Radiation dose descriptors: BERT, COD, DAP, and other strange creatures.

Over the years, a number of terms have been used to describe radiation dose. Eight common radiation dose descriptors include background equivalent radiation time (BERT), critical organ dose (COD), surface absorbed dose (SAD), dose area product (DAP), diagnostic acceptable reference level (DARLing), effective dose (ED), fetal absorbed dose (FAD), and total imparted energy (TIE). BERT is compared to the annual natural background radiation (about 3 mSv per year) and is easily understandable for the general public. COD refers to the radiation dose delivered to an individual critical organ. SAD is the radiation dose delivered at the skin surface. DAP is a product of the irradiated surface area multiplied by the radiation dose at the surface. DARLing is usually the radiation level that encompasses 75% (the third quartile) of the data derived from a nationwide or regional survey. DARLings are meant for voluntary guidance. Consistently higher patient doses should be investigated for possible equipment deficiencies or suboptimal protocols. ED is obtained by multiplying the radiation dose delivered to each organ by its weighting factor and then by adding those values to get the sum. It can be used to assess the risk of radiation-induced cancers and serious hereditary effects to future generations, regardless of the procedure being performed, and is the most useful radiation dose descriptor. FAD is the radiation dose delivered to the fetus, and TIE is the sum of the energy imparted to all irradiated tissue. Each of these descriptors is intended to relate radiation dose ultimately to potential biologic effects. To avoid confusion, the key is to avoid using the terms interchangeably. It is important to understand each of the radiation dose descriptors and their derivation in order to correctly evaluate radiation dose and to consult with patients concerned about the risks of radiation.