Full text of DOI:10.1093/oxfordjournals.rpd.a006520

Radiation Protection Dosimetry
Vol. 95, No. 1, pp. 37–42 (2001)
Nuclear Technology Publishing
RADIATION DOSE ESTIMATES IN INDIAN ADULTS IN
NORMAL AND PATHOLOGICAL CONDITIONS DUE TO
99Tcm-LABELLED RADIOPHARMACEUTICALS
K. Tyagi†, S. C. Jain† and P. C. Jain‡
†Centre for Environment and Explosive Safety
Metcalfe House, Delhi 110054, India
‡Department of Physics and Astrophysics
University of Delhi, Delhi 110007, India
Received July 5 2000, in final revised form February 13 2001, accepted February 21 2001
Abstract — ICRP Publications 53, 62 and 80 give organ dose coefficients and effective doses to ICRP Reference Man and Child
from established nuclear medicine procedures. However, an average Indian adult differs significantly from the ICRP Reference
Man as regards anatomical, physiological and metabolic characteristics, and is also considered to have different tissue weighting
factors (called here risk factors). The masses of total body and most organs are significantly lower for the Indian adult than for
his ICRP counterpart (e.g. body mass 52 and 70 kg respectively). Similarly, the risk factors are lower by 20–30% for 8 out of
the 13 organs and 30–60% higher for 3 organs. In the present study, available anatomical data of Indians and their risk factors
have been utilised to estimate the radiation doses from administration of commonly used 99Tcm-labelled radiopharmaceuticals
under normal and certain pathological conditions. The following pathological conditions have been considered for
phosphates/phosphonates — high bone uptake and severely impaired kidney function; IDA — parenchymal liver disease, occlusion
of cystic duct, and occlusion of bile duct; DTPA — abnormal renal function; large colloids — early to intermediate diffuse paren-
chymal liver disease, intermediate to advanced parenchymal liver disease; small colloids — early to intermediate parenchymal
liver disease, intermediate to advanced parenchymal liver disease; and MAG3 — abnormal renal function, acute unilateral renal
blockage. The estimated ‘effective doses’ to Indian adults are 14–21% greater than the ICRP value from administration of the
same activity of radiopharmaceutical under normal physiological conditions based on anatomical considerations alone, because
of the smaller organ masses for the Indian; for some pathological conditions the effective doses are 11–22% more. When tissue
risk factors are considered in addition to anatomical considerations, the estimated effective doses are still found to be generally
somewhat higher for the Indian, for both normal and pathological states (but lower than the values based on anatomical consider-
ations alone). However, when the radiopharmaceutical is administered in quantities proportional to the body mass, the effective
doses are 11–28% lower for the Indian under both normal and pathological conditions. It may be concluded that Indians are at
a lower risk of radiation health detriment in comparison with the ICRP adult on administration of the various 99Tcm-labelled
radiopharmaceuticals considered in this study.
INTRODUCTION
Radionuclide imaging is routinely carried out in
Table 1. Comparative anatomical data on masses of Indian
nuclear medicine centres to assist the physician in diag-
and ICRP Reference Man (male).
nosis of the clinical status of the patient. Most of the
centres prefer 99Tcm-labelled radiopharmaceuticals due
Indian adult
ICRP
Reference Man
to the easy availability of 99Tcm, its short half-life, the
absence of particulate emission, and a photon emission
with a principal gamma energy of 141 keV, which
makes it an ideal choice for imaging with a gamma
camera. ICRP 53(1) has given organ dose coefficients
and effective doses from administration of a large num-
ber of radiopharmaceutials for the ICRP Reference
Body mass (kg)
Height (cm)
Adrenals (g)
Brain (g)
52
164
13
70
170
20
1250
250
220
1160
860
100
140
35
1400
330
310
1800
1000
100
180
35
Heart (g)
Adult and other age groups; these values were updated Kidneys (g)
in ICRP publications 62(2) and 80(3). The computations
Liver (g)
Lungs (g)
Pancreas (g)
were based on MIRD schema.
The ICRP Reference Man represents a typical Cauca-
Spleen (g)
sian adult of West European or North American origin
Testes (g)
Thyroid (g)
19
20
Contact author E-mail: scjain007Ȱyahoo.com
37

K. TYAGI, S. C. JAIN and P. C. JAIN
and habitat(4). The average Indian adult differs signifi- Dang et al found changed metabolic characteristics
cantly from his ICRP counterpart as regards anatomical, like decreased biological half-lives for some com-
physiological and metabolic characteristics. Jain et al(5) pounds, voiding habits, etc. Moreover, for Indians,
and Dang et al(6), based on post-mortem studies, have Mehta and Sarangpani(7) suggested new ‘tissue risk fac-
reported lower masses for both total body and specific tors, RFT,’ for the Indian population based on cancer
organs for Indian adults. They also reported signifi- morbidity and mortality data. The tissue risk factors for
cant changes in physiological parameters like body Indians are 30–60% higher than the ICRP tissue weight-
fluid compartments, blood compartments, respiratory ing factors for the following tissues: bone marrow,
parameters, daily water and diet intake, elemental testes, ovaries and breast, but 20–30% lower for other
composition of the various body compartments, etc. organs including those under ICRP’s ‘remainder’. The
Mehta–Sarangpani tissue risk factors may be called
‘country-specific tissue weighting factors’.
In the present study, available anatomical data of
Indians and their risk factors have been utilised to
estimate the effective doses from commonly used
99Tcm-labelled radiopharmaceuticals (pertechnetate,
RBC (red blood cell); HSA (human serum albumin);
phosphates/phosphonates; DMSA (dimercaptosuccinic
acid); gluconate/glucoheptonate; IDA (iminodiacetic
acid derivative); DTPA (diethylenetriaminepentaacetic
acid); citrate; large colloids (100–1000 nm); small
colloids (Ͻ100 nm); MIBI (methoxyisobutylisonitrile);
MAG3 (mercaptoacetyltriglycine); and HMPAO (hexa-
methylpropylene amine oxime)) under normal physio-
logical and pathological conditions.
Table 2. Comparison of tissue risk factors (RFT) of Indian
with tissue weighting factors (WT) of ICRP Reference Man.
Organ
Indian RFT
ICRP WT
Bladder
Bone marrow
Bone surface
Breast
Colon
Liver
Lung
Oesophagus
Skin
Stomach
Thyroid
Remainder
Gonads
Total
0.04
0.16
0.01
0.08
0.08
0.04
0.08
0.04
0.01
0.08
0.04
0.04
0.30
1.00
0.05
0.12
0.01
0.05
0.12
0.05
0.12
0.05
0.01
0.12
0.05
0.05
0.20
1.00
MATERIALS AND METHODS
The masses of ten organs, viz. adrenals, brain, heart,
kidneys, liver, lungs, pancreas, spleen, testes and
thyroid, were obtained from the studies of Jain et al(5)
Table 3. Estimated effective dose (mSv/MBq) from 99Tcm-labelled radiopharmaceuticals in normal physiological conditions.
99Tcm-labelled
radiopharmaceuticals
ICRP
adult
Indian adult
Anatomical
Anatomical ϩ Risk
consideration*
factor considerations*
Pertechnetate
RBC
HSA
Phosphate/phosphonate
DMSA
Gluconate/glucoheptonate
IDA
1.00 E−03
6.54 E−03
5.95 E−03
5.80 E−03
8.83 E−03
5.48 E−03
15.88 E−03
5.20 E−03
6.19 E−03
9.55 E−03
9.98 E−03
9.09 E−03
8.24 E−03
7.13 E−03
9.26 E−03
1.16 E−03 (16.0%)
7.52 E−03 (14.9%)
6.81 E−03 (14.5%)
6.97 E−03 (20.0%)
10.65 E−03 (20.6%)
6.43 E−03 (14.7%)
18.72 E−03 (17.9%)
6.14 E−03 (18.1%)
7.32 E−03 (18.2%)
11.12 E−03 (16.4%)
11.64 E−03 (16.6%)
10.34 E−03 (13.7%)
9.39 E−03 (13.9%)
8.59 E−03 (20.4%)
10.61 E−03 (14.6%)
0.99 E−03 (Ϫ1.0%)
6.41 E−03 (Ϫ2.0%)
6.17 E−03 (3.6%)
6.76 E−03 (16.5%)
9.25 E−03 (4.7%)
5.11 E−03 (Ϫ6.8%)
15.30 E−03 (Ϫ3.7%)
5.54 E−03 (6.5%)
6.68 E−03 (7.9%)
9.78 E−03 (2.4%)
10.49 E−03 (5.1.%)
9.18 E−03 (0.9%)
8.37 E−03 (1.5%)
7.53 E−03 (5.7%)
8.85 E−03 (Ϫ4.4%)
DTPA
Citrate
Large colloids
Small colloids
MIBI (Rest)
MIBI (Exercise)
MAG3
HMPAO
*Values in bracket indicate the % change as compared to ICRP adult.
38

RADIATION DOSE TO INDIANS FROM 99Tcm RADIOPHARMACEUTICALS
and Dang et al(6) based on 12,000 post-mortem reports for the Indian population. In addition, the ‘effective
of accident cases in the Indian population. Table 1 gives dose’ to the Indian adult is estimated when the activity
the comparative anatomical data for the Indian adult and of radiopharmaceutical administered is proportional to
ICRP Reference Man. In the present study, for the the body mass. When deciding on the appropriate activi-
organs whose masses are not available in the Indian ties to be administered to younger age groups, it is usual
context, the masses are taken to be proportional to the to consider that the activity to be administered per unit
body weight. These organ masses were used to estimate body mass would be the same as that for the adult. On
dose coefficients (Sv.BqϪ1) in the average Indian adult the same basis, since the adult Indian’s body mass is
by computing dose transformation factors (DTF) using only 74.3% of that of the ICRP Reference Man, the
the method of Yamaguchi(8) for the principal gamma activity to be administered could be taken to be 74.3%
energy of 99Tcm. In the absence of specific information, of that for the ICRP Reference Man.
it has been assumed that the distribution and metabolism
of the radiopharmaceutical in Indians are exactly similar effective doses to the ICRP adult and Indian adult have
to those for the ICRP Reference Man. been calculated and expressed as percentage change. For
For comparison, the relative differences between
For the other organs weighing more than 20 g, DTF computing the relative difference, the estimated ‘E’
has been computed considering the organ masses to be value for the Indian adult is subtracted algebraically
proportional to the body weight. For organs weighing from the corresponding ‘E’ value for the ICRP adult,
less than 20 g, DTF is taken as 1. The dose coefficients divided by the latter, and the resultant value multiplied
for the various organs given in ICRP publications 53, by 100 to express it as a percentage.
62 and 80 are then multiplied by the corresponding
DTFs to estimate dose coefficients for the organs of the
RESULTS AND DISCUSSION
Indian adult(1–3)
.
Table 2 lists the tissue risk factors, RFT for Indians
Table 3 gives the estimated effective doses to the
and compares them with the tissue weighting factors WT Indian adult from administration of various 99Tcm-
for the ICRP Reference Man. The dose coefficients labelled pharmaceuticals under normal physiological
obtained by the method described in the previous para- and certain pathological conditions; these are compared
graph are multiplied by the appropriate tissue weighting with the corresponding effective doses to the ICRP Ref-
factors as given in ICRP publication 60(9), and following erence Adult. The calculations for the Indian adult have
the guidelines as given in ICRP publication 67(10) to been made (i) based on anatomical considerations alone
give the effective dose (E). The ‘effective dose’ to the and (ii) based on anatomical plus risks factor consider-
Indian adult is also estimated for 14 radiopharmaceut- ations. On anatomical considerations alone, it is found
icals listed earlier, taking into account the risk factors that the effective doses to the Indian adult from the
Table 4. Estimated effective dose (mSv) from various 99Tcm-labelled radiopharmaceuticals in normal physiological
conditions when the activity of the radiopharmaceuticals is administered proportional to body mass.
99Tcm-labelled
radiopharmaceuticals
ICRP adult
(unit activity
in MBq)
Indian adult
(0.743ϫ activity to ICRP adult)
Anatomical
Anatomical ϩ risk
consideration*
factor considerations*
Pertechnetate
RBC
HSA
Phosphate/phosphonate
DMSA
Gluconate/glucoheptonate
IDA
1.00 E−03
6.54 E−03
5.95 E−03
5.80 E−03
8.83 E−03
5.48 E−03
15.88 E−03
5.20 E−03
6.19 E−03
9.55 E−03
9.98 E−03
9.09 E−03
8.24 E−03
7.13 E−03
9.26 E−03
0.86 E−03 (Ϫ14.0%)
5.57 E−03 (Ϫ14.8%)
5.05 E−03 (Ϫ15.1%)
5.17 E−03 (Ϫ10.8%)
7.90 E−03 (Ϫ10.5%)
4.06 E−03 (Ϫ25.9%)
13.89 E−03 (Ϫ12.5%)
4.55 E−03 (Ϫ12.5.%)
5.43 E−03 (Ϫ12.2%)
8.25 E−03 (Ϫ13.6%)
8.63 E−03 (Ϫ13.5%)
7.68 E−03 (Ϫ15.5%)
6.96 E−03 (Ϫ15.5%)
6.37 E−03 (Ϫ10.6%)
7.87 E−03 (Ϫ15.0%)
0.73 E−03 (Ϫ27.0%)
4.75 E−03 (Ϫ27.3%)
4.57 E−03 (Ϫ23.1%)
5.01 E−03 (Ϫ13.6%)
6.86 E−03 (Ϫ22.3%)
3.70 E−03 (Ϫ30.8%)
11.37 E−03 (Ϫ28.5%)
4.11 E−03 (Ϫ20.9%)
4.95 E−03 (Ϫ20.0%)
7.22 E−03 (Ϫ24.1%)
7.78 E−03 (Ϫ22.4%)
6.81 E−03 (Ϫ25.0%)
6.21 E−03 (Ϫ24.6%)
5.59 E−03 (Ϫ21.5%)
6.65 E−03 (Ϫ29.1%)
DTPA
Citrate
Large colloids
Small colloids
MIBI (Rest)
MIBI (Exercise)
MAG3
HMPAO
*Values in bracket indicate the % change as compared to ICRP adult.
39

K. TYAGI, S. C. JAIN and P. C. JAIN
administration of the same activity of the radiopharma- doses are 11–26% lower for the Indian, while on anatom-
ceutical as to the ICRP Reference Adult are 14–21% ical plus risk factor considerations, the values of the ‘effec-
higher than those to the ICRP Adult; this may be attri- tive dose’ are 14–31% lower.
buted to the smaller body and organ masses of Indians.
Similar comparisons as in Tables 3 and 4 have been
When both anatomical and risk factors are taken into made for certain pathological conditions, which have been
consideration, the ‘effective doses’ are 1–7% lower for considered in ICRP 53. Table 5 gives details of the patho-
the Indian adult in the case of 99Tcm-labelled pertechnet- logical conditions considered in the present study. Tables
ate, RBC, glucoheptonate, IDA and HMPAO, but 1– 6 and 7 give the computed effective doses for different
19% higher for HSA, phosphonate, DMSA, DTPA, cit- pathological conditions. For identical administered activi-
rate, large colloids, small colloids, MAG3 and MIBI, as ties, the effective dose to the Indian adult are 11–22%
compared to the ICRP adult. The higher values for the higher for the Indian based on anatomical considerations
Indian adult in the later cases may be attributed to the alone. If both anatomical and risk factors are taken into
higher RFT value of 0.16 for bone marrow as compared account, the ‘effective doses’ to the Indian are marginally
to 0.12 for WT given by ICRP.
(0.2–2%) lower for parenchymal liver disease and
Table 4 gives the effective dose estimates to the Indian occlusion of cystic duct, while for all other cases the effec-
adult when the administered activity is proportional to the tive doses to the Indian are 3–16% higher (Table 6). If
body mass. As mentioned earlier, two cases are con- the administered activity is proportional to body mass, the
sidered, viz. (i) based on anatomical considerations alone, effective doses to the Indian are 10–18% lower on the
and (ii) based on anatomical plus risk factor consider- basis of purely anatomical considerations, while the ‘effec-
ations. From anatomical consideration alone, the effective tive doses’ are 14–28% lower on the basis of anatomical
plus risk factor considerations (Table 7).
Table 5. Pathological conditions considered for different nuclear medicine investigation.
Radiopharmaceuticals/pathological
conditions
Presumption for dose estimation
Phosphate/phosphonate
High bone uptake and/or severely impaired kidney
function
Average bone uptake of 70% is assumed with no excretion.
In normal conditions, the bone uptake is assumed to be 50%.
IDA
Parenchymal liver disease
Damage of liver cell and destruction of hepatic architecture.
Liver uptake is 35% or lower as compared to 85% in normal
physiological conditions.
Occlusion of cystic duct
(cholecystitis)
Obstruction of the cystic duct with associated inflammation
of the gall bladder wall. Liver uptake may be 70% as in
normal case but nothing will go to the gall bladder.
A gallstone can pass from the gall bladder and be lodged in
common bile duct resulting in total or partial occlusion.
Liver uptake will be 85% but no excretion either into the
gall bladder or GI tract. Excretion exclusively via kidneys.
Occlusion of the common bile duct
DTPA
Abnormal renal function
The retention half-life is 1000 min as compared to 100 min
in normal cases. The renal transit time is increased to 20
min from 5 min in normal cases.
Large colloids/small colloids
Early to intermediate parenchymal liver disease
The bilirubin level is 2–5 mg%. The liver and spleen uptake is
50% and 20% as compared to 70% and 10% in normal cases.
The bilirubin level is 5–30%. The liver and spleen uptake
are 30% each.
Intermediate to advanced diffuse parenchymal disease
MAG3
Abnormal renal function
The renal function is bilaterally impaired. The clearance rate
through kidney is one tenth that for the normal case and the
renal transit time is 20 min as compared to 4 min in normal
cases.
Acute unilateral renal blockage
For dosimetric purposes, it is assumed that a fraction of 0.5 of
the activity is taken up by one kidney and slowly released to
the blood with a half-life of 5 days and subsequently excreted
by other kidney, which is assumed to function normally.
40

RADIATION DOSE TO INDIANS FROM 99Tcm RADIOPHARMACEUTICALS
While the findings of the present study should not be values. However, when the activity of the radio-
taken to be directly applicable to other adult popu- pharmaceutical administered is normalised to unit body
lations, say Japanese or Chinese, one could broadly say mass (i.e. the activity administered to the Indian is 52/70
that the radiation doses would be slightly lower to these or 0.743 times that of the ICRP value), the effective
populations, as these populations have higher body and doses are estimated to be less than for the corresponding
organ masses as compared to Indians but are still likely ICRP cases; the ‘effective doses’ are markedly less,
to be less compared with doses to the ICRP Adult. In particularly if both anatomical and risk factors are con-
this connection, reference may be made to an earlier sidered together.
study by Jain et al(11)
.
It may be concluded that Indians are at lower risk of
radiation health detriment in comparison to the ICRP
Adult for administration of the various 99Tcm-labelled
radiopharmaceuticals considered in the study, parti-
CONCLUSION
The present study suggests that for the same amount cularly when the activity administered is proportional
of administered activity of various 99Tcm-labelled radi- to the body mass which is around 74% of the value
opharmaceuticals in normal physiological as well as cer- administered to the ICRP Reference Adult.
tain pathological conditions, radiation doses are higher
than those to ICRP Reference Man due to smaller body
and organ masses of Indians. When the specific tissue
risk factors for Indians are additional taken into account,
the estimated ‘effective doses’ are still found to be
somewhat higher, but less than for the previous case,
as compared to his ICRP counterpart, which may be
attributed to the fact that tissue risk factors for most
organs of Indians are less than the corresponding ICRP
ACKNOWLEDGEMENTS
The authors are grateful to Dr A. K. Bhalla, Director,
CEES for his encouragement and permission to carry
out the work. Thanks are also due to Shri A. Nagarat-
nam, Ex-Director, Defence Laboratory, Jodhpur and Dr
A. R. Reddy, Director R&D Hqrs for their very useful
suggestions and keen interest in the present study.
Table 6. Estimated effective dose (mSv/MBq) from various 99Tcm-labelled radiopharmaceuticals in pathological conditions.
99Tcm-labelled
radiopharmaceuticals
ICRP
adult
Indian adult
Anatomical ϩ Risk
Anatomical
consideration*
factor considerations*
Phosphate/phosphonate
3.59 E−03
4.17 E−03 (16.1%)
4.04 E−03 (12.5%)
(High bone uptake and/or severely impaired kidney
functions)
IDA
9.93 E-03
15.03 E−03
3.93 E−03
4.66 E−03
9.24 E−03
11.60 E−03
11.72 E−03 (18.0%)
18.10 E−03 (18.3%)
4.59 E−03 (16.7%)
5.39 E−03 (15.6%)
10.86 E−03 (17.9%)
13.68 E−03 (17.9%)
9.91 E−03 (Ϫ0.2%)
14.98 E−03 (Ϫ2.1%)
4.44 E−03 (12.9%)
5.22 E−03 (12.0%)
9.89 E−03 (7.0%)
(Parenchymal liver disease)
IDA
(Occlusion of cystic duct)
IDA
(Occlusion of the common bile duct)
DTPA
(Abnormal renal function)
Large colloids
(Early to intermediate diffuse parenchymal liver disease)
Large colloids
12.78 E−03 (10.1%)
(Intermediate to advanced diffuse parenchymal liver
disease)
Small colloids
(Early to intermediate diffuse parenchymal liver disease)
Small colloids
10.01 E−03
11.70 E−03 (16.8%)
11.57 E−03 (15.5%)
(Intermediate to advanced diffuse parenchymal disease)
Large colloids
MAG3 (Abnormal renal function)
MAG3 (Acute unilateral renal blockage)
11.91 E−03
9.24 E−03
6.34 E−03
10.30 E−03
14.06 E−03 (18.1%)
10.86 E−03 (17.9%)
7.04 E−03 (10.9%)
12.50 E−03 (21.6%)
13.32 E−03 (11.8%)
9.89 E−03 (7.0%)
6.15 E−03 (2.8%)
10.49 E−03 (1.9%)
*Values in bracket indicate the % change as compared to ICRP adult.
41

K. TYAGI, S. C. JAIN and P. C. JAIN
Table 7. Estimated effective dose (mSv) from various 99Tcm-labelled radiopharmaceuticals in pathological conditions when
activity of the radiopharmaceuticals is administered proportional to body mass.
99Tcm-labelled
radiopharmaceuticals
ICRP
adult
Indian adult (0.743ϫ activity to ICRP adult)
(unit activity
in MBq)
Anatomical
consideration*
Anatomical ϩRisk
factor considerations*
Phosphate/phosphonate
(High bone uptake and/or severely
impaired kidney functions)
IDA
(Parenchymal liver disease)
IDA
(Occlusion of cystic duct)
IDA
(Occlusion of the common bile duct)
DTPA
3.59 E−03
3.09 E−03 (Ϫ13.9%)
2.99 E−03 (Ϫ16.7%)
9.93 E−03
15.30 E−03
3.93 E−03
4.66 E−03
9.24 E−03
8.69 E−03 (Ϫ12.4%)
13.43 E−03 (Ϫ13.4%)
3.40 E−03 (Ϫ13.4%)
3.99 E−03 (Ϫ14.3%)
8.05 E−03 (Ϫ12.8%)
7.35 E−03 (Ϫ25.9%)
11.05 E−03 (Ϫ16.2%)
3.29 E−03 (Ϫ16.2%)
3.87 E−03 (Ϫ16.9%)
7.33 E−03 (Ϫ20.6%)
(Abnormal renal function)
Large colloids
(Early to intermediate diffuse
parenchymal liver disease)
Large colloids
(Intermediate to advanced diffuse
parenchymal liver disease)
Small colloids
(Early to intermediate diffuse
parenchymal liver disease)
Small colloids
11.60 E−03
10.01 E−03
11.91 E−03
10.15 E−03 (Ϫ12.5%)
8.68 E−03 (Ϫ13.2%)
10.40 E−03 (Ϫ12.4%)
9.48 E−03 (Ϫ18.2%)
8.58 E−03 (Ϫ14.2%)
9.88 E−03 (Ϫ17.0%)
(Intermediate to advanced diffuse
parenchymal liver disease)
MAG3 (Abnormal renal function)
MAG3 (Acute unilateral renal
blockage)
6.34 E−03
10.30 E−03
5.22 E−03 (Ϫ17.6%)
9.27 E−03 (Ϫ9.9%)
4.56 E−03 (Ϫ28.1%)
7.78 E−03 (Ϫ24.4%)
*Values in bracket indicate the % change as compared to ICRP adult.
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