Use of effective dose in medicine

This paper does not necessarily reflect the views of the International Commission on Radiological Protection. The protection quantity 'effective dose' was developed by the International Commission on Radiological Protection (ICRP) for use in the radiological protection of workers and the public. In this context, it is used as a risk-adjusted dosimetric quantity to optimise protection, comparing received or planned doses with constraints, reference levels, and limits expressed in the same quantity. Considering exposures incurred during medical procedures, effective dose can be of practical value for comparing: doses from different diagnostic examinations and interventional procedures; the use of similar technologies and procedures in different hospitals and countries; and the use of different technologies for the same medical examination, provided that the representative patients or patient populations for which the effective doses are derived are similar with regard to age and sex. However, as stated in ICRP Publication 103, '… risk assessment for medical diagnosis and treatment… is best evaluated using appropriate risk values for the individual tissues at risk and for the age and sex distribution of the individuals undergoing the medical procedures'. This topic was explored in a session of the First ICRP Symposium with arguments for and against the use of a new quantity referred to as 'effective risk', and examination of variations in estimated risk for different diagnostic procedures according to the age and sex of the exposed individuals. This paper restates the primary purposes of effective dose, and summarises estimates of variation in individual risk from medical procedures. The authors support the judicious use of effective dose as an indicator of possible risk, but caution against the use of effective risk as compared with the calculation of scientific best estimates of risk with consideration of associated uncertainties.