation exposure and pregnancy: when should we be
concerned? Radiographics 2007;27:909–917.