The myth of mean dose as a surrogate for radiation risk?
The current estimations of risk associated with medical imaging procedures rely on assessing the organ dose via direct measurements or simulation. Each organ dose is assumed to be homogeneous, a representative sample or mean of which is weighted by a corresponding tissue weighting factor provided by ICRP publication 103. The weighted values are summed to provide Effective Dose (ED), the most-widely accepted surrogate for population radiation risk. For individual risk estimation, one may employ Effective Risk (ER), which further incorporates gender- and age-specific risk factors. However, both the tissue-weighting factors (as used by ED) and the risk factors (as used by ER) were derived (mostly from the atomic bomb survivor data) under the assumption of a homogeneous dose distribution within each organ. That assumption is significantly violated in most medical imaging procedures. In chest CT, for example, superficial organs (eg, breasts) demonstrate a heterogeneous distribution while organs on the peripheries of the irradiation field (eg, liver) possess a nearly discontinuous dose profile. Projection radiography and mammography involve an even wider range of organ dose heterogeneity spanning up to two orders of magnitude. As such, mean dose or point measured dose values do not reflect the maximum energy deposited per unit volume of the organ, and therefore, effective dose or effective risk, as commonly computed, can misrepresent irradiation risk. In this paper, we report the magnitude of the dose heterogeneity in both CT and projection x-ray imaging, provide an assessment of its impact on irradiation risk, and explore an alternative model-based approach for risk estimation for imaging techniques involving heterogeneous organ dose distributions. © 2010 SPIE.
