Patient Exposure from Radiologic and Nuclear Medicine Procedures in the United States: Procedure Volume and Effective Dose for the Period 2006-2016

Abstract

Background Comprehensive assessments of the frequency and associated doses from radiologic and nuclear medicine procedures are rarely conducted. The use of these procedures and the population-based radiation dose increased remarkably from 1980 to 2006. Purpose To determine the change in per capita radiation exposure in the United States from 2006 to 2016. Materials and Methods The U.S. National Council on Radiation Protection and Measurements conducted a retrospective assessment for 2016 and compared the results to previously published data for the year 2006. Effective dose values for procedures were obtained from the literature, and frequency data were obtained from commercial, governmental, and professional society data. Results In the United States in 2006, an estimated 377 million diagnostic and interventional radiologic examinations were performed. This value remained essentially the same for 2016 even though the U.S. population had increased by about 24 million people. The number of CT scans performed increased from 67 million to 84 million, but the number of other procedures (eg, diagnostic fluoroscopy) and nuclear medicine procedures decreased from 17 million to 13.5 million. The number of dental radiographic and dental CT examinations performed was estimated to be about 320 million in 2016. Using the tissue-weighting factors from Publication 60 of the International Commission on Radiological Protection, the U.S. annual individual (per capita) effective dose from diagnostic and interventional medical procedures was estimated to have been 2.9 mSv in 2006 and 2.3 mSv in 2016, with the collective doses being 885 000 and 755 000 person-sievert, respectively. Conclusion The trend from 1980 to 2006 of increasing dose from medical radiation has reversed. Estimated 2016 total collective effective dose and radiation dose per capita dose are lower than in 2006. © RSNA, 2020 See also the editorial by Einstein in this issue.

Conflict of interest statement

Disclosures of Conflicts of Interest: F.A.M. disclosed no relevant relationships. M.M. disclosed no relevant relationships. M.B.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received reimbursement from the American College of Radiology for travel/accommodations/meeting expenses. Other relationships: disclosed no relevant relationships. C.E.C. disclosed no relevant relationships. J.G.E. disclosed no relevant relationships. D.P.F. disclosed no relevant relationships. D.L.M. disclosed no relevant relationships. H.D.R. disclosed no relevant relationships. M.T.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author’s institution has received royalties from Wolters Kluwer; has received an honorarium from Galera Therapeutics. Other relationships: disclosed no relevant relationships. D.C.S. disclosed no relevant relationships. A.J.A. disclosed no relevant relationships. W.E.B. disclosed no relevant relationships. G.M.G. disclosed no relevant relationships. R.H.S. disclosed no relevant relationships. J.M.S. disclosed no relevant relationships. R.J.V. disclosed no relevant relationships.

Figures

Figure 1:

Bar graph shows estimated average annual individual effective dose in the United States from diagnostic and interventional patient radiation exposures (in millisieverts). Comparison between 2006 and 2016 has been computed by using weighting factors from International Commission on Radiological Protection (ICRP) Publications 60 and 103. EUS-60 = effective dose to a person in the United States using tissue-weighting factors from ICRP Publication 60 (8), EUS-103 = effective dose to a person in the United States using tissue-weighting factors from ICRP Publication 103 (9). Adapted with permission of the National Council on Radiation Protection and Measurements.

Figure 2:

Chart shows percentage of collective effective dose (717 000 person-sievert in the United States from different modalities for 2016. Collective effective doses were obtained by using tissue-weighting factors from International Commission on Radiological Protection Publication 103 (9). Adapted with permission of the National Council on Radiation Protection and Measurements.

Figure 3:

Bar graph shows total CT procedure volume trend data reported by IMV Medical Information Division in the United States from 1993 to 2016 (IMV 2017 CT Benchmark Survey). This provides general temporal trend information. The sudden drop from 2011 to 2012 is partially due to the Centers for Medicare and Medicaid Services’ bundling of certain procedures, including abdomen and pelvis. (Note: These values are slightly different from those estimated in National Council on Radiation Protection and Measurements [NCRP] Report 184 as these IMV values do not include PET/CT, SPECT/CT, or multiple scans within a single procedure or adjustments made for possible overestimation of certain types of procedures.) Adapted with permission of the NCRP.

Figure 4:

Bar graph shows IMV Medical Information Division estimates of trend data for total nuclear medicine procedures (non-PET) according to year (IMV 2015 [15]). Estimates for 2016 were a total of 13.5 million procedures, of which about 1.9 million were clinical PET procedures. Adapted with permission of the National Council on Radiation Protection and Measurements.