Vanderbilt University - Radiation Dose Calculator and Consent Language Generator

Vanderbilt University HSRC/RDRC

Radiation Dose Calculator and Consent Language Generator

This form gives radiation dose estimates for certain radiographic and nuclear medicine procedures, based on literature reported values. Individual organ doses and total body effective doses are given for these specified examinations, and some combinations of examinations. In addition, a short statement is generated, which may be useful as part of a patient consent form document, explaining the radiation doses as numerical values and as equivalent days of exposure to natural background radiation. If you print this form for inclusion with your HSRC application, please be sure that all of the data are legible on the output.

DISCLAIMER: All information provided on this Dose Caclulation Website is provided as a service to Vanderbilt University investigators only as related to research studies that will be submitted and reviewed by the IRB HSRC/RDRC and IRB Committees. Information on this web site is subject to change without notice. Although every reasonable effort is made to present current and accurate information, Vanderbilt University makes no guarantees of any kind. The information on this website should not be used for medical diagnosis or treatment purposes, or be substituted for medical advice. It is your responsibility to research the accuracy, completeness, and usefulness of all information found on this site. Vanderbilt University assumes no responsibility or liability for any consequence resulting directly or indirectly for any action or inaction you take based on or made in reliance on the information, services, or material on or linked to this site.

To use this form:

Select the radiologic examinations you wish to employ from the drop-down lists. You may choose up to three radiographic exams (x-ray or CT) and two nuclear medicine exams. You can select studies from more than one major category. Fluoroscopic exams are less straightforward; contact the office noted at the bottom of this form for assistance.
You may also enter the number (N) of each type of study in the small boxes to the left of the drop-down lists. This is optional; if you enter nothing, one study will be assumed to be done.
For nuclear medicine studies, default values for the administered radioactivity of the various exams are supplied automatically. You can supply your own value for administered radioactivity (in millicuries), if you know it to be different by entering the new value in the box immediately to the right of the drop-down list. To accept the default values, just leave default values supplied unchanged. For example, the default value for administered radioactivity for a "Tc-99m Macro aggregated albumin (MAA)" is 4 millicuries; this value will appear in the box if you choose this scan. If your protocol uses a maximum of 2 millicuries, select "Tc-99m Macro aggregated albumin (MAA)" in the drop-down list, delete the "4" and enter "2" in the box to the right of the "Tc-99m Macro aggregated albumin (MAA)" selection.
For a rough Spanish translation of your risk statement, check the box provided.
When everything looks good, push the "OK" button. If you need to, push the "Clear" button and try again.

Radiographic Procedures

N:
N:
N:

Nuclear Medicine Scans

Activity (mCi):
Activity (mCi):

Check this box to include a rough Spanish translation of the consent form language.

Organ Doses - These values may be entered in the HSRC proposal form table:

Consent Language - You can copy and paste this text into your consent form document, with some minor editing:

Vanderbilt review procedures:

HSRC review:

For total effective doses less than 10 mrem, an administrative review is performed.
For total effective doses between 11 mrem and 3000 mrem, applications are reviewed by 3 reviewers .
For total effective doses over 3000 mrem, a full committee review is performed.

All RDRC applications, regardless of dose level, always go to the full committee for review.

References: Most radiology doses taken from ICRP Publication 62 and most pharmaceutical doses taken from ICRP Publications 57 and 80. For the HSRC form just reference "Vanderbilt University Radiation Dose Calculator Web Page"

For dose-related questions contact:

Human Subjects Radiation Committee
Vanderbilt University Institutional Review Board
504 Oxford House
Nashville, TN 37232
(615) 322-2918