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Uses of Effective Dose

The Good, the Bad, and the Future

Bushberg, Jerrold T.1

doi: 10.1097/HP.0000000000001014

Effective dose (E) is a risk-adjusted dosimetric quantity developed by the International Commission on Radiological Protection. It is a key metric for practical management of the risk of stochastic health effects in a comprehensive radiation protection program. The International Commission on Radiological Protection and others have emphasized repeatedly that E is not intended to represent an actual radiation dose and should not be used as a risk-related metric for a specific person or population. The cancer risk uncertainties in the low-dose range and the underlying approximations, simplifications, and sex- and age-averaging used in generating E make it unsuitable for this purpose. However, in practice, medical imaging professionals and authors of peer-reviewed medical publications frequently and incorrectly use E as a surrogate for whole-body dose in order to calculate cancer risk estimates for specific patients or patient populations. This frequent misuse has popularized E for uses for which it was neither designed nor intended. Alternatives to E have been proposed that attempt to account for known age and sex differences in radiation sensitivity. E has also been proposed as a general indicator for communicating radiation risk to patients, if its limitations are kept in mind. Forthcoming guidance from the International Commission on Radiological Protection will likely clarify if, when, and how some form of E may be used as a rough indicator of the risk of a stochastic effect, possibly with some modifications for the substantial variations in risk known to exist with respect to age, sex, and population group.

1Associate Chairman, Department of Radiology, Clinical Professor of Radiology and Radiation Oncology, School of Medicine, University of California, Davis, 2315 Stockton Blvd., FSSB 2500, Sacramento, CA 95817; and Chair of Board of Directors and Senior Vice President, National Council on Radiation Protection and Measurements, 7910 Woodmont Avenue, Bethesda, MD 20814.

The author declares no conflicts of interest.

For correspondence contact the author at the above address, or email at

(Manuscript accepted 1 October 2018)

© 2019 by the Health Physics Society