No abstract

An important part of the justification process is assessment of the radiation risks caused by exposure of a patient during examination. The authors developed official national methodology both for medical doctors and sanitary inspectors called 'assessment of radiation risks of patients undergoing diagnostic examinations with the use of ionizing radiation'. The document addresses patients of various age groups and a wide spectrum of modern X-ray and nuclear medicine examinations. International scale of risk categorisation was implemented by the use of effective dose with account for age dependence of radiation risk. The survey of effective doses in radiology, including CT, mammography, and intervention radiology, and nuclear medicine, including singlephoton emission tomography and positron emission tomography, for patients of various age groups from several regions of Russia was used for the risk assessment. The output of the methodology is a series of tables for each diagnostic technology with lists of examinations for three age groups (children/adolescents, adults and seniors) corresponding to various radiation risk categories.

The aim of this study was to evaluate adult patient doses in Russia in the context of patient protection. Effective doses from x-ray and nuclear medicine examinations were assessed using two approaches. The first was based on data collection performed by the authors in hospitals in St. Petersburg and other 17 Russian regions. The second approach was to assess mean doses through the collective dose estimated annually within the federal data bank ESKID. In 2015, 203 million examinations were conducted in Russia, i.e. 1.4 examinations per capita. The number of examinations has increased by 35% over the last 10 years. Patient doses from x-ray examinations are strongly dependent on the imaging modality. Mean dose increases by an order of magnitude with each x-ray modality from dental examinations (0.01-0.1 mSv) to radiography (0.1-1 mSv), fluoroscopy and CT (1-10 mSv) and to interventional examinations (more than 10 mSv). Mean doses for x-ray examinations are comparable with that of foreign countries. Scintigraphy examinations with 99m Tc are associated with mean doses of 1-5 mSv. Mean doses from PET/CT whole body examinations are 15-25 mSv with similar contributions from CT and radiopharmaceuticals. In nuclear medicine, patient doses are lower compared to other countries. According to ESKID data the collective dose from medical exposure in Russia has decreased from 140 000 man-Sv in 2000 to 77 000 man-Sv in 2015. Medical exposure contributes about 13% into a total collective dose. The maximum contribution was from CT examinations, i.e. 45% in 2015. A range of mean doses between different hospitals was up to two orders of magnitude for radiography and one order of magnitude for CT. In interventional studies, the scatter of individual doses was significant. Significant variations in doses between hospitals and some regions indicate the potential for optimization with the focus on interventional examinations, CT and nuclear medicine examinations combined with CT.

Санкт-Петербургский научно-исследовательский институт радиационной гигиены имени профессора П.В. Рамзаева, Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человека,

During last 50 years, firstly in the RSFSR in the USSR (1970-80), then in the Russian Federation - RF (1990-2019), the authors studied the radiation safety issues of patients from medical exposure. The reader is offered a complex radiation-hygienic analysis of the 50-year medical exposure of patients and of the population in Russia to inform and analyze the available data on the most common type of use of ionizing radiation sources in the national economy. For a half century, several generations of people have changed and medical diagnostic X-ray equipment and technologies have also radically changed. The information from this article was obtained on the basis of radiation-hygienic statistics, as well as considered our research. The data is presented at the federal level in the form of the volume of research carried out- determined by the number of X-ray procedures, as well as the level of medical exposure in the form of effective dose of patients in Russia - a huge region with a population of about 150 million people, where about 200 million X-Ray procedures were performed annually, i.e. about 10 billion X-Ray procedures for the entire observation period. During the study, a collective effective dose was - 6.5 million person-Sv at the rate of 100 thousand person-Sv and more per year. The paper presents the dynamics and the structure of the studied indicators depending on the type of medical exposure, as well as its localization. The contribution of the X-ray diagnostics to the total volume of radiation diagnostics, which is developing dynamically, is presented. It was found that throughout the study, there were two oppositely directed processes: an increase in the number of X-Ray procedures and a decrease in the effective doses of patients. At present, the minimum dose has been reached, after that it has been increasing began, associated with the use of new computer technologies. It was determined that, depending on the localization, the main radiation load during X-ray procedures falls on the skeleton and digestive organs. It is shown that during the study period (in 1986) there was an accident at the Chernobyl, which significantly affected on medical activities and, in particular, X-ray diagnostic indicators. The paper shows the consequences of these situations. In general, the data presented is huge in volume and significant in information content. The information obtained on the basis of such a unique data is representative and allows, firstly, to analytically study the issues of radiation protection of patients and, secondly, to plan the strategy and tactics of its development.