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UNSCEAR 1977 Report -d United Nations Scientific Committee on the Effects of Atomic Radiation 1977 report to the General Assembly, with annexes NOTE The report of the Committee without its annexes appears as Official Records of the General Assembly, Thirty-second Session, Supplement No. 40 (A/32/40). In the text of each annex, Arabic numbers in parentheses are references listed at the end. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. UNITED NATIONS PUBLICATION Sales No. E.77.IX.1 Price: $U.S. 28.00 (or equivalent in other currencies) Produced by UNIDO, Vienna -- ANNEXF Medical irradiation CONTENTS Paragraphs Paragraphs INTRODUCTION •..........•....... 1-9 B. Diagnostic uses of radiopharmaceuticals 117-130 1. Trends in frequencies and I. BASIC INFORMATION ••..•....... 10-31 techniques •.••..••••.••• 117-122 A. Method of data presentation ..... 10 2. Individual dose per unit procedure 123-130 B. Individual dose per unit procedure .. 11-14 {a) Administered activity .•... 123-125 C. Collective dose per type of procedure 15-30 {b) Dose per examination .... 126-130 1. Purpose of assessment ...•.•. 15-17 2. Limitations in the use of the collective dose as a measure of III. THERAPEUTIC USES OF RADIATION 131-153 detriment from medical exposures 18 A. Treatment with e.xternal beams and 3. Weighting for relevance ...•.. 19-20 sealed sources •.....•.•••..•. 131-145 4. Assessment of collective dose .. 21-26 1. General ....•.•••....•. 131-132 5. Accuracy of assessments ..... 27-30 2. Trends in radiotherapy practice 133-135 D. Groups of potential epidemiological 3. Dose data in radiotherapy ..•.. 136-137 Information of epidemiological interest .•................. 31 4. interest .............. 138-142 II. DIAGNOSTIC USES OF RADIATION 32-126 5. Genetically significant dose ... 143-145 A. X-ray diagnostic radiology .......• 32-116 B. Therapeutic uses of radiopharma· 1. Trends in frequency and technique 32-46 ceuticals ........•••••...... 146-153 2. Individual dose per unit procedure 47-80 1. lodine-131 therapy for hyper­ (a) Accuracy of dose estimates thyroidism and heart disease 147-148 and reasons for variation .. 47-51 2. Jodine-131 therapy for cancer of (b) Doses to various organs .. 52-75 the thyroid ........••... 149-150 (c) Embryo and foetal exposures 76-77 3. Polycythemia vera patients treated (d) Comparison of procedures 78-80 with l2p ••••••••••••••• 151-153 3. Collective dose to various organs from different types of procedures 81-108 IV. WASTE DISPOSAL OF MEDICALLY USED (a) Accuracy of assessment .•. 82 RADIOPHARMACEUTICALS •..•...• 154-156 (b) Collective dose to various organs •.•.......... 83-92 {c) Annual genetically significant V. CONCLUSIONS 157-161 dose ...•..•...•... 93-108 4. Groups of epidemiological interest 109-110 Page 5. Potential means of dose reduction 111-116 References ....................•.. 349 Introduction are of particular interest since they contribute the highest man-made per caput doses in the population, are I. The Committee has previously presented data on given with high instantaneous dose rates and cause the the medical irradiation of patients in its reports of 1958 highest individual organ doses short of accidental (242), 1962 (243) and 1972 (244). Medical exposures exposures. From the radiation protection point of view, 301 they also offer the largest scope for implementing further studies, so that it is now relatively clear to what methods of dose reduction without loss of the extent medical exposures contribute to the total genetic information required. They differ from many other dose in both developing and developed countries. In the types of exposure in that they usually involve irradiation developing countries the level of the GSD will usually of limited regions of the body. They also differ in that reflect the availability of x-ray facilities. In order to the individuals who are irradiated are those who may meet the medical need, such services may need to be expect to benefit directly from the particular treatment expanded. This is likely to increase the genetic dose in or examination. these countries in spite of any recommendations for good practice that are aimed at decreasing GSD. 2. A particularly difficult problem, however, arises when risk of medical irradiation is compared with the 6. The emphasis on the GSD may have detracted risk from other sources of man-made exposure or from attention from exposure of organs other than the gonads natural background radiation. The organ doses received and may therefore have led to an under-estimation of in diagnostic radiology may range over four orders of the overall risk from certain types of examination that magnitude (from a few millirads to a few tens of rads) usually cause very low gonad doses. One-example is the and will usually be given at high dose rates, compared chest examination, which involves irradiation of such with other man-made and natural sources. The various radiosensitive tissues as lung, breast, marrow and effects of radiation depend in a complex manner on the sometimes also thyroid. The 1972 report, accordingly, dose, the part of the body exposed, the dose rate and gave more information on the dose in the active marrow. the length of time during which the total dose was A number of groups of patients were also reported who received (described in Annexes H, I and J). Therefore, had been identified as receiving high doses, and some the detailed estimation of the risk from medical had been shown to have a higher incidence of certain exposure is very complex; however, it is possible, by diseases than comparable but non-irradiated groups. In making simple assumptions about the relationship this report, further attention is given to identifying between dose and effect (as has been described in examinations in which particular organs may receive Annex A), to use the product of the number of persons high doses. An attempt is also made to give a fuller in a subgroup and the dose received by a particular organ picture of the patient's dose distribution, including data as a measure of the relative radiation detriment. The on doses in radiosensitive tissues such as bone marrow. Committee has used this concept of collective dose for thyroid, lung and breast. the estimation of the relative risk in diagnostic radiology. 7. In presenting data on dose levels in medical 3. However. since in radiotherapeutic practice, as procedures, the Committee has three different purposes compared with diagnostic practice, considerably higher in mind. Firstly, it is of interest to know, for individuals, doses are given to smaller groups of patients, and since the doses to. particular organs from the various types of the dose-effect relationship is likely to be different, the medical irradiation and, particularly, the extent of the Committee has followed the practice of quoting, for variation of such doses for any one type of investigation, radiotherapy the average organ dose together with the as a basis for any attempt to weigh the radiation risks number of patients in the treated group. In this way it is against the expectation of benefit to the individual hoped that there will be a clear indication that there patient and for differential cost-benefit analyses of may well be differences between the relative risk protective measures (100). Secondly, it may be of estimates from a given collective dose from diagnostic interest to know both the individual and the collective organ doses from various medical practices as part of the radiology and those from an equivalent numerical presentation of man's total radiation exposure. Thirdly, product for a radiotherapeutic practice. For this reason, the identification of some highly exposed groups may be it is important that the risks from the two practices of interest in epidemiological studies; for this purpose, should not be compounded or summed. the collective dose would be of interest. 4. A vast amount of information on medical exposures was summarized in the 1958, 1962 and 1972 8. As has been stated in paragraph 1, medical reports. Nevertheless, since the variation in practice and exposure is unique in the sense that the benefit is usually performance is large, not only from one country to limited to the individuals who are irradiated. Assess­ another, but also between different hospitals and ments of individual doses in relation to the expected different radiologists, it is difficult to give a comprehen· benefit are therefore usually sufficient for justification sive presentation of the situation. Some of these and optimization purposes. Only in special cases, e.g., variations arise from the differing needs of the individual public health examinations (267). or medico-legal patients. e.g., in the extent or duration of a particular examinations, is there an expected benefit to society in examination; other variations occur because of the type addition to that measured by the benefit to the of equipment available and the standard of the individual. In such cases there may also be a need to performance. The Committee has found no reason to assess the collective dose from a given practice as a compile data merely for recording purposes. but has whole. tried to present information which might be useful for risk assessment, trend consideration and radiation­ 9. The information sought for any individual is the protection evaluation. dose to those particular organs which are considered to be at risk (see Annex G). Only then would it be possible 5. In the previous reports special emphasis was put to make a complete assessment of the radiation risk on assessments of the annual genetically significant dose from that irradiation. Such complete information has (GSD). The presentation of such data has encouraged only rarely been presented, principally for a few 302 therapeutic procedures, e.g.
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