The fundamental physical quantity for relating all biologic effects to radiation exposure is the absorbed dose, the energy imparted per unit mass of tissue. Absorbed dose is expressed in units of joules per kilogram (J/kg) and is given the special name gray (Gy). Exposure to ionizing radiation may cause both deterministic and stochastic biologic effects. To account for the relative effect per unit absorbed dose that has been observed for different types of radiation, the International Commission on Radiological Protection (ICRP) has established radiation weighting factors for stochastic effects. The product of absorbed dose in Gy and the radiation weighting factor is defined as the equivalent dose. Equivalent dose values are designated by a special named unit, the sievert (Sv). Unlike the situation for stochastic effects, no well-defined formalism and associated special named quantities have been widely adopted for deterministic effects. The therapeutic application of radionuclides and, specifically, α-particle emitters in nuclear medicine has brought to the forefront the need for a well-defined dosimetry formalism applicable to deterministic effects that is accompanied by corresponding special named quantities. This commentary reviews recent proposals related to this issue and concludes with a recommendation to establish a new named quantity. COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.