Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action

  • Marco BrambillaEmail author
  • Jenia Vassileva
  • Agnieszka Kuchcinska
  • Madan M. Rehani
Computed Tomography



To have a global picture of the recurrent use of CT imaging to a level where cumulative effective dose (CED) to individual patients may be exceeding 100 mSv at which organ doses typically are in a range at which radiation effects are of concern


The IAEA convened a meeting in 2019 with participants from 26 countries, representatives of various organizations, and experts in radiology, medical physics, radiation biology, and epidemiology. Participants were asked to collect data prior to the meeting on cumulative radiation doses to assess the magnitude of patients above a defined level of CED.


It was observed that the number of patients with CED ≥ 100 mSv is much larger than previously known or anticipated. Studies were presented in the meeting with data from about 3.2 million patients who underwent imaging procedures over periods of between 1 and 5 years in different hospitals. It is probable that an additional 0.9 million patients reach the CED ≥ 100 mSv every year globally.


There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients. The actions include development of appropriateness criteria/referral guidelines by professional societies for patients who require recurrent imaging studies, development of CT machines with lower radiation dose than today by manufacturers, and development of policies by risk management organizations to enhance patient radiation safety. Alert values for cumulative radiation exposures of patients should be set up and introduced in dose monitoring systems.

Key Points

• Recurrent radiological imaging procedures leading to high radiation dose to patients are more common than ever before.

• Tracking of radiation exposure of individual patients provides useful information on cumulative radiation dose.

• There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients.


Radiation protection Patient safety Radiologic Technology Risk Radiation dosage 



Cumulative effective dose



The authors wish to acknowledge the contribution of the following colleagues for responding to the survey and for providing data: Avramova-Cholakova Simona, Bigand Emeline, Bosmans Hilde, Faj Dario, Fitton Isabelle, Georgiev Emil, Griciene Birute, Habib Geryes Bouchra, Kotiaho Antti, Kulich Miloslav, Krynke Leonid, La Grange Cindy, Le Roy Julien, Melchor Joyce, Milyan Yuriy, Plagnol Vincent, Rampado Osvaldo, Rosales Espizua Francisco Javier, Sana Paolo, Sanchez Roberto, Salat Dusan, and Tölli Jukka.

Funding information

Participation in the IAEA meeting was funded by the IAEA, the Governments of the participating Member States, or by the represented international organization. No funding support was provided by the IAEA or other agencies for conducting the survey and this work.

Compliance with ethical standards


The scientific guarantor of this publication is Madan M Rehani.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because no change of intervention in patient management was part of the work that involved data analysis retrospectively.

Ethical approval

Institutional Review Board approval was not required because only summary data (total numbers) were needed for the analysis. The centers providing data were responsible to follow their local rules.


• retrospective

• observational

• multicenter study


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Medical Physics DepartmentUniversity Hospital “Maggiore della Carità”NovaraItaly
  2. 2.Radiation Protection of Patients Unit, Radiation Safety and Monitoring Section, NSRW, International Atomic Energy AgencyVienna International CentreViennaAustria
  3. 3.Medical Physics DepartmentMaria Skłodowska Curie Memorial Cancer Centre and Institute of OncologyWarsawPoland
  4. 4.Massachusetts General HospitalBostonUSA

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