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Answer to Question #3009 Submitted to "Ask the Experts"Category: Medical and Dental Patient Issues — Diagnostic X Ray and CT The following question was answered by an expert in the appropriate field: Q
My 30-year-old daughter recently had a PICC placed by a radiologist, using fluoroscopy. There were no problems. Can you speculate as to dose of radiation she might have received? She was alarmed when she read (Shiralkar et al. 2003) that an arteriogram of the leg exposes a patient to 400 times the amount of radiation as a chest x ray. It would be reassuring to learn that PICC placement is nowhere near that amount.
A
It is difficult to speculate the radiation dose without knowing the line placement location and how long the fluoroscopy was being used. A PICC (Peripherally Inserted Central venous Catheter) line can be placed most anywhere, but the more common locations are the arm and upper chest. I'm going to make the assumption that your daughter's was placed in her arm or upper chest and I am going to use average fluoroscopy data from my organization to give you a dose estimate. As for the fluoroscopy, placement of these lines generally uses only about 15-30 seconds of x-ray exposure. This would result in an entrance skin exposure of about 0.5-1 roentgen, where the roentgen is a unit of radiation exposure, and an absorbed dose in the radiation-exposed tissue of about 0.45-0.9 rad, where the rad is a unit of radiation dose. These numbers are based on average x-ray output by the machines where I work but they should give you a general idea. As for comparison to a chest x ray, it is a little difficult without knowing where the PICC was placed. If it was placed in the arm, the effective dose (which is the equivalent whole body radiation dose in mrem of biological consequence) is essentially nothing, that is, it is equivalent to having no chest x rays. If the PICC was placed somewhere in the chest, the effective dose for 30 seconds of fluoroscopy should be less than 0.02 rem (Rosenstein 1992). That is similar to the effective dose received from a two-film chest x ray. Neither of these estimated doses is of any biological concern. Kelly Classic References
Editor’s Note: The relationships between the roentgen, rad, and rem are discussed in the "Ask the Experts" section of the Health Physics Society Web site, Q257 .
Answer posted on 20 October 2003. The information and material posted on this Web site is intended as general reference information only. Specific facts and circumstances may alter the concepts and applications of materials and information described herein. The information provided is not a substitute for professional advice and should not be relied upon in the absence of such professional advice specific to whatever facts and circumstances are presented in any given situation. Answers are correct at the time they are posted on the Web site. Be advised that over time, some requirements could change, new data could be made available, or Internet links could change. For answers that have been posted for several months or longer, please check the current status of the posted information prior to using the responses for specific applications.
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