Recent advances in medical X-ray imaging have enabled the development of new techniques capable of assessing not only bone quantity but also structure. This article provides (a) a brief review of the current X-ray methods used for quantitative assessment of the skeleton, (b) data on the levels of radiation exposure associated with these methods and (c) information about radiation safety issues. Radiation doses associated with dual-energy X-ray absorptiometry are very low. However, as with any X-ray imaging technique, each particular examination must always be clinically justified. When an examination is justified, the emphasis must be on dose optimisation of imaging protocols. Dose optimisation is more important for paediatric examinations because children are more vulnerable to radiation than adults. Methods based on multi-detector CT (MDCT) are associated with higher radiation doses. New 3D volumetric hip and spine quantitative computed tomography (QCT) techniques and high-resolution MDCT for evaluation of bone structure deliver doses to patients from 1 to 3 mSv. Low-dose protocols are needed to reduce radiation exposure from these methods and minimise associated health risks.

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This article expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about radiation protection for endoscopic procedures, in particular endoscopic retrograde cholangiopancreatography (ERCP). Particular cases, including pregnant women and pediatric patients, are also discussed. This Guideline was developed by a group of endoscopists and medical physicists to ensure that all aspects of radiation protection are adequately dealt with. A two-page executive summary of evidence statements and recommendations is provided. The target readership for this Guideline mostly includes endoscopists, anesthesiologists, and endoscopy assistants who may be exposed to X-rays during endoscopic procedures.

Background-Radiofrequency (RF) cardiac catheter ablation procedures may require extended fluoroscopic exposure resulting in elevated radiation risk. The aim of the present study was to accurately establish RF ablation radiation risk levels and to provide means for accurate patient risk estimation from studies performed in any electrophysiology laboratory. Methods and Results-Fluoroscopy required during cardiac ablation was classified into 4 types identified by beam orientation and irradiated tissue: (1) posteroanterior exposure during catheter advancing from the groin to the heart, (2) posteroanterior heart exposure, (3) left anterior oblique heart exposure, and (4) right anterior oblique heart exposure. The duration of each exposure was monitored in 24 patients undergoing RF cardiac ablation. Dose per minute of fluoroscopy was measured at 15 organs/tissues for each projection with the use of anthropomorphic phantom and thermoluminescence dosimetry. The effective dose rate was 219, 144, 136, and 112 Gy/min for groin-to-heart posteroanterior, posteroanterior, left anterior oblique, and right anterior oblique exposure, respectively. A typical ablation procedure results in a total effective dose of 8.3 mSv per hour of fluoroscopy. The average excess of fatal cancers was estimated to be 650 and 480 per million patients undergoing RF ablation requiring 1 hour of fluoroscopy for US and UK populations, respectively. The average risk for genetic defects was determined to be 1 per million births. Conclusions-Radiation risk from RF cardiac ablation is moderate compared with other complications, but it may highly exceed radiation risk from common radiological procedures. Efforts should be made toward minimization of patient radiation risk from RF ablation procedures. (Circulation. 2001;104:58-62.)

z overscanning in multidetector (MD) helical CT scanning is prerequisite for the interpolation of acquired data required during image reconstruction and refers to the exposure of tissues beyond the boundaries of the volume to be imaged. The aim of the present study was to evaluate the effect of z overscanning on the patient effective dose from helical MD CT examinations. The Monte Carlo N-particle radiation transport code was employed in the current study to simulate CT exposure. The validity of the Monte Carlo simulation was verified by (a) a comparison of calculated and measured standard computed tomography dose index (CTDI) dosimetric data, and (b) a comparison of calculated and measured dose profiles along the z axis. CTDI was measured using a pencil ionization chamber and head and body CT phantoms. Dose profiles along the z axis were obtained using thermoluminescence dosimeters. A commercially available mathematical anthropomorphic phantom was used for the estimation of effective doses from four standard CT examinations, i.e., head and neck, chest, abdomen and pelvis, and trunk studies. Data for both axial and helical modes of operation were obtained. In the helical mode, z overscanning was taken into account. The calculated effective dose from a CT exposure was normalized to CTDI(free in air). The percentage differences in the normalized effective dose between contiguous axial and helical scans with pitch = 1, may reach 13.1%, 35.8%, 29.0%, and 21.5%, for head and neck, chest, abdomen and pelvis, and trunk studies, respectively. Given that the same kilovoltage and tube load per rotation were used in both axial and helical scans, the above differences may be attributed to z overscanning. For helical scans with pitch = 1, broader beam collimation is associated with increased z overscanning and consequently higher normalized effective dose value, when other scanning parameters are held constant. For a given beam collimation, the selection of a higher value of reconstructed image slice width increases the normalized effective dose. In conclusion, z overscanning may significantly affect the patient effective dose from CT examinations performed on MD CT scanners. Therefore, an estimation of the patient effective dose from MD helical CT examinations should always take into consideration the effect of z overscanning.