UNITED NATIONSREPORT OF THE
UNITED NATIONSSCIENTIFIC COI\IMITTEE
ON THE
EFFECTS OF ATOMIC RADIATIONNOTE
Throughout this report and its annexes cross-references are denoted by a letter
followed by a number: the Jetter refers to the relevant technical annex (see Tableof Contents) and the number is that of the relevant paragraph. \Vithin each technicalannex, references are made to its individual scientific bibliography by a number
without any preceding letter.
Symbols of United Nations documents are composed of capital letters combined with figures. Mention of such a symbol indicates a reference to a United
Nations document.

ANNEXES

Annex C

MAN-RPADE SOURCES(Other than environmental contamination)

Paragraph
I. INTRODUCTION.............................................

1

11. MEDICALUSES OF X-RAYSB ~ ' DRADIOACTIVE MATERIALS ..........
The genetically significant dose ..............................
Calculations ............................................
Statistical data .........................................
Exposure of the bone marrow ...............................
Diagnostic uses of X-rays ..................................
Estimates of the genetically significant dose ................
Estimates of bone marrow dose ..........................
Accuracy of estimates ...................................
Reduction of gonadal dose ................................
Radiotherapy .............................................
Genetically significant dose ...............................
Bone marrow dose ......................................
Internally administered radioisotopes ........................

.....................................
........................................

Occupational exposure
72
Medical workers
73
Atomic energy workers .................................. 77
Industrial and research workers ........................... 80
Summary .............................................. 82
IV. OTHERMAN-MADE SOLTRCES OF RADIATION ...................... 84

APPE~-DICESI-X :DATAFOR EVALUATIONDIAGNOSTIC

OF THE GENETICALLY SIGNIFICANTDOSE FROMX-RAY
EXPOSURE

I. Australia
11. Austria
111. Denmark
IV.England and Wales
V. France
VI. Japan
VII. New Zealand
VIII. Noway
IX. Sweden
X. United States of America
DATAON DI-&GNOSTIC X-RAYEXPOSUBE: C O N M DOSE FOR EXAMINATIONFOR THE 31OST IIIPORTAXT E X P O S t . CLASSES

1. The various estimates of genetically significant
dose which have been available to the Committee are
discussed in this annex, and some preliminary estimatesof mean marrow doses are also given. The presentation follows, as far as possible, the scheme given inchapter 111.

11. MEDICALUSES OF X-RAYS
AND RADIOACTIVE NATERIALS

2. Medical uses of X-rays and radioactive materials
are responsible for the largest man-made =posures ofmany populations at the present time, the doses possibly
ranging up to more than 100 per cent of the dose due
to natural sources in some of the countries for which
estimates have been made.
3. The medical exposure is mainly an exposure ofpatients undergoing diagnostic examinations or radiation therapy. It is also an occupational =posure, fromwhich, however, the dose to the population as a whole iscomparatively very small. This occupational exposure istreated separately in paragraphs 72-83.
4. In view of the importance of the medical exposure,
the Committee invited the International Commission on
Radiological Protection (ICRP) and the International
Commission on Radiological Units and h,Ieasurements(ICRU)"(a) T o consider and discuss the question of how
to arrive at reliable data indicating the doses to different parts of the body (particularly the gonads) received by indi~idualsand, in the aggregate, by large
population groups due to medical uses of ionizing
radiations and"(b) T o examine what recording system, if any, isat present feasible for the determination of the relevant dose values."
The two Commissions formed a joint study group to
consider and prepare a report1 for the Committee on
these problems.* The following is the summary of theirreport.**" I . Prelintinary cottsiderations" ( a ) The principal objective has been to recommend methods for the evaluation of the geneticallysignificant annual gonad dose, G,, which arises frommedical uses of ionizing radiation.
" (b) It is assumed that the magnitude of the significant gonad dose due to natural background may betaken as a standard of reference and that 25 per centof this dose is the greatest absolute accuracy which
need be aimed at for an initial determination.
"(c) While not always yielding values strictly interms of G, as defined in paragraph 4 (of the
ICRP/U Study Group report), the preliminary sur-

* N ~ EThroughout:
this report and its annexes cross-reierences are denoted by a letter followed by a number: the letterrefers to the relevant technical annex (see Table of Contents)
and the number is that of the relevant paragraph. Within eachtechnical annex. references are made to its individual scientificbibliography by a number without any preceding letter.
**The references to pages in the Joint Study Group report
have been omitted here.

veys which have already been conducted have yieldedvalues of G, of the order of 100 mrad (probablevalue) and 50 mrad (minimum value) for the U.S.A.
and of the order of 2010 mrad (minimum values)for Denmark, Sweden and the United Kingdom(England and Wales).
"(d) These surveys show at present that diagnosis
makes a much larger contribution than therapy, andthat some 85 per cent of the diagnostic dose arises
from 6 or 7 types of examination, constituting only
about 10 per cent of all examinations of the types
listed.;"(e) It follows that, as regards dosimetry, those
6 or 7 types call for special consideration in future
surveys.

"2. Recont~~tendatio?ls"(a) It is recommended that the basic studies becontinued and extended, making use of suitable ionization dosemeters in order to obtain data that may
be used in the preparation of standard tables whichgive the average gonad dose in mrad corresponding
to each type of diagnostic and therapeutic use of ionizing radiation. Special attention should be paid to thesix or seven types of diagnostic examinations which
account for 85 per cent of the gonad dose.
"(b) I t is recommended that in all countries theanalysis of film records, together with the results of
2 ( a ) above, be used as a first approximation to G,.
If the dose so calculated exceeds a few per cent of
natural background. a detailed analysis is recommended.
"(6) It is recommended that where required, themore detailed analysis should be obtained by meansof a sampling programme, operated through personal
contact between trained surveyors and both medical
institutions and radiation practitioners, and that dataobtained from this sampling programme should be
used for the determination of G,.
"(d) It is recommended that prior to initiating themain sampling programme (referred to in 2 (c)above), a number of presurveys should be conductedin order to obtain information useful in planning andconducting the programme.
" (e) I t is recommended that in preparation for themain sampling programme, careful planning and instructional programmes should be initiated by aproperly selected group of medical physicists. healthphysicists, radiologists, statisticians, biometricians,
and surveyors. Appropriate dosemeters should .bemade available to the surveyors who should be instructed in their use.
" ( f ) I t is suggested that surveys will result in
improved practices with a consequent reduction in
exposure. This is likely to be a most important consequence of all surveys, and specific suggestions are
made for the reduction of gonad dose due to diagnostic
procedures.

t The list referred to here excludes dental examinations andmass miniature radiography.

"3. Not recrmt)iaelrded"The systematic recording and registration of theradiation received by every member of the population
is not recommended."/

5. The ICRP/ICRU Joint Study Group was mainly
concerned with how the genetically significant doseshould be assessed. This problem is discussed in further
detail in this report. As the scheme of computation iscommon for all types of exposure, it is presented separately, before the various classes of exposure are
discussed.

The gei~eticallysigtlificant dose

Cdculations
6. A general definition of genetically significant dose
has been given in chapter 11. Approximations must be
made to calculate this dose, the most obvious being consideration of groups rather than individuals. It is convenient to start with the approximate definition*

where D= (annual) genetically significant dose,

Nlk= (annual) number of individuals of age

class k, subjected to class j exposure,
Nk =total number of individuals of age-class k
wjk=future number of children expected by an
exposed individual of age-class k subsequent to a class j exposure,
wk =future number of children expected by anaverage individual of age-class k,
dlk =gonad dose per class j exposure of an individual of age-class k,(F) and (Ail) denote "female" and "male" respectively.
7. For the practical work, Equation (1) can be simplified considerably, the iirst step being to replace thedenominator by W O N where
,

and

1

..

w =-

2 w; N;

expressed by the present specific annual birth rate.
This makes i t possible to calculate, by summation, thetotal future expected number of children of an individual of any age, and hence also the mean for any
age-group. If significantly less than unity, the probability of an individual of age a to reach age t should
also be considered. This gives

w;= 2 c;1-8

at P; (t)

(4)

where
wl

=expected future number of children of anindividual of age a. With kno~vledgeof
the function nri of age, the average w;
for any age-group k can be calculated,=age-specificannual birth rate, i.e., annualc',expected number of children of an individual of age-group t,=number of years included in age-group t,At
P i (t) =probability of an individual of age a toreach age (group) t.

10. I t must be noted that c; may have a tendency
to change considerably before an average individual ofa specified age has reached the age-group in question.
-4s it is, however, difficult to predict the values for the
future, c; has been assumed not to vary with time.
11. We= wi+, is the number of children expected by
the average individual during his whole life. The range
of w' is normally 0.8-2, and the range of W' is 2-4
for most developed countries. The ratio IV/w ranges
from 1.5 to 3.
12. The female and the male contribution to thegenetically significant dose can both be written

13. If the gonad dose due to an examination of typej is nearly uniform for all age-classes k, thenapproximately for all k, and Equation (5) reduces to-. (3)k

In the last expression, * denotes the sex. N is the tota
number of individuals of the population. I t should benoticed that w.N is about twice the future numberof children expected by the present population eventhough the value of w may be as low as 0.8.
8. -4s equation (1) has w* in both the numerator
and denominator, the numerical value of w has nodirect relevance, and all terms can be expressed byhelp of the ratio w , ~ / w . For understanding of thedemographic background, however, it is valuable torealize that m must be calculated from the sum of the
age-group products \\.;:N,
for a population. whichmeans that an assumption has to be made regarding
the expected fzctitre number of children (w;) of anindividual in any specified age-group.
9. The assumption could be that the average individual?\i~ill have a future annual child-expectancy* T h e degree of approximation involved in the use of equation(1) depends on the definition of classes j. In theory, there need
be no approximation since the classes may be made so restrictive as to include only one individual per class.

where D; is the contribution from type j examinationof the specified sex to the genetically significant dose.
This again can be written as

which is the expression that has been used for presentation of the data in most of appendices I-X.
14. The necessary information to make it possible
to calculate D; by help of Equation (8) is:=the mean gonad dose per individual
undergoing class j examination,(b) N;/N = the relative frequency of class j examination, i.e., the number of examinations per capita, per year,(a) d;

(G) w;/w =the relative child-expectancy of theaverage'lass jexamination.
T h e formula is applicable also to foetal exposure(w, =W) which must not be overlooked.

administered radioisotopes.
In collecting these data, examinations and treatments
should be classified by(i) radiological type ;(ii) anatomical part ;(iii) age and sex of patient:(iv) disease (for therapy and radioisotopes, at least).
F,, (;I, (;;I(i;;), the classifications recommended
by the ICRP/ICRU Study Group1 should be used.

15. Often dl varies considerably from hospital tohospital. hIost of the uncertainty in estimates of Dl
is probably due to the difficult);of estimating a reliableaverage of d l for a population.
16. If there are no data On the child-ex~ectmc~
ofthe parients*
estimate
D; may be
made, under the assumption that the child-expectancy
is not influenced by the nature of the condition forwhich the patient is examined. w; can then be calculated from the age-distribution of the patients andthe normal child-expectancy for each age-group,

20. The dassification of examinations suggested by
the ICRP/ICRU Joint Study Group' has been slightly
rearranged, for the purposes of this report, to comprisel. Hip and femur (upper third)
2. Femur (middle and lower third)
3. Pelvic region
2 . .
4. LumbosacralNikw--r nrn Nn ,~r W;'
1(9)5. Lumbar spineN;
Ni
6. Dorsal spine
7. Urography (descending [intravenous] pyelowhere w* can be taken from Equation (4). If w;/w is
not given in the primary material, it may be recalcuPP~Y
lated from N;/N, d' and this approximation of D;, but
8. Retrograde (ascending) pyelography
will in that case reflect only variations in the age9. Urethrocystography (bladder examinations, q s distribution of the patients examined and not indicate
tography, urethrography)
any dependence of child expectation on type of examination.
10. Pelvimetry
11. Hysterosalpingography
17. I n the case where the age-distribution in an
12. Obstetrical abdomen
examination class is not known, a yet more simplified
13. Abdomen (pancreas, spleen, liver, pneumoperiassumption must be used, namely
toneum, general =aminations of the urinary
w;=\V* for all persons below mean age of childbearing
tract)
14. Lower gastrointestinal tract (small intestine, apw; = O for all persons above mean age of childpendix, colon, "barium enema")bearing
15. Upper gastrointestinal tract (pharynx, oesoIf n is the total number in the population below thephagus, stomach, "barium swallow and meal")mean age of child-bearing. it follows from Equation (3)16. Gall bladder fcholeqstography)that
17. Chest (heart, cardiac angiography, aorta, respiran*(10)
tory system, lungs)
N
18. Thorax (sternum. ribs, shoulder, clavicle)
which is also, indirectly, a definition of the "mean age
19. Upper limb (hand, forearm, upper arm)of child-bearing". Equation (8) reduces approxileg and foot20. hwermately to
21. Head (skull, cervical spine)
N n;~;="-l.d,=-.-.
(11)
22. Dentaln N
n23. Mass miniature radiography (photofluoroscopy)
Statistical data
21. For countries where a large part of the radiological work is done in private offices, much of it perhaps
18. The scheme of calculation presented in paraby "on-radiologists, it is very difficult to determine thegraphs 6-17 is the one that has been followed by theCommittee in evaluating
data on gonad a- total number of CXaminationS per year, and Still moredifficult to establish the number of ~~iUninati0nSof eachposure. The difficulty of applying any standardized
type or the age and sex distribution of the patients exmethod of calculation to a large amount of heterogeneous
information from various countries
the im- amined. Film consumption provides some check on total
volume of radiography, but none at all on fluoroscopy.
portance of carefully planning any survey of -posure
Underthese circumstances it appears that a rather carelevels which is to yield a statistically useful result.
fully organized survey along the lines suggested by the
19. ~ ~ ~ r o ~ rmeasuresi a t e should be taken to deterICRP/ICRU study Group is required to obtain themine more accurately the frequency of each type ofn,cessary data. ~t is important to specify whether aexamination or treatment. The data available at theor a figure for film cont,td number ofpresent time are particularly scarce or unreliable withsumption in a country, in fact includes all practrces.
regard to the following :Special care should be given the resent at ion of dental( a ) Diagnostic examinations by non-radiologists (byand mass chest examinations.
radiographic and fluoroscopic methods but pamcularlypart of thediag22. F~~countries
by the k n e r ) in countries where these constitute an
nosticis \\..here thebymajor
govemen:al!nStlNappreciable part of the total radiological practice.
tions and a high percentage of the examnatlons Is( b ) X-ray treatment.
carried out in hospitals, it is probable that the total
number of procedures is known fairly accurately and( c ) Diagnostic and therapeutic uses of internally-'

w*=-,.w'

6329. According to another hypothesis, there is a threshold dose ior the induction of leukemia; in this case a
per capita marrow dose has no relevance but the individual marrow doses become the determining factors. As
the relevant dose may then well be the maximum doseto the marrow. wherever it occurs. the mean dose will
not give a measure o i the possible risk.
30. As the evaluation of the significance of a marrow
exposure may involve the number of "years-at-risk",
the mean life-expectancy of each dass of patients should
be studied.
31. More extensive measurements of the marrow dose
resulting from diagnostic and therapeutic proceduresshould be made.

that sampling of representative hospitals is satisfactoryfor determining the number oi examinations of eachtype carried out.
23. All iniormation on the number of films, views
taken, size of fields and radiographic factors used for an"average" examination are helpful for calculation ofdose in the absence of measurements, or as a check onmeasured values. Measurements performed by specialists give, however, more reliable results than any calculations.
21. The gonad dose per examination should be determined more carefully for those exposure classes inwhich the doses are expected to have the greatest genetic
significance. The dose should be investigated in a mannerthat permits the assessments of an average for a whole
population. The doses received by children require particular attention since few data are available. In any
estimates of genetically significant doses, at least children and adults should be treated separately and, when
the inaccuracy in other factors has been reduced suficiently. it may be desirable to classify adults on the basisof size as well.
25. Foetal exposure has a special genetic significancebecause of the comparatively high relative child-expectancy, which in the case of the foetus becomes W/w(stillborns neglected).
26. The difference between the mean child-expectancyof each class of patients and the-mean child-expectancyof the same age and sex group in the population should
be determined with regard to its correlation with :( a ) type of diagnostic examination ;( b ) disease treated and type of treatment.
The correlation with type of diagnostic examination
may prove to be small but there is at present no evidence.
In therapy, the dependence on disease treated is obvious
but must be determined quantitatively to permit accurate
estimation of the genetically significant dose.

32. The weight and distribution of active marrow at
different ages should be determined.
Diagi~osticuses of X-rays
33. It has been estimated that 75 to 90 per cent of thetotal dose from medical uses of ionizing radiations resultsfrom the diagnostic uses of X-rays.'
Estbmtes of the genetically significant dose
34. It should be noticed that almost all estimates of
the genetically significant dose from diagnostic exposure
have been made under the assumption that the childexpectancy of the patients is not influenced by the natureof the condition for which they were examined. This
assumption has not yet been supported by any evidence.
35. The Committee has considered data on gonad exposure from diagnostic X-ray procedures in Australia.*
Austria? Denmark,' England and Wales5 F r a n ~ e , ~and U.S.A.l0 Some authors
J a ~ a nN
, ~~ n v a y Swedeng,~
have reported all data needed for an estimate of thegenetically significant dose (with the exception stated inparagraph 34), while others have given less complete
information. Because of the different procedures of
estimates and bemuse of the difference in diaenostic
practice, the data are not strictly comparable. ~ G v e v e r ,as far as practicable the material is presented in thisaccording to the same uniform scheme, following
the procedure given in paragraphs 6-26.
36. The material from the various countries is presented separately in appendices 1-10. as it has beenfound difficult to make a step by step comparison of
the data. So far as possible the anatomical classificationof examinations recommended by the ICRP/ICRU
Study Group1 has been used. When the original report
differs from this classification, the authors' own terms
have been used. within quotation marks, following thenumber of the most closely related standard class. For
uniformity of presentation, the data are recorded interms of equation (8).

Exposure of the botle marrow
27. ~ c c o r d i nto~ one h~potllesis.the possible adiation induction of leukemia is a linear function of dose.
The same dose to different individuals will probably
entail different degrees of risk for the subsequent
occurrence of the disease, depending upon the age at
the time of exposure and other unknown factors. As theappropriate weighting procedure is not ]inown, the various contributions to marrow exposure must. at present,pe compared without weighting, and the per capita dosein a population is taken as approximately determining
the total number of cases of leukemia t.0 be expectedduring the years following a certain =posure.
28. For the linear dose-effect relationship the relevant
dose is assumed to be the mean marrow dose, averaged
over the whole mass of active marrow (ca. 1,500 g inan adult). The active marrow is taken to be distributed
approximately as follows :Spinal column ........... -40 per centRibs and sternum ......... . 2j ""Pelvis ................... . I j
S ~ ~ ....................
l l
10 " "
Other (e.g. in extremities.
etc.) .................. .10
Infants and children have a wide distribution of active
marrow throughout the skeleton. making estimates ofthe mean dose difficult, especially as the distribution isdependent on age.
(I..

37. The procedure by kvhich Dj was estimated foreach countv is indicated in the introduction to each setof tables. Values of dl for some of the more important
examinations are collected in appendix XI.
38. The most obvious feature of the detailed results
has already been pointed out by the ICRP/ICRU Study
Group1 and by others. namely that about 85 per cent of
the genetically significant dose results from s i s o r seyen
anatomical types of examinations (those in the reglonof the lower abdomen and pelvis). during which the
gonads are usually in the primary beam. although these
constitute less than 10 per cent of the total number of
examinations.

,A

dc

64

39. Data from countries for which it has been possible
to calculate both the per capita gonad dose and thegenetically significant dose indicate that. at present. thesedoses are almost the same. This is, of course, a mere
coincidence and is true only for the total of all contributions. The relative contribution from the various exposure dasses is quite different in the two cases. For
example, while both the annual per capita gonad dose
and the annual genetically significant dose in the British
minimum estimate (see appendix I V ) are 23 mrem,
the corresponding contributions for an esamination 01

Yeur ofst&

CantryPop@tion
at !rm of
study
(N)

Annual number of examinations Conper ccrpifa of falal popu&fion s u m plion o j d n n n d*R
X-ray
genetiPopulolion
Expccrcd Relative
jlmsally
undcr
number child Radiogof
expect- raphy
Anmnal signiffman
Meanchild chrldrm ancy (except -F
numbermnl
agc ojchild
ctpcclafter dental & Flu*>Ipndose A
bearingawy
birth
mass or+
Mass
.D
(Di)
(*R+*F)(n)((m) ( W / m ) m m y ) nopy nrrwys D e d d(mem) (mcm)id,';;;

Aumalia.. ...... 19551957
Austria.. . . ..... 1955-195

9,500,000
6,974,000 3,095,000
Denmark........ 1956-1957 4,450,000 (1,610,000) 0.92
England di Wales. 1955
44,440,000 (18,700,000) 0.93
Fnnce.. ...... . 195i
42,000,000 19,000,000
Japan..... ...... 19%
90,000,000 55,000,000
New Zesland.. .. 1957
2,221,000 (1,160,000) 1.71
Norway ......... 1956
3,400,000!.heden......... 1955
7,178,000 (2,980,000) 0.91
U.S.A.. . ..
1955-1956 162,000,000 81,700,000.

......

a group with a low child-expectancy such as "female
bladder". are 0.26 and 0.08 mrem, and the contributions
from a high child-expectancy group such as .'ioetal exposure in pelvimetrv" are 1.4 and 3.4 mrem res~ectivelv.
- 40.
the' available data have beenAcollect;din table 1, w h i h gives a comparison the frequency of
es-nations
and the level exposure in various countries. The per ,-@ita number of radiographic e d a i n a tions reported by Martin in Australia is unusually highand is the lnain source for the high estimate o i thegenetically significant dose in this country.

2.54
2.20
3.28
2.19

2.25
2.76
2.36
2.21
1.55
1.92
2.4l
1.98

-.

0.48
0.19 no data
0.067 0.31 O.OOi5 na data
0.23-*
0.23 no data
0.30 -*
0.076 0.0?1
0.15 0.62c 0.50° no data
0.25 0.04 0.26 no data
0.34 -- 0.09
0.24
0.15
0.31
0.14 (0.3b)10.25 0.08 0.13 0.4 (1.2b)-.

160 (?ad) 330(5gd)
1.0
0.86

17d
23d
57d

7jd
75d
75d

Pn
capifadace(mrcm)

Dl/f

150 (2Sd)
16-24
17d

Zd

6jd

23d
5Td
10-30

1.1
1.0
38
115
36
0.68 141 (50") 430 (150d) 210 (75d)170

Fluoroscopy is generally performed only in connexion withradiography.
b Number of films.
26,000,000 fluoroscopic examinations per year in France include 19,000,000 mass surveys on the population under age 30.

In addition, 2,000,000 photofluoroscopic examinations are performed annually, so the total number of mass survey euarnlnations is likely to exceed 21,000,000 per year.

Estimates of bone marrow dose
41. The reports on the dose resulting from the treatment of Atzkylositlg Sporzdylitis provide the best basis atpresent for evaluation of a possible risk for radiation-induced leukemia." A discussion on the interpretation ofthis material is given in chapter V. It should be noticed
that some references to marrow dose in literature referto the mean spi~ralmarrow dose instead of the averageover the whole mass of active marrow. The latter doseis only about 40 per cent of the mean dose in the spine
marrow if other marrow than the spinal has not been
exposed.
42. Few measurements of the dose resulting fromdiagnostic X-ray exposure of the bone marrow havebeen published. The annual mean marrow dose fromdiagnostic X-ray exposure in Australia has been estimated to be about 100 mrem per capita.lz An attempt
has been made here to make another estimate based upona good current practice and an average frequency of examinations in the same countries which have reported
data on gonad exposure.
43. A representative number of examinations of eachtype N,, has accordingly been taken from the data on thegenetically significant dose, and the mean marrow dose,
averaged over the whole active marrow dose, has been
calculated from available information on number of films
per examination, size of films, skin dose per film, percentage depth dose, etc. Since the estimate at best is only
a very preliminary one, it has been considered justifiable to make several simplifying assumptions.
44. All estimates have been based on "standard man"as defined by the ICRP?3 It has been assumed that the
total weight of active marrow is 1,500 grams and that
it is distributed as follows: spinal column, 40 per cent;ribs and sternum, 25 per cent; pelvis, 15 per cent ; skull,
10 per cent ;other, 10 per cent. No estimates for children
have been attempted ;this would be more difficult becauseof the wide distribution of active marrow throughout
the skeleton of a child and the dependence of this distribution on age.

d Minimum estimate.

45. The number of films per examination have been
determined from manuals of radiology"*15 and frompublished reports on radiographic techniques. The number of films assumed per esamination range from one to
five (including spot films), depending on the anatomicalpart ; the average is 2.6 as compared with an average of3 assumed by Laughlin and Pullman.l0 In most cases,
Webster and Merrill's1° values of skin dose have beenused. These are considerably lower than many of the
published values (e.g. Ritter, Warren and PendergrassL7) but are not as low as those of Ardran andCrooks.18 They are probably fairly representative of thebest present-day radiological practice but may be ?Ppreciably lower than the skin doses in average pracace-

46. The half-value layer of the incident radiation has
been assumed to be 3.0 mm of aluminium in all cases,
corresponding to an effective voltage of 33.6 kV- The
position of the marrow for each view has been determined from "A Cross-Section Anatomy" by Eycleshymer and Schoemakerle and the amount of marrow
included in the field estimated from reproductions
typical radiographs as found in manuals of radlographlcoftechniques.15'16 The percentage depth dose at the level
the marrow has been determined in each case fro111
depth dose tables published by Johns, Epp and Fedorul<,?O
their values being corrected for differences in focusskin distance and for shielding of marrow by the surrounding bone.. The absorption coefficient assumed forbone is not too Important since, for the quality of radiation used. the reduction in dose due to bone shielding isprobably less than 20 per cent in every case. No correction has been made for the fact that the marrow islocated in a trabecular bone structure since it has been
estimatedz1that the increase in marrow dose due to proximity of bone is not inore than 5 to 15 per cent for radiation of diagnostic quality.

47. The product of the skin dose, the corrected percentage depth dose and the fraction of active marrowassumed to be in the field gives the contribution to themean marrow dose for each location of marrow. Calculation of dose by this method gives values somewhat
lower than measurements of marrow dose reported byJones and Ellis2' but are not in serious disagreement.
The calulated doses are in good agreement with somepreliminary measurements by Laughlin et al.'? of thedose received by the marrow of the vertebral column
during a photoffuorographic chest examination.

48. The estimates of mean marrow dose from fluoroscopic procedures are much more uncertain than thosefrom radiography. Skin dose rates of 5 r per minute and
10 r per minute have been assumed for radiologists andnon-radiologists respectively, and the total time of fluoroscopy taken to be two to five minutes depending on ex-

amination. For a country, such as the United States,
where the number of examinations by non-radiologists
is high, the annual contribution from these examinations
to the per capita mean marrow dose can be estimated tobe between 10 and 20 mrem. In the examinations madeby radiologists the fluoroscopic contribution to the percapita mean marrow dose is less important although theindividual dose from this practice in =treme cases may
be very high.
49. From the mean marrow dose. calculated under
the simplified assumptions specified above, a per ca.pita
marrow dose from each type of examination has been
estimated, assuming an average frequency of each examination fairly representative for countries such as theUnited Kingdom, the United States and Sweden. The
breakdown of the total by type of examination is given
in table 11.
50. It is apparent from the table that the highest contribution to the per capita mean marrow dose comes fromexaminations of the gastro-intestinal tract and that mass
chest X-ray surveys are of relatively much greater importance here than they are in the case of geneticallysignificant dose. The sum of the contributions in thetable is approximately 45 mrem/year and after allowancefor the contribution from fluoroscopy, the per capita
mean marrow dose might be of the order of 50-100 mrem
per year, somewhat lower than the Australian estimate"and current British estimateP3.
51. The mean marrow dose per examination in mass
chest X-ray procedures has been measured by several
investigators, who report doses between 70and 120 mrem

TABLE
11. ANNUALPER CAPIT.4 MEAN LIARROW DOSE FROM DIAGNOSTIC
X - R A Y EXPOSURE (EXCLUDLVG FLUOROSCOPY)(Figures based upon an assumed average practice, cf. text)
manow

N o . exom.
9erl.OW(mrcm)

IOU
pop.

Mcon

dmc

No.

vim5

Eraminolion

1. Lower femur.. ....... 1 AP
2. Hip and femur.. ..... 1 -4P
3. Pelvis.. ............. 1 . w
4. Lumbe-sacral. ....... 1 AP
5. Lumbar spine.. ...... 1 AP
6. Dorsal spine. ........ 1 AP
7. Inuav. pyelography.. 5 l\P
2 AP
8. Retrog. pyelography.
1 AP
9. Urethrocystography..
10. Pelvimetry ........... 1 AP
11. Salpingography....... 3 AP
12. Abdomen (obstetrical) 1 AP
13. Abdomen..
1 AP
14. Lower G.1 ............ 2 -4P
15. Upper G.I.. .......... 1 -4P
16. Cholecystography..
4 PA
17. Chest.. ............. 1 PA
18. (a) Ribs and sternum. 1 PA(b) Shoulder.. ....... 1 P-4
19. Arm.. .............. 1
20. Foot.. .............. 1
21. (a) Skull.. .......... 1 AP(b) Cervical spine. . . . 1 r\P
22. Dental.. ............ 1
23. Mass min.b.. ........ 1 P-4.
.
.

..........

...

dAnnuol W~$itomMOW

daw(mrcm)+ 1 LAT+ 1 LAT+ 1 L.4T + 2 OBL+ 2 LAT+ 1 LAT + 1 OBL+ 1 LAT + 2 OBL+ 1 outlet + 2 LAT+ 3 PA+ 2 PA + 1 L-AT
+ 1 L.4T+ 1 LAT+ 1 L.4T+ 1 PA + 2 LAT+ 1 PA + 2 L.4T

" -4merican practice including about 100 examinations per year per 1,000 of total population gives a mean marrow dose of 8 mrem per cafifu and year. Britlsh practice involves only
20 examinations per year per 1,000 of total population, which corresponds to less than
0.4 mrem #r caPi!u and year. The asumptions on location of active marrow make estimatesfor shvll esDosure verv uncertain.
b See disiussion in text, paragraphs 51-52.

66

for good practice, with examinations involving only apostero-anterior vie^.^^*^^*^^-^^ In some countries lateralviews are taken in addition to the postero-anterior view.'3
Although the doses reported per examination might beconsidered as low estimates for the current practice,there are indications that it may be possible to reduce thisexposure considerably in the future.
52. The relatively high per capita mean marrow dosefrom mass chest X-ray examinations is due to the highirequency of this examination. Assuming 10 per centof the population examined each year the annual per
capita mean marrow dose from this type of examination
would be 10 mrem; however, certain regions report ashigh frequency as one examination per capita per year
which would result in the ten-fold per capita dose.
53. I n countries where fluoroscopy has not been replaced by photofluoroscopy for mass s u r v e y ~the, ~ annual
per capita mean marrow dose probably results to a highdegree irom these surveys and may considerably exceed
100 mrem.

Accuracy of estintutes
54. The Committee is in agreement with the suggestion of the ICRP/ICRU Study Group1 that since theaccuracy in estimating the annual genetically significant
dose to a "normal" population due to natural sources isabout r 25 mrem, the same absolute accuracy is satisfactory for a first estimate. at least, of the genetically significant dose due to medical sources. This means an accuracy of e 25 per cent for e.g. the United States andabout & 100 per cent for countries such as Denmarkand Sweden. I t is stated by Osborn and S m i t h w a t theestimate for the United Kingdom may be out by a factorof 2 to 10 and there is a factor of nearly 3 between theminimum and probable doses estimated for the UnitedStates.lo It is evident that the accuracy desired for evena first estimate has not yet been obtained: the eventual
objective should be to reduce the absolute uncertainty ofthe estimate well below that of the baclcground dose.
55. It is convenient to discuss the inaccuracies in theestimates which have been made of the genetically significant dose in terms of equation (8). As pointed out inparagraphs 21-22, the total number of examinations is
not very accurately known in countries where a largepart of the radiological work is done in private offices andeven by non-radiologists.
56. Estimation of the factor w,/w in equation (8)depends. as has already been said, on trvo considerations : (a)the age and sex distribution of patients receiving each type of examination and ( b ) the difference
between the child-bearing expectancies of class jk andclass k as a whole. There does not appear to be any
evidence on the latter point. However, for most typesof diagnostic examination wj, may not differ greatly
from wk. Further, it is only for the six or seven examinations which make the largest contributions that a difference between w,r and wkcan affect appreciably the estimate of genetically significant dose.
57. The determination of the distribution of the total
number of examinations on various exposure classes andon age and sex groups must be made by sampling procedures. This is difficult to carry out satisfactorily unlessa high percentage of the examinations are made out at a
relatively small number of hospitals.
58. The same difficulty is related to the estimate of arepresentative average gonad dose per examination. As
the gonad dose per examination varies from hospital

to hospital it is very f i c u l t to give an average with agood accuracy. This is probably the main source of uncertainty to the calculated genetically significant dose andthe per capita mean marrow dose. Values o i the gonaddose per examination as measured in various countries
are collected by type of -amination in appendis XI.
59. Another source of uncertain5 in the per capita
mean marrow dose is the scant information on the distribution of active marrow.

Redrrctioft of gonadal dose

60. From an international point of view, the mostserious criticism is the fact that to date, estimates areavailable for only six or seven countries. Fortunately,
the have been made for some of the countries in which
medical exposures may be expected to be highest.
that
61. It has been demonstrated1*g*13*1~~~8f2*2~a6*a1
gonad doses can be reduced very decidedly by improved
techniques (e.g., by a factor of 50 to 100) for some cuaminations of males. The greatest attention must be
paid. of course, to the six or seven esaminations which
contribute the largest significant doses. Methods havebeen pointed out by the ICRP.'J3
62. The following is quoted from the report of the
ICRP/ICRU Joint Study Group :l" 1. Currettt Recomniendations"Equipmeat for fluoroscopy"The fixed total filter equivalent value should be atleast 2 mm aluminium, and should be based on thevalue obtained at the highest voltage of the X-ray
apparatus.
"The use of a timer to measure the fluoroscopy timeis recommended.
"Procedure for fltcoroscop y"Before a fluoroscopic examination is begun, theeyes must be sufficiently dark-adapted. In order towork with the lowest possible dose-rate, the adaptation period should be at least 10 minutes. A smaller
time may be used if there has been preliminary
adaptation using red goggles.
"Eqrtipnzeltt for radiography" A total filter of at least 2 mm aluminium should
be used.
"An automatic switch should be incorporated.
"Other types of diagnostic work
"Dental radiography"Fluoroscopy is strongly deprecated.
"klobile diag,rostic equipment"All transportable equipment should be provided
with cones or with other restricting devices so that thesmallest anode s k i distance is normally at least 30 cm(12 in.).
"It should be noted that damage has occurred toworkers and patients from contact radiography.
"At least 1.5 mm aluminium equivalent should be
provided as a fixed total filter.
"Fluoroscopy should be used only if the eqtlipmel?t
meets the requirements recommended for fluoroscoPlc
equipment.
"Protection of patients"General rules"By X-ray protection of the patient it is meant thatthe radiation exposure of the patient should be-reduced as much as is compatible with successful dlag-

nostic investigation or therapeutic treatment. In thecase of non-malignant diseases, therapeutic treatment
shall be employed with caution. I n all therapeutic anddiagnostic exposures, the integral dose should be kept
as low as possible in order to protect the patient asmuch as possible from the radiation. Moreover, forthis purpose, the tube-current, or the mAs value, andthe number of examinations should be kept to a minimum. An automatic timer should indicate the lengthof the diagnostic or therapeutic exposure. In all diagnostic investigations, the beam that strikes the patient
should have a cross-section no larger than is essential
for the investigation. This is of articular importancein fluoroscopy. In all irradiations the gonads should beprotected as much as possible by collimation of thebeam or by protective screens. I n the case of children,
it is important, in view of the little known action ofradiation on
tissues, to be cautious about repeating diagnostic examinations and to avoid too frequent systematic esarninatiorls of the whole of thebody.
"Exposzire ijt diag,rostic CZa?71i?Zati0lls"For ease and clarity in the consideration of
exposures received in diagnostic work, it is recommended that tables be set up giving doses for radiograpy and fluoroscopy of lung, stomach, intestines, etc,
Integral dose should also be taken into account as it
gives a much clearer picture of the true exposure.
Special attention should be given to the possible hazards to pneumothoras patients who. as a result of themany screenings after each inflation, may receive large
doses. The screenings should be replaced in part byradiographs.
"Radiation certificate"In view of the continually increasing medical andtechnical use of ionizing radiation, it is desirable toaccumulate information regarding the doses received
both by individuals and by the population as a whole.
As far as the indiyidual is concerned, the information
could be obtained by the introduction of a certificate
in which are recorded details of all radiation exposure(medical and occupational) received through life.
Probably it is impracticable to introduce such a certificate at preset, but it is recommended that all radiologists and dentists keep records of the doses given,and the field sizes and radiation qualities used. in all
diagnostic procedures. ( I t is presumed that suchrecords are already available in the case of therapeutic
procedures.)"2. Reco?nmendaiions regardi?lg the followi~zg
items are tcitder consideration" ( a ) The provision of specially designed protective devices for the gonads of patients.
" ( b ) Additional recommendations regarding minimum film-focus distances.
" ( c ) Increasing the protective requirements fordiagnostic and therapeutic tube housings.
"(d) Improvements in beam collimation.
" ( e ) The pro~isionof permanent filters of at least
2 mm A1 equivalent on all diagnostic X-ray tubes.
"(f) The ad\-antages of using high voltage techniques for diagnostic J\-ork.
(6') The provisionercposure counters on all
diagnostic equipment.
''(12) The use of image intensifiers to reduce thedose to the patient, and consequently to the operator,"

rather than as a means of permitting more extensive
and prolonged fluoroscopy than hitherto.''63. It is improbable that there will be great improvement in accuracy of estimation of gonad doses until therange of actual doses is reduced appreciably by conscientious adherence to procedures as have been recommended by the ICRP. In this connexion it is probablethat the "feedback" suggested by the ICRP/ICRU
Study Group is already operating, i.e., the attention toestimation of the genetically significant dose is already
reducing the dose.
64. Reduction o i gonad dose may also be obtained in
the future by means of improved radiological equipment
and supplies, e.g., faster films. faster screens, etc. The
advantage to be gained by increased use of image amplifiers has already been pointed out by the ICRP/ICRU.l
65. Finally, reduction in gonad dose can be achievedby a reconsideration by the medical profession of thecircumstances under which X-ray diagnosis is appropriate. This could be facilitated bv statistical informationon the significance of each aimination class for the
reduction of any specified morbidity. When medical
decision has been taken, administrative co-ordination
should be improved between authorities who require thatcertain examinations be made in the routine health surveillance of whole populations or special groups such as
school-children, students, employees, immigrants.
66. The tables in appendix XI point to the possibilityof carrying out some examinations at much lower gonad
exposure levels than are likely to be obtained in the
average case at present. The annual genetically significant dose that may be achievable without detriment todiagnostic information has been estimated to be less than
30 mrem for AustraliaZand 15 mrem for S ~ e d e n . ~Radiotherapy
Geiietically signijica~ztdose
67. S. H. Clark3' has estimated the genetically significant dose due to radiotherapy in the United States as
about 10 mrem per year. This figure, quoted by Laughlin
and P ~ l l m a n , is
' ~based on the assumption that treatmentof malignant conditions are not genetically significant.
I t may hence be an under-estimate. For Australia,
Martin2t3=reports an estimate of the contribution to thegenetically significant dose from radiotherapy as 28
mrem per year, assuming a normal child-espectancy ?fall surviving patients that were not assumed to be stenlized by the irradiation. Surrey by Purser and Quistss
yields an estimate of 1 mrem per capita gonad dose per
year in Denmark. I n the Danish survey it was found that
22 per cent of the genetically significant dose resulted
from treatment of malignant conditions, assuming thatthe patients treated for malignancies have one-fifth thechild-expectancy of normal individuals.
Bone nzarrow dose
68. I t does not appear possible to estimate T%-itbany
certainty even the order of magnitude of the per capita
mean marrow dose, due to radiotherapy, from the data
at present available to the Committee.
I~zfer?zallyad?riinistered radioisotopes
69. The principal contributions to the population dosefrom &e medical use of radioisotopes arise from the useof 113'and P3'which are most widely em~loved.Whileconsiderable quantities of -qu19Sare ;sed.-thG biologicalsignificance of esposure from this course is negligible

75. The age-distribution of the workers is usuallysuch that about 50 per cent are under the mean age o iHence. the genetically significant dose
~hild-bearing.~*'.~~
is approximately equal to the per capita dose. Averageannual doses ranging from 500 - 5,000 mrem have beenreported to the Committee as resulting from occupational medical exposure,~7*iciebut this esposure does
not refer to all installations shown in table 111. F o r
example, the exposure oi dentists or their assistants is
usually very
and most radiotherapy with X-rays
can be carried out under conditions ensuring good proAnnual average doses of up
tection of the pers~nnel.'~to 5,000 mrem refer to less than 0.2 persons per 1,000of the total population and result therefore in a percapita dose of less than 1 mrem per year, mostly from
X-ray diagnostic ~ o r k . ~ ~ * ' ~76. Medical radioisotope work is usually performed
with little exposure of the pers~nnel.'~An important
exception is the work with implantation of radium applicators and needles where the personnel may at present
be exposed to considerably more than 100 mrern per
week.so.66.~: This cuposure, however, involves only avery small group of people.

since A U ~ ~ generallyVSlimited to palliative treatment
of incurable conditions. Other radioisotopes are usedin very small quantities and aln~ostentirely for diagnostic purposes.
70. Estimates of the per capita gonad dose resulting
from the use of 1131 and P3Qan be based upon information about either treatments or radioisotope shipments, the first approach being more accurate and preferable.3i~39.40From the report of the ICRP/ICRU
Joint Study Group1 and other information available to~ ' ~ likely that the geneticallythe C ~ m r n i t t e e , ~it~seems
significant dose is lower than 1 mrem per year, evenin the countries ior which the highest figures can be
expected.
71. Some experience on the effects of ingesting radioactive substances relates to the early period when thehazard was not realized. The work with radioactive luminous materials was early recognized as hazardous if
not properly conducted:' but radioactive contrast media
such as Thorotrast were being used occasionally in
X-ray diagnostic work until a few years ago. The highretention of the radioactive material in the liver and thespleen resulted in rather high exposure, with dose-ratesof the order of 0.3 rem per day during periods ofyear^.'^*'^

Atontic erlergy workers
77. More complete and more accurate data are available for this group than for any other occupationally=posed group, since in countries in which atomic energy
establishments are operated, monitoring procedures havebeen set up to cover exposed personnel.
78. The contribution from =posure of atomic energy
worlters to the genetically significant dose to the population is about 0.1 mrem per year or less in countries forwhich it has been estimated.4i~46*51~s2
However, since thenumber of atomic energy workers is =petted to increasein the near future, this figure may increase in proportion.
79. The figures in table I V have been taken from a report of the United States Atomic Energy Commissiot~.~~111. IXDUSTRIAL
ASD RESEARCHUSES OF X-UYS ASD
RADIOACTIVE bf ATERIALS

Occtrpaiional exposure
72. The exposure from industrial and research usesof X-rays and radioactive materials is mainly an occupational one. The estent to which non-occupationally
exposed individuals are esposed depends upon the degree of environmental contamination. The latter problem
is treated in annes D.

T;IBLEIV. EXPOSURE
OF ATOMIC ESERGYPERSONNEL IN THE UNITEDSTATESOF AMERICA

Medical workers
73. The countries reporting on the number of persons
in medical radiologicalhave presented
figures ranging from 0.17-4.69 per 1.000 of the total
population. Ilowever, in many cases it is not clear what
has been meant by "medical worker".

( a ) Exposure of A.E.C. contracfor persotrnel
to penetrating radialion (1955)
Annual dose (mrcm)

0- 1,000
1,000- 5,000
5 , ~ 1 0 , ~ 0
10,0~15,000>15,000

74. The following table shows the extent of X-ray
work in New Zealand's and Swedeni' and gives anidea of the relative number of various installations incountries with =tensive medical facilities.

I957

Type of inrfdlalion

0.14
0.02
0.24

0.15
0.01
0.40

0.46
0.03
0.93

0.02

-

-

-

TOTAL
ALDICAL
0.42
Shoefitting ............... 0.03
Veterinary.. ............. 0.01
Industrial. .............. 0.003
Research and educational.. 0.01

Year

1.42

0.004
0.02
0.03

iiighest dose
(repn)

1947 .................... 23.5
1918.. .................. 20.3
1949 .................... 13.6
1950 ....................
9.0
1951 ....................
7.1
1952 .................... 15.7
1953 .................... 12.9
1954.. .................. 27.8
1955.. .................. 17.9

-

0.56

94.2
5.2
0.5
<0.1
<0.01

100.0

(b) Highest accumulated yearly doses lo individual
A.E.C. contractor employees during routine operations(accidents excluded)

Sxeden. 1955

Number of
Number of
Number ofpzaqils per
planls pcr crposcd vurfins~.ooOofI , W ofpcr 1.000 of
totai$opulalM; total poprrbfion foldpopulalron

Diagnostic.. .............
Therapy ................
Dental.. ................
Chiropractors andnaturopathic...........

Pnrrnlage

56,708
3,157
285
41
3
60,194

TABLE
111. N U A ~ B E
O FRX-RAY IXSTALLATIONS,
bz ~ ~ n d .

N u n k of rorkus

0.01
0.06
0.02

69

Average of 10
highest dosu
(rent)

5.2
1.2
2.6
2.2
1.8
2.9
3.4
3.9
4.1

Itdustrial and researclt workers
80. The information on exposure of industrial andresearch workers is less complete than the information
on exposure of the other occupational group^.^^'"^^'^*^^
As is evident from the relation between the number of
persons and number of plants in table 111, the concept"research worker" is not well defined. If the exposure
is assumed to be equal to that in the group of medical
workers, the contribution to the population dose is lower,
because of the smaller number of workers. Industrial
yradiography is one of the main sources of exposureof this81. A speaal occupational problem is the exposure ofworkers in mining and milling radioactive materials suchas uraniurn.*8*54 If not properly conducted, this work
may involve considerable hazard to the workers.

82. From the information surveyed above, it appears
that the contribution from occupational exposure to thegenetically significant dose is less than 2 mrem per year

for most countries. Despite the fact that this contribution is relatively small and the corresponding contribution to doses significant for somatic injury is also small,the exposure of radiation workers merits special attention for two reasons : ( a ) there n4l be a considerable
increase in the near future in the number of atomic
energy employees in many countries, and ( b ) individual
exposures may be high even though the contribution to
the mean dose of the population is small.
83. Methods for reducing the occupational exposure
have been pointed out by ICRPISand ILO.SS
IV. OTHER
MAN-MADE SOURCES OF RADIATION
81. Watches and clocks with radioactive luminous
dials give an annual genetically significant dose of about
1 mrem.46*"X-rays from television receivers contributeless than 1 mre~n.'~X-rays from shoe-fitting fluoroscopes contribute still less, as they normally expose a
relatively small number of i n d i ~ i d u a l s . ~(However,~~'~~~~
they might be an important hazard to the exposed individuals, see reference 64.)

DATA FOR EVALUATION OF THE GENETICALLY SIGNIFICANT DOSE
F'RORl DIAGNOSTIC X-R4Y EXPOSURE

APPENDIXIAUSTRALIA
The data on gonad exposure in Australia have beentaken from papers by Martin21S6.The author has rear-

ranged his material for the purpose of this report.
Martin's estimate of the annual genetically significant
dose is unusually high. This is mainly due to the highper capita number of examinations, which the author
has assumed to be 60 per cent higher than the number
for England and Wales (cf. paragraph 40).

(See Appendix I. Table I on page 71.)

. . . . .

6 : : : :- ZQ s a s s

E?

o

0 h

=-23

I

ci +

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dInM-In
GOOmd

n99994q?8a2

ooooeoooooc

~8

c c

.B::::.-c .. .. L =e
Y

.

.

.

.

C

.

.

.

.

5 : ;gzKKo e ~ g g''02 $
~ ~ g

<uhEX

.

3

--

-

AFJPEXDIX
I1
AUSTRIAThe data submitted by 4ustriaS do not permit a presentation according to Equation (8). The folloiving
information is giv& :I

d , fmrcm)(A) Radiography:
Pelvis, hips. lumbar_spine - 6 . &-Abdomen, colon, genitoun'nary
Pelvimetry, obstetrics.,..............

7.5

40-240 (AP) 6-24 (-4P)
20-80 (Lat) 8-30 (Lat)
6,000,- 0.75 -- 200 (AP)- - - 1,000 (Lat)
Other classic techniques. . 52
60

12,000-i

10Tomography.. .........
0.152
2
Other special techniques..
O.i5
Dental.. ............... not known
10-10010-1002
1
Mass surveys.. .........
7.5(B) FIuuroscopy:
hlass surveys.. ......... negligible310
not h o n n not knouvn
Other examinations..

-

...

-

From the above data, the per capita gonad dose fromdiagnostic X-ray exposure is estimated to be 16-25 mrem
per year.
APPENDIX
I11
i ':rDENMARKThe pritnary ntaterialIt

1. The following estimate of the genetically significant dose from diagnostic X-ray procedures in Denmarkis based upon data published by Hammer-Jacobsen.' The
author assumes the annual number of examinations in
Denrnarlc to be 1,000,000 plus 1,000,000 mass chest

photofluoroscopies. The data are assumed to be representative for 1956 (the dose-measurements were madeduring September 1956-February 1957).
2. The examinations cover the total practice withradiography and fluoroscopy combined. However. thedistribution of examinations with respect to type andsex is as observed in one hospital in which about 5 percent of the total number of examinations are performed.
3. The author estimates a per capifa dose of 26 mremfrom the above data, but considers that this may be aminimum estimate.
4. No data on foetal exposure are given. The author
estimates the foetal contribution to the total per capita
dose in proportion to the relation foetal/female contribution given by Osborn and S ~ n i t h . ~Presentation of the nratmial for this report
5. The Danish data include values for Nj and dl inall cases needed for an estimate of Dj.
6. No values for w,/w are given. The values for wj/w
presented in the table for England and Wales have beenused as substitutes in the first approximation. This gives
female and male contributions of 5 and 8 mrem to thegenetically significant dose, as compared to the author's
per capita doses of 7 and 15 mrem respectively.
7. If the foetal contribution is taken in proportion to
the female contribution and the ratio 72.2 per cent fromthe British report is used, the foetal value will be 4 mrem.
This seems, however, to be a low value, as a back calculation by help of the known value of wj/w for the
foetus, implies a foetal dose of, e.g., less than 500 mrem
per examination from pelvimetry, whereas other countries report values ranging from 2,500-4,500 mrem.

DATAFOR EVALUATION OF THE GENETICALLY SIGNIFICANT DOSE FROM DIAGSOSTIC X-RAY EXPOSURE
APPEXDIX111. TABLEI.
DENMARK
Molu

Fcmoks

No.

T>*c of crominolion

1.OW

N I/N

dl
mrcm

wj/w

Di

mrrm

1.000

NI/N

dl
mrcm

Tot&
=i/m

Dj
mrcm

Di

wrm

Dl

b n ccnl

0.7
0.09
2.2
911
2.5
54
1. Hip and femur.. ................
4.3
3.25
1.7
0.6
0.7
0.00
2.
"Knee and aus". ..............
0.9
0.13
2.5
527
0.7
195
3. Pelvic region. ...................
97
4*(~umbarspine. ..................
3.1
206
0.6
0.42
4.3
5.
2.2
20
6. Dorsal spine.. ...................
1.1
14
0.7
0.01
4.3
948
4.3
525
0.8
1.81
7. Intraven. pyelography.. ..........
0.9
2,400
0.4
1,060
0.8
0.34
8. Retrograde pyelography ..........
"Urethrocystography" .........
0.0
430
0.00
0.4
3,450n
0.3
0.04
0.4
4,720
0.4
406
9.( "Cptogr. dur. micturition*'. . . .
0.9
1.51............. 2.2564
10. Pelvimetry.. .....,
1.1
0.18
0.9
183
11. Hysterosalpingography ...........
1.8
0.64
2.0
177
12. Obstetrical abdomen. ............
0.4
567
0.4
19
0.6
0.02
13.
"Abdomen, A. P., urin.". .......
0.2
0.02
4.3
37
4.3
19
"Bariumenema". .............
14.
0.4
0.02
7.4
19
7.2
8.4
15. "Barium swallow and meal". ....
0.2
0.01
2.0
1.7
4.0
14.5
16. "Gall bladder". ...............
1.3
0.00
34.6
0.33
0.07
"Chest" ...................... 36.0
34
0.5
0.01
4.5
"Chest, special". ..............
3.8
5.0
0.20
0.7
0.00
2.2
2.0
0.03
"Shoulder" ....................
18ll.1 "Ribs and sternum". ...........
0.2
0.15
0.4
0.00
0.4
0.45
19.
".km and hand". .............
5.8
0.05
1.1
0.00
9.4
0.24
20.
"Foot" ........................
2.9
0.6
1.0
0.00
4.7
3.25
"I-Iead". ...................... 14.8
0.2
1.5
0.00
17.5
0.8
21.{ "Teeth" ......................
1.0
0.00
1.8
4.4
1.3
0.8
0.5
0.00
3.8
1.6
"Cervical spine". ..............
4.0
0.17
0.5
0.00
22. Dental.. . . . . . . . . . . . . . . . . . . . . . . .
23. hiass min. radiography. .......... 110
0.15
1.3
0.02
110
0.25
SLT-TOTALS 5.25
Allo\x-ance for foetal exposure, assumed to be 72.2% of female contribution. .................

-

-

-

-

The dose 3,450 mrem for m2les in item 9 is an average of dose measurements from 7 male adults urethrog-raphygraphy2 male adults cystopphy.

++ 1 boy urethro--APPENDIXIV
E N G L A N D A N D WALES
The pri?nary ntaterial
1. The Committee has not received material uponwhich it can base an estimate of the probable geneticallysignificant dose for England and Wales. I t is, however,possible to give a lower limit under certain assumptions.
The primary figures (for radiography and fluoroscopy
combined) have been taken from a report by Osborn
and Smith (1956).5 These authors have used values forthe gonad dose per examination published by Stanford
and Vance (1956).5* They computed the product N;
w; d; using the follotving statistics:( a ) The total number of diagnostic =aminations per
year based on official figures.
( b ) The distribution of examination with respect totype, age and sex in what was believed to be a representative sample of hospitals.
(c) The child-expectancy derived from official statistics and assumed not to be influenced by the natureof the condition for which the patient was esamined(except in the case of hysterosalpi~gograph~).

2. An estensive British survey of the diagnostic e s posure in the United Kingdom is at present being made,5B
but no data are a~ailablefor this report.
Presentation of the material for this report*
3. After division by wN the values reported by
Osborn and Smith may be taken as approsirnate lower
limits of the contributions to the genetically significant
dose for England and Wales. The values of w,/w foreach examination class have been caIculated from the
known values of Nj/N, dj and the approximation of
Dj, and should depend only upon the age-distribution
within the class following the assumption under 1. ( c )above.
*These calculations are based on available figures which insome cases have been "rounded off" in publication. The results
are therefore approximate and, although adequate for thepresent purpose, are less accurate than could be derived from
calcul~tionsbased on the original data.

NUMBEROF E-WIINATIONS PER 1,000 OF TOTAL POPULATION(1000 N;/N)

ENGU~
AND WALESAPPENDIXIV. TABLEI.
Exam.
No.

Fcmalcs( d l ages)

Malet(all n;u)

ForlJ g o M d r

1.
2.
"Hip and femur".
3. Pelvis .............................
4.
5.
"Lumbar spine". ................

................

6.
7.

8.

"Thoraac spine". ................
"Pyelography" ...................

.......................
......................

9.
"Bladder"10. Pelvimetry..
11. Salpingography ....................
12.
13.
"Abdomen with obstetric".
14.
"Barium enema".. ...............
15.
"Barium swallow and meal". ......
16. Cholecystography
17. Chest.. ...........................
shoulder". ...
18. "Ribs and sternum
19.
m..... .........................
20. Lowerleg .........................
21.
"Mead
cervical spine". .........
22. Dental ............................
23. Llasssurveys ......................
24. Others.. ..........................

.......

..................

+

.-

+

Including 1.91 obstetrical.
Including alloa-ance for possible pregnancy in non-obstetric abdominal examinations.
Large film.
G Sial film.
6 t h exam. a t hospitals.

RELATIVECHILD EXPECTANCY(.r;/rv>
APPENDIX

IV. TABLE11.

ENGLAND
AND WALES

Exam.
No.

Females(all ores)

1.
2. "Hip and femur". ................
0.75
3. Pelvis.. ...........................
0.93
4.
5. "Lumbar spine". ................
0.63
6. "Thoracic spine". ................
0.67
7.
8. "Pyelography".. .................
0.81
9. "Bladder" .......................
0.30
10. Pelvimetry.. ......................
0.94
11. Salpingography ....................
1.07
12.
13. "Abdomen with obstetric". .......
1.08
14. "Barium enema". ................
0.22
15. "Barium swallow and meal". ......
0.40
16. Cholecystography.. ................
0.16
17. Chest .............................
1.3/0.50
18. "Ribs and sternum
shoulder".
0.38/0.67
19.Arm ..............................
1.1
20. Lower Leg. .......................
0.98
21. "Headcervical spine". .........
1.5/0.52
22. Dental.. .......................... 0.53/1.0
23. hfass surveys.. ....................
1.32
24. Others.. ..........................

+

...

+

Maks
(all ages)

Foctd goMdr

1.13
0.56

2.36

0.83
0.80

u

0.53
0.23

u

-

-

1.54
0.58
0.43
0.28
1.3/0.85
0.74/0.88
1.5
1.2
1.6/1.1
0.37/0.87
0.88

2.36

u

CI

Y

u

U
Y
U
C

Y

u
a
Y
C
U

(See footnotes to table I).

GONAD DOSE PER EXAMINATION(d; in mrad or mrem)
APPENDIXIV. TABLE
111.
ENGLAND
AND WALES
Fcmalcs(all ogrs)

&am.

No.

1.
2. "Hip and femur".. ...............
. 3. Pelvis.. ..........................
4.
5. "Lumbar spine". ................
6. "Thoracic spine". ................
7.
8. "Pyelography" ...................
9. "Bladder" .......................
10. Pelvimetry ........................
1 1. Salpingography ....................
12.
13. "Abdomen with obstetric". .......
14. "Barium enema". ................
15. "Barium swallow and meal". ......
16. Cholecystography ..................
17. Chest .............................
18. "Ribs and sternum shoulder". ...
19. Arm.. ............................
20. Lower leg.. .......................
21. "Headcervical spine". .........
22. Dental.. ..........................
23. Mass surveys.. ....................
24. Others.. ..........................

++(See footnotes to table I).

Mnks(all arcs)

F&ANNUALGENETICALLY SIGNIFICANT DOSE
(D; in mrem)
APPENDIX IV. TABLEIV.
ENGLAND
AND LVALES
Fmdes(all ages)(aU arcs)

0.82
0.51

4.18
1.60

2.34
0.02

0.56
0.03

8. "Pyelography"............... 2.33
9. "Bladder".. ................. 0.08
10. Pelvimetry. ................... 0.65
1 1. Salpingography ................ 0.24
12.
13. "Abdomen with obstetric". ....
14. "Barium enema". ............
15. "Barium swallow and meal". ..
16. Cholecystography..............
17. Chest.. .......................
18. "Ribs and sternum - shoulder"
19. Arm ..........................
20. Lower leg. ....................
2 1.
"Head cervical spine". .....
22. Dental.. ......................
23. Mass surveys.. ................
2 4 Others.. ......................

0.67
0.02

Pn vnl

M&s
Foc!d

T d

aftold1.

2. "Hip and femur".. ...........
3. Pelvis. ........................
4.
5. "Lumbar spine" ..............
6. "Thoracic spine". ............
7.

-

+

TOTAL

The pritnary material
1. The estimate presented here is based upon datasubmitted by Reboul and Istin." The authors assume theannual number of radiographic examinations in France
to be 5,000,000 plus 1,300,000examinations of employees
and militaries. The distribution on various types of
examinations is studied on 18.889 cases. The data are
assumed to be representative for 1957.
2. The authors point out that the foetal exposure due
to pelvimetry and obstetrical examinations is lower inFrance than in other countries, due to the low frequencyof these examinations.
3. 28,000,000 flrtoroscopies are performed annually,
19,000.000 of which are examinations of patients underage 30, mostly in mass chest examinations. There are
only 2,000,000 photofluoroscopies per year. The gonaddose from photofluoroscopy has been estimated by
Turpin, Dupire, Jammet and Leje~ne.~O
4. The authors consider their values to be minimum
estimates.

Presel~tationof tlre material for this report
5. The French data include values of N, for the wholematerial, and the corresponding values of dl in mostcases. Where the dose is not reported, an average dose,
likely to be representative, has been used. These values
are indicated with an asterisk in the table.

6. Values for the relative child =pectancy (wj/w)
cannot be derived from the French data. However, anapproximate figure can be calculated from the inf ormation on the fraction of patients under age 30, for eachtype of examination. The approximate figures differ
little from the values of wj/w presented in the table
for England and Wales. Therefore, the British values
may be regarded as fairly representative also for the
French material, and they have accordingly been usedin the calculations.

7. The contribution from radiography, 27 mrem, ismost likely a very low estimate. An interesting featureof the French material is the remarkably high contribution of fllcoroscopy used in mass survey exa~ninatw~rs.
Because of the uncertainty with regard to average mewing time and other factors determining the dose per=amination, the total value 57 mrem must be considered
uncertain by at least a factor of two.

DATAFOR EVALUATION O F T H E GENETICALLY SIGNIFIC-U'T DOSE FROM DIriGNOSTIC X - K ~ PEXPOSURE
A.

L ' ~ ~ l J - 4 ~ COXTRIBUTION FROM j,000,000 RnDIOGR4PHIC EXAhlIXATIOXS(foetal exposure escluded)

APPESDIXV. TABLE
I.

FUNCE
Fcmclcs

No.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

lo00
NI/X

E x a m i d i o n s i d s i n ; radiography"Membres inf. 1/3 sup.". ............
"Bassin" (items 10 and 12 excluded)"Colonnes lombaires" ...............

di
mrem

w w

Males

Djw)

wen:

loo0

Ni/N

di

mrcm

Told
wi/w

D
mrcm

Dj

mrcm

Percent

1.59. . 3.30
2.43"Colonnes dorsales". ................ 1.70
"Urographies".. .................... 1.38
"Urhtho-Cysto" (not ind. item 11).
0.25

...

"Pelvimetries". ..................... 0.038"Hy~terogra~hies".................. 0.46
"Grossesses". ...................... 0.26.. 0.043............... 0.046........................... 0.28....................... 2.28..................... 0.5 1....................... 3.1 7
16. "Veeicules". ....................... 1.97........................ 20.7....................... 0.042................... 0.1 2................... 1.07
1.50........ 1.93.............. 2.41.......................... 2.57................... 0.94
22. 23. "Radiophotographies". ............. .240
TOTALS

B. ADDITIOS.~LCONTRIBUTION FROU 1 , 3 0 0 , 0 0 0 RADIOGRAPHIC EXAMINATIOKS OF EMPLOYEES AND MILITARIESContribution estimated in ~ r o ~ o r t i oton number of examinations, photofluoroscopy excluded. ............

5.2

19.3

0.2
0.4
27

0.7
1.5
100

C. ALLO\VANCEFOR FOETAL EXPOSURE
Estimate from British values in proportion to the frequency of esaminations
U X . : Dj (mrcm)

10. "Pelvimetries" ................................ 3.47
12. "Grossesses". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.73

U.K.:1000 S J NFrance: 1000 N I / N

0.58
1.94

0.038
0.26

T0r.u R4DIOGRAPEY:

D. COXTRIBUTION
FROM FLUOROSCOPY
19,000,000 esaminations under zge 30, with an average gonad dose of 30 mrem per esam. (mostly mass surveys)
1000 h',/N

23.

"Examens syst6matiques". ........................

452

dl (ivrcm)

30

wdw

2.21
TOTALDL4GP;OSTIC:

30
57

APPESDIXV I
JAPANThe data submitted by Japan7 do not permit a presentation according to Equation (8). The following
information is given :TyPo ojercminc!ion

lOC4 Nj/Ndi (mrem)(A) Radiography:
Chest, large film. ............ 109
Chest, tomography. ......... 57
Abdomen ................... 68
Mass surveys. .............. 260
Others ..................... 46( B ) Ruoroscopy:
Chest.. .................... 18-4bdomen ...................
22

were children. The age-distribution in the various typesof examinations is based upon a materid of 39,315
examinations.
3. The total number of =aminations for 1955 was
found to be 1.910,000. The annual increase during theperiod 1915-1931 was 15.5 per cent. The number ofmass miniature radiographs during 1955 was estimatedat 1,000,000.

4. In addition to the actually occurring doses, theauthor presents "possible" values iound after simple
measures to reduce the gonad exposure. If the indications for pelvimetry and obstetric =aminations are mademore restrictive, the achievable annual genetically significant dose that would result is estimated to be 15 mrem
instead of the value of 38 mrern found for 1955.
Preselttatio~tof the ntaterial for this report

From the above data, the per capita gonad dose from- 30
diagnostic X-ray e~posureis estimated to be
mrem per year.

5.
the original paper thesignificant
do, ,as calculated for each su; as an average dose per
productive eamete. The sum of these doses was taken
io espress "the radiation burden to the zygote. The
figures in the following table have been recalculated by
the author to conform with the presentation in thisreport.

APPENDIXVIINEW ZEALAND
1. No typosure data have been submitted from New
Zealand. but it has been re~ortedthat an extensive survey of 'diagnostic expos&e has been initiated. New
Zealand has full records of all diagnostic X-ray plants
in the countrv and a svstem of medical services that
permits a qu&titative issessment of virtually all diagnostic X-ray work done.
2. D~~~on the number of maminations have beenreported45to the Committee and are presented in table I
in the main text of annex C. A characteristic feature is
the high annual number of dental(0.24
per capita). 95 per cent of these are made on school
children between the ages of 12 and 16.
3. The frequency of mass miniature chest -amination (with an annual number of 0.09 per capita) is
reported together with the information that 23 per centof all notified cases of pulmonary tuberculosis are discovered by mass X-ray surveys, with a case yield of
about 1.8 per 1.000 examinations.

APPENDIXXU N I T E D STATES O F AMERICA
The pritrtary material

1. The estimate of the genetically significant dose for
the United States of America is based upon a surveyof literature up to about the middle of 1956, reported
by L u ~ h l i nand Pullmanlo. In the report, which is only
preliminary~the authors have computed the probableannual gonad dose per person up to age 30 years. They
also give a ~ ~ t i n i f ~ t estimate.
zrt~z
2. The most characteristic feature of these data isthat the surveyors have listed radiography and fluoroscopy separately and, in the case of fluoroscopy, also
separated radiologists' examinations from those of nonradiologists.
3. The primary material of the Laughlin-Pullman
report is shown in the tables I to VI, with regard to
the estimate of the probable dose. The probable percapita gonad dose Up to age 30 is found to be about
140 = 100 mrem. The minimum estimate is 50 i 30
mrem.

APPEXDIXV I I INORWAYme data submitted by ~~~~~~6 do not permit any
estimate of the genetically significant dose. ~~~~d doses
have been measured by Koren and M a ~ d a l ;their~~annual consumption of X-ray films is 1.1 per capita, thevalues are included in the tables in appendix XI. As thecontribution from diagnostic X-ray procedures to thegenetically significant dose is likely to be high enough towarrant more detailed analysis, which is reported to beplanned.

Preserztatiort of the rrraterial for this report
4. AS nothing is h-own about the actual child-espectancy of patients undergoing X-ray e.aminations, thefirst approximation has been to assume that it is not
influenced by the nature of the condition for which thepatient was esarnined. The value of w,/w for each ex*ination class would then depend only upon the age-dlstribution within the class. With this assumption, theannual gonad dose per person up to age 30 years may
be taken as an approximate figure for the annual genetically significant dose. w , l w has been calculated frpm
the known valuesof N,/N, d j and this approximah~nof D ~~t. has been necessary to assume that the dose per
czsarnination is the same for the two age-groups "12-29
years" and "over 12". Tables VII to XVI give the final
presentation of the material.

APPENDIXI X
SWEDEN
Tlre prittzary ntoterkl
The estimate of the genetically significant dosefrom diagnostic X-ray procedures in Sweden is baseda report by L a r s s ~ n The. ~ data are representative
for 1955.
2. Dose measurements were performed on 1.957 patients in 17 X-ray departments. Of the patients, 394'.

77

APPI':NL)IXIX.

DATAFOR EVALUATIONTAIILEI.

OF TIIE GENETICALLY

---

1.WO

0.14
Oa008
0.21

2GO
35
200

0.11
0.021
0.10

0.12
0.040
0.30

2.47

0.31

490

1.06

011

0.28

0.2

om40

0.020

926

1.40

0.22

1840
1080

0.11
0.28

0.011
<0.0006

'

2000

1.12

0.0036

"

285
1160
1620
20
16.8

0.M4
0.84
0.13
0.060

<OMH)6
0.030
0.10
0.17
0.017

4.1

0.003

2.2

2.4

0.6

0.008

4.4

<Ob <0.0064<(0.05227

6.8........... 2,04'~nlrnrcnoluumgn1,hy''.

I

400
1
280

................... 1.3 0.10................. 0.84 0.71............. 3.8 025. 3.6 0.42......... 0.20 028
10. Pdvimetry ................. 0.59 0.44
fl.30b
11. IIyslcr~lpingogrnyhy...... 1.2
12. Obaktrical nbdomcn ......... 0.59 0.44
13. "Abdomen sway" ..... ... 2.4
0.30
0.20
14. "Coluu" ................. 4.8037
16. "8tomach" ........... .... 17.1
10. Cholooys~rn~~liy........... 8.6 0.36
Chest". ..... ........ ... 41.0
0.37

I"laser lag, ~ U U
fore, nnc~

39.6

0.41

22. Don ....................... 128

0.41

21.

D;
(mrm)

G/w

0. Urclhrocyalqrnyhy:::d;(mrcm)

N;/N

j1Tl~orni~wino"

8.

1.m

(mrm)

) . ' L u m b a r n n d a l spine"

;:

D;

d;
(mrw)

1. "11i11"
2. "l~am~~r"
3. Pclvicmgion..
6.

Fminls dildrrn

NSN w'dw

Tws ofaantination

upper nrm. 1111nd.fool"..

X-RI\YEXPOSURE-

Fernole adultr

Nu.

SIGNIFICANT DOSE FROM DIAGNOSTIC

<<I

1.43

*

'

0.31

'

445
(910) d
1240

.

0.034

'

"
'
"

'

105

<<I

0.086
0.00
0.044
0.0007
0.013

<<Om7

* A correction of the normal anc-apccific ehilcl-upcctnncy has been mode hcre.
b Every three wornen arc crpected t o have n child nubsequently.
111nll cawo of foctr~lexDmure except pelvilaetry nnd obstetric111 nbdo~nen.1l1efoetrll co~ltributionhne h e ndcrivcd from the assumption that 5.6 pcr cent of tllc won~enin fcrtilc nuee wcrc pregnant.
d lrlcl~iclingtwo ~ ~ ~ l i 0 g r 0 1 over1 h 8 tile t r i ~ o n c .

NUMBEROF FEJI-LE

UNDER AGE 30 PER 1000 OF TOTAL POPULATIOS(1000n ,(')/N)

E-WMATIONSA P P E ~ I X.
X TABLEI.

USA
Radiography

Fluoroscopy

Exam.

No.

1.
2.
3'
4.
5.
6.
7.

8.

9.
10.
11.
12.
14.
13.
15.
16.
17.
18.
19.
20.
21.
22.
23.

2.54*

. "Skeleton-pelvic region". ............

2.810

0.35b

0.50'

1.11
0.71
2.26
0.08
0.62

0.301

0.28'

0.40b

,

1 "Pyelography". .....................

"Urinary tract". ....................
Pelvimetry.. ..........................
Salpingography.. ......................
Abdomen (obstetrical). .................

1"Abdomen and colon". ...............

-

Stomach and upper G.I.. ...............
"Gall bladder". .....................
Chest (lungs, heart, oesophagus). ........

(3.6)

3.26
3.53
0.81
9.5

" S k e l e t o n ~ t r e m i t i e sand chestp'. ....

(2.8)

3.26

}

(1.0)
(1.0)

Head.. ...............................
2.17
(2.0)
275'
Dental ...............................
35*.e
Mass surveys.. ........................(all age4 (0-29): 20.4

Pelvis and hips.
Heart.

b Lumbar spine.

--b Including 1/3 of all examinations of age-group under 2 years.
i Including 0.10 from chiropractors.

Including 0.09 from chiropractors.
d Each film counted as one examination.

(Figures in brackets b e bctn drrwcd by an arbitrary split of a$gure for a larger group o j examination-classes.)Children under 10 years.

FEMALEGONAD DOSE PER EXAMINATION(d,(q in mrem)
APPENDIX
X. TABLE
11.

USA
ibdiography

Flvorascopy

i b d i d o g u k andna-radidogists

Exam.

NO.

0-1 1

I

"Skeleton--pelvic region". ............

Radi&isls

12-29

0-11

Non+didonnsis
12-29

0-1 1

12-29

1

) "Pyelography". .....................
.....................

"Urinary tract".
Pelvimetry ............................
Salpingography ........................
Abdomen (obstetrical). .................

1
I

\

20.
21.
22.
23.

J

"Abdomen and colon". ...............
Stomach and upper G.I..
"Gall bladder". .....................
Chest (lungs, heart, oesophagus). ........

...............

"Skeleton-xtremities

and chest".

....

.

.

Head.. ...............................
(60)
Dental ................................
4.
Mass surveys.. ........................(all ages 0-29) :* See footnotes to table I.

0.2
2'
3

5

(30)

be looO

b The dose from chiropracto~has been a ~ ~ ~ m e d

USA
--

-

Radwgrrphy
Erarr..

NO.
1.

i!
5.
6.
7.

1

I

+I I

) "Abdomen and colon". ...............

::: }

0-11

12-29

G11

12-29

5.6b

0.7.

2.6b

1.0

-

0.1.

0.5.

0.6s

1.7.

2.6
1.5

5.3
3.2

0.8
0.2

1.P
0.4

O.0ls

0.01.

(0.04)

0.03

Chest (iungs, heart, oesophagus). ........

(0.4)

....

(0.03)

0.00(0.01)

0.00

0.00
1.10.129.5(0.01)

0.00

2.5

6

4aSkeleton-extrernitiesand chest".

(1.1)
(0.7)

2.6
1.4
11.2
1.6
0.3
3.2
2.1
0.3
0.01

Stomach and upper G.I.. ...............
"GaU bladder". .....................

20.
21.
22.
23.

12-29

&-on-radidopitlr

2.5.

" ~ h l e t o n - p l v i c region".. ...........

"Urinary tract". .....................
Pelvimetry.. ..........................
Salpingography. .......................
Abdomen (obstetrical). .................

13.
14.
15.
16.
17.

&dioloeOfs

non-mdiulogisls

1 "Pyelography". .....................

9.
10.
11.
12.

Flroroscopy

Radwlopis!~andHead.. ...............................
(0.02)
Dental.. ..............................
0.3'
hlass surveys.
(all ages 0-29):
TOTAL 6.5.........................

b Induding 0.2

See footnotes to table I.

4

9from chiropractors.

NUMBEROF HALE EXAblINATIONS UNDER AGE 30, PER 1,000 O F TOTAL POPUIATION(1,000 nlM/N)
APPENDIXX. TABLE
117

No.

:

1

E: j
3.

7.

8.

13'
14.
15.
16.
17.
18.

-

"Skeleton-pelvic

region". ............

"Skeleron-estremities and chest". ....

&I 1

12-29

0.40h

0.5ji

1.24

-

0.341

0.31'

8.99
1.19

2.02
2.43

0.44
0.29

0.53
0.67

0.25.

0.51.

(0.69)

1.60

-

-

(4.1)
(3.2)

3.63

(1.1)

0.10'

0.79

3.63
3.93
0.91
10.6

(1 .I)

0.05'

Head.. ...............................
(2.2)
2.42
Dental ................................
33**=
1724
Mass surveys.. ........................(all ages 0-29): 16.7

Pelvis and hips.
b Lumbar spine.

Including 0.09 from chiropractors.
d Each film cwnred as one exam.
Children under 10 5-ears.
Geni to-urinary region.
f

12-29

3.11°

"Pyelography" ......................

Stomach and upper G.I.. ...............
"Gall bladder". .....................
Chest (lungs, heart, oesophagus). ........

1

0-1 1

0.45b

} "Abdomen and colon". . . . . . . . . . . . .
I

12-29

2.85.

"Urinary tract". .....................
Pelvimetry ............................
Sal pingography .. :. ....................
Abdomen (obstetrical). .................

9.
10.
11.
12.

20.
21.
22.
23.

0-1 1

USA

u Heart.

b Including 1/3 of d l exams. of age-group under 2 years.

Including 0.1 1 from chiropractors.
(Figrrres i n brackets have been derived by an arbitrary split of a
j'igirre for a larger group o j cxan;inafionclasses.)

&IALE GONAD DOSE PER EX4JIINATIOS(dl in mrem)

APPENDIXX. TABLE
V

USA
Radiography

h%.
NO.

1. '
2.
3.
4.
5.
6. ,

0-1 1

region". ............

I "Pyelography". .....................
"Urinary tract". .....................
Pelvimeuy.. ..........................
Salpingography ........................
Abdomen (obsteuical) ..................
"Abdomen and colon". ...............

1

12-29

Noa-raddcgists
0-11

12-29

2,000b2,000.

6,000'

2,000

2,O0OB

6,000.

2,o0Ob6,000"

750
500

750
500

2,000
600

750
500

20b

20a

(40)

10

300

-

-

-

Stomach and upper G.I.. ...............
"Gall bladder". .....................
Chest (lungs, heart, oesophagus). ........

(120)

200
200
10
1.2

and chesty*.....

(120)

1.O

(40)

5

0.6
8.
1

(a)

5

: ]

20.
21.
22.
23.

0-11

2,0ooa

9.
10.
11.
12.
14.
Is.
15.
16.
17.

Radido~~s:~

12-29

1,100*"Skeleton-pelvic

7.

8s

Fluoroscopy&d~ologirfsand
non-rad;ologirts

dSkeleton-ruemities

(750)
(750)

Head .................................
(120)
Dental ................................
12.
&lass surveys. ....................... ..(all ages 0-29):

See footnotes to table I.

The dose from chiropractors has k e n assumed to be 2,000
rnrem/exam.

ANNUAL MALE GONAD DOSE PER PERSON UNDER AGE 30n,(M)(1.98 X

X dlMin mrem)

APPENDIX X. TABLE
VI.

USA
Radiograph3
Radiologists andnon-radiologists

Exam.
No.

Fluorarcopr
Rodiologisis'"
Urinary tract". .....................
Pelvimetry ............................
Salpingography ........................
Abdomen (obsteuical). .................
"Abdomen and colon". ...............

)
I

a

(1.6)

Stomach and upper G.I.. ...............
"Gall bladder" ......................
Chesr (lungs, heart, oesophagus). ........

(1.6)

and chest". ....

(0.8)

"Skeleton-xtremities
J

-

(1.o)

Head. ................................
(0.5)
Dental.. ..............................
0.8%
Mass surveys.. ........................ (all ages 0-29) :T0r.u.
14.5

See footnotes to table I.

b Including 0.4 from chiropractors.

81

Nan-radidogisls!A

NUMBEROF FEMALE EXA~~INATIONSPER 1000 OF TOTAL POPULATION(1,OOO.Nj(F)/N)
APPE~PIXX. TABLE
VII.
Flrcoaos~Rndiograflhy
Radidogisis andeon-radidogirts
Exam.
No.

0-1 1

"Skeleton-pelvic

USA

Rodidopitts

O m 12

1&*on-radiokuirfs

Oon 12I

Own 1213-11{

region". ............

,"Urinary tract". .....................
Pelvimetry ............................
Salpingography ........................
Abdomen (obstetrical). .................

} "Abdomen and colon". ...............
stomach and upper G.I.. ...............
"Gall bladder". .....................
Chest (lungs, heart, oesophagus). ........

I

1 "Skeleton-extremities and chest". ....

20.
21.
22.
23.

J

-

(1.0)
(1.0)
(3.6)
(2.8)

Head.. ...............................
(2.0)
Dental ................................
35
hiass surveys.. ........................ (All ages)

9.1
515
61

FEMALEGONAD DOSE PER EXAMINATION(djcF)in rnrem)

USA

APPE~IS
X. TABLE
VIII.
--

Rndionafhy
Exam.
No.

1.
2.
3'
4.
5.
6.

0-11

Radidorisls

O w It.

0-11'

Na-rndidozislro w 12'0-11

ODIr 12.

1,000

2,600b500" S k e l e t o n l v i c region". ............

1,000
1,300

7.

"Pyelography" ......................
8.
9.
"Urinary tract". .....................
10. Pelvimetry.. ...........................
11. Salpingography .........................
12. Abdomen (obstetrical). ..................

}

13'"Abdomen and colon". ...............
14.
15. Stomach and upper G. I.. ................
16.
"Gall bladder". .......................
17. Chest (lungs, heart, oesophagus). .........

:: }

20.
21.
22.
23.

Flnaorwpy

Rodidogish andnon-radidogists"Skeleton-xtremities

-

1,200

-

1,000
2,500
10,000
260

(550)
(350)
(60)

500
300
200
0.3

(60)
(60)

0.5
0.2

1,000

3,000

1,000

3,000

1,500

750

1,500
750

1,000
500

1,500
350

15

15

(30)

10

(30)
(30)

5
5

and chest". ....

Head. .................................
Dental .................................
Mass surveys.. .........................

-

4

7

(All ages)

I t has been assumed that the dose in the age-group over 12
years is the same zj in the age-group 12-29.

3

b

i

Weighted average including chiropractors' contribution.

RELATIVEFEMALE CHILD EXPECTANCY(n~l'F)/w)

APPEXDIXX. TABLEIX.

USA
Radiologish andmn-radidogisfs

Exam.
xo.

0-1 1

Over 12Rodidogisls
0-11

Non-rodidogisls

OoerIZ

0-11

Over 12/ 1~Pyelography17......................

"Urinary tract". .....................
Pelvimetry .............................
Salpingography .........................
Abdomen (obstetrical). ..................

I

-

-

...............

1.98
1.98

.........

1.98

....

1.98

"Abdomen and colon".
Stomach and upper G. I.. ................
"Gall bladder". .......................
Chest (lungs, heart, oesophagus).

I"Skeleton-extremities and chest".

Head.. ................................
Dental.. ...............................
Mass surveys.. .........................

1.98
1.98
(All ages):

Figures back-calculated from tables 11, 111 and VII.

F E J CONTRIBUTION~
TO THE AXNUAL GEKETICALLY SIGNIFICmT(D1(qin mrem)a
APPE,VDISX. T-~BLE
X.

No.

5.
6.

I

0-1 1

"Slteleton-pelvic

region".

}}......................

...............

"Abdomen and colon".
13.
14.
15. Stomach and upper G. I.. ................
16.
"Gall bladder". .......................
17. Chest (lungs, heart, oesophagus). .........

f:

20.
21.
22.
23.

1

"Skeleton-xtremities

and chest". ....

Head.. ................................
Dental .................................
Mass surv~ys...........................

Rndidogists
0-11

OorrIZ

Non-rodidogists
0-11

Ooa 1 2

0.7

2.6

2.5

5.6
1.0

......................

1

OFn I.?

............

7'"Pyelography"
8.
9.
"Urinary tract".
10. Pelvimetry.. ...........................
11. Salpingography .........................
17. Abdomen (obstetrical). ..................

USA
Fluoroswpy

Radiography

Rndidogisis andnon-mdidogists
Exam.

DOSE

2.6
1.4
11.2
1.6
0.3

0.1

0.5

0.6

1.7

2.6
1.5

5.3
3.2

0.8
0.2

1.4
0.4

(0.4)

3.2
2.1
0.3
0.01

0.01

0.01

(0.04)

0.03

(0.3)

0.00

(0.01)

0.00

0.00
1.1
0.1
29.5

(0.01)

0.00

2.5

6

-

(1.1)
(0.7)

(0.2)
0.3
()\I1ages):
TOTAL
6.5

Figures identical with those in table 111.

83

4

9

NUMBEROF K4LE EXUIINATIONS PER 1000 OF TOTAL POPULkTION(l,OOO.N,'"'/N)
APPENDIXX. TABLE
XI.
Radiography

Fluoroscopy

Radido ists andnon-rutdolists
a m .

No.

0-1 1

1. '
2.
3. ,
4.
5.
6.

USA

Rodidoyirls

Ouer 120-11

Non-rodidogisls

&e?It

0-11

Oon12

\

2.85
,#

Skeleton-pelvic region". ............
1

0.45

7.

8. ] "Pyelography". .....................
9.
"Urinary tract". ....................
10. Pelvimetry .............................
11. Salpingography .........................
12. Abdomen (obstetrical). ..................
13.
"Abdomen and colon". ...............
14.
15. Stomach and upper G. I.. ................
16.
"Gall bladder" ........................
17. Chest (lungs, heart, oesophagus). .........

(4.1)

and chcst". .....

(3.2)

)

:;: }

20.
21.
22.
23.

"Skeleton-xtremities

-

-

-

(1.1)
(1.1)

Head.. ...............................
(2.2)
33
Dental ................................
Mass surveys.. ........................ (..211 ages):

7.0
10.3
580
69

MALE GONAD DOSE PER EXUILWATION(dt(lf)in mrem)
APPESDIS X. TABLE
XII.

USA
Radiography

Eiom.

KO.

0-1 I

1.
2.
3.
4.
5.
6.
7.
8.

-)

9.
10.
11.
12.

"Urinary tract". .....................
Pelvimetry ............................
Salpingography.. ......................
Abdomen (obstetrical).. ................

20.
21.

22.
23.

&r

Radiologists
12.

.Volt-radidogisls
0-11

Oon 12-

2,000

2,000

5,200'~

2,OOo
300

2,000

6,000

2,000
600

750
500

(40)

10

bll

OWlZ.

1,100

, "Skeleton-pelvic

1
: }
14.
1315.
16.
17.

FIuor05~0pu

Radidogisls andnon-radidogislr

region". ............
2,ooo"Pyelography " ......................

"Abdomen and colon". ...............

Stomach and upper G. I.. ...............
"Gall bladder". ......................
Chest (lungs, heart, oesophagus).. .......

-

-

-

-

(750)
(750)

200

(120)

200
10
1.2

~iSkeleton-extrerniriesand chest". .....

(1 20)

1.O

Head.. ...............................
Dental ................................
Mass surveys ..........................

(120)
12
(All ages):

0.6
8
1

* I t has been assumed that the dose in the age-group over 12
years is the same as in the age-group 12-29.

5(a)b Weighted average including chiropractors' contributions.

5

REL~TIVEMALE CHILD EXPECT-a-CY(\V~(~~)/W)~
APPENDIXUSA

X. TABLE
XIII.
Rodiogmghy

Erom.
.No.

0-11

6.
7.
8.
9.
10.
11.
12.
14.
13*
15.
16.
17.

h e r I.?

Raddogisu&I1

OIKl12Na-rudXo&u
0-11

Orcr I t

1.98

0.57

1.98

0.18

'

1.
2.
3'
4.

5.

FIiullosm~y

Radidoguh andnon-radiologisfs

1.98. "Skeletonpelvic region". ............

0.55
1.98

,
"P~elography". .....................
''Urinary tract".
Pelvimetry ............................
Salpingography.
Abdomen (obstetrical). .................

0.47.....................
.......................

1

-

-

"Abdomen and colon". ...............
Stomach and upper G. I...
"Gall bladder".
Chest (lungs, heart, oesophagus). ........

:;: }"Skeleton-rtremities

-

1.98

0.50

1.98

0.58

1.98

0.4

1.98

0.59

1.98

0.4

1.98

0.51
0.6
0.6

1.98

0.6

1.98

0.4

1.98

1

1.98

0.4

1.98
1.98
(-411 ages)

0.6
0.6
0.7

1.98

0.4

and chest1*.

Dental ................................
Mass surveys.. ........................

0.62

1.98

..............
......................

....
Head.. ...............................

20.
21.
22.
23.

1.98

0.5

Figures back-calculated from tables V, VI and XI.

MALE CO~TRIBUTION TO THE ANNUAL GESETICALLY SIGNIFICANT DOSE
in rnrern).
APPENDIXX. TABLE
XIV.
Radidogisb andnon-radiologists

Erom.
No.

0-1 1

.....................

.......................

"Urinary tract".
Pelvimetry ............................
Salpingography ........................
Abdomen (obstetrical). .................

} "Abdomen and colon". ...............

I...............

Stomach and upper G. I..
"Gall bladder". ......................
Chest (lungs, heart, oesophagus). ........
1

19.
20.
21.
22.
23.

} "Skeleton-extremities and chest". ....
Head .................................
Dental ................................
blass surveys.. ........................

(0.8)

(0.5)
0.8
(All ages)
TOTAL 14.5

Figures identical with those in table VI.

Om I 2RodidogisIr
0-11

OanJ2

USA

Kon-rdidogisit
0-11

&uIP

FOETALEXPOSURE
USA

APPE~TDIX
X. TABLE
XV.
Es'zm.

di

ntrcm

No.

1.
2.

314.

dh*Nd-V
r1.000(back-2fZalcd)

Di
mrem.

'

:

5.
6.
7.
8.
9.
10.
11.
12.

8

icS*eleton--plvic region". "Pyelography" ..............................

,"Urinary tract". ............................
Pelvimetry.. ................................. 4,000
Salpingography ...............................
Abdomen (obstetrical). ........................
400) "Abdomen and colon". ......................

Stomach and upper G.I.. .......................
"Gall bladder". .............................
Chest(lungs,heart,oesophagus)................

15.
16.
17.

:: }

20.
21.
22.
23.
24.

"Sbleton-tremities

0.3

and chest". . . . . . . . . . . . . .

Head ........................................
Dental .......................................
Masssurveys .................................
Others .......................................

TOTAL

a

1/0.67 of the figures given by Laughlin and Pullman.

GENETICALLYSIGNIFICANT DOSE (Dj IN LIREM); SUMXL4RY TABLE
APPENDIXX. TABLE
XVI.
Exam.
No.

Childre8) "Pyelography". ..................

\

i9:
20.
21.
22.
23.

-

"Abdomen and colon". ............
Stomach and upper G.I.. ............
"Gall bladder". ..................
Chest (lungs, heart, oesophagus). .....

5.5

1

Mole
adt~lrs

FoetalTold

PCTcent

2.2"Urinary tract". .................
Pelvimeby .........................
Salpingography .....................
Abdomen (obstetrical). ..............

1FcnalcadrJls

USA

9.3

1.5

.

1.1

0.0

0.0

1.1

0.8

Head.. ............................
Dental.. ..........................
Rlass surveys. ......................

0.7
1.1

0.0

0.0
2.7
0.0

0.7
4.9
0.1
141

0.5
3.5
0.1
100

"Skeleton-estremities and chest".

*

TOTAL35.2
Included in adult figures.

1.1
0.1
44. i

40.7

20.7

DATA ON DIAGNOSTIC X-RAY EXPOSURE: GONAD DOSE PER EX4i)lINATIONFOR THE MOST DIPORTAIYT EXPOSURE CLASSESAPPENDIXXI
The tables I to XIV have been taken from the reportof the ICRp/ICRU Joint Study Group. They shoxv
estimates of various authors of the gonad doses due togiven types of examinations. The wide variations prob-

ably result from different techniques rather than fromuncertainty in measurements. Hence the lower values
indicate what levels may be achieved with good practice.
Further details and references are given in the I C R ~ICRU Study Group report.

3feanucRrfncncc

Tcchnirol dolo

HammerJacobsen(1957)
Denmark'

62-64 kv,
400-450 mi\s
F F D = 100 cm
2 films per
examination

LarssonSweden960-70 kv,
200-500 m ~ s
3 films per
examination

mrnls madeonA{&

Frnrolr

Patients:
12 male9 female567(20-3600)

53(30-100)

Patients:
19 male18 female1150(1 00-2600)

205(75450)

480
840
2100
650-2000

270
420
900
600-1000Years:
0- 2
2- 7
7-1 2
12-30

Laughlin and
Pullman(1957)U.S.A.10
Stanford andVancc 11955). , 68 kv. 200 m ~ s
U.S.A.@F F D = 90 cm

Technical dala

Measitremcntrmodc
onHammerJacobsen(1957)
Denmark4

Patients:
7 male4 female

Koren andiLIaudalNorwap62 kv, 250 mAS
F F D = 100 cm
2 films per
examination

Phantom

50-78 kv, 80 m ~ sPatients:
6 male2 femaleLailghlin and
Pullman(1 957)
U.S.A.10-

Patients

5840 kv, 250 m,ks
F F D = 100 cm
2 films per
examination

LarssonSweden9

CoMd do- pa cxaminalion (wad)' :Rcmmkr

Gonad dore pcr cxaminafwn (mrad)
Rnnurkr

Years:
12-30

M&

F

d

1650

300

=

Teclt~ticoldata

Measurcmn:ls
ma& 011

Denmark'

60-63 kv,200-360 mas
F F D = 100 cm
1-2 films per examination

Patients:
7 male1 female

Koren and Maudal
Norway@70 kv. 250 mAS
FFD = 100 c n ~Phantom

LarssonSu-edens

59-64 LT, 500 mu
F F D = 100 cm
1 film per examination

Patients:
16 male20 fema!e

65 kv, 100 m.u
F F D = 90 cm

Patients

Reference

Hammer-Jacobsen(1957)

Gonad dare n jVm(mra8

Remarks

Ma&

F e d

Gonad datc pn uaminaIion

had)

Molr

Fcmak

567
(50-2500)

70

1100

210

Laughlin and
Pullman (1957)
U.S.A.10
Stanford and V a n e(1955)

U.K.s'65 kv, 100 m4s
FFD = 90 cm,
no extra hlter
65 kv, 100 m s
FFD = 90 cm,

ArdranandCrooks

AP

1100

Normaltechnique

2000<3mmAl-filter

210

670

(1957)

U.KY

75 kv, 80 me
FFD = 110 cm,
3 mrn Al-filter.
The same, but testes,covered with lead

* Measurement made on hantom.

t Atomic Energy ~ e s e a r c Establishment.
i'AERE'I
technique

480
20

80,

TABLEIV. LUMBARSPINE
Rcfermce

Hammer-Jacobsen(1 957)
Denmark'
Koren and Maudal
Norwaybs

Afeasnrenunfs

Technical da~amodcan65-84 kv, 1250 AS
FFD = 100 cm
3 films per examination

Patients:
22 male22 femaleI

Phantom

68h,310 rnAs
FFD = 100 cm
75 kv, 500 n u s
FFD = 90 cm

LarssonSweden965-70 kv, 500 m4s
FFD = 90-100 un
4 films per examination

Patients:
12 male7 femaleLaughlin and
Pullman (1957)
U.S.A.10

1

72 kv, 500 m s
FFD = 90 cmt

120 kv, 20 mas
FFD = 90 cm
120 kv, 60 rnis
FFD = 90 cm

Ardran and Crooks(1 957)
UK26

1

F~

68 kv, 200 m.u
FFD = 90 cm,
no extra filter
68 kv, 200 m s
FFD = 90 cm,
4 3 mm Al-filter
75 kv, 80 m ~ s
FFD = 110 cm
3 mm -4l-filter
The same, but testes,covered with lead

Measurement made on phantom.

t Atomic Energy Research Establishment.

,a[&prmolr104(10-400)222(20-600)

AP

4.5

60

4.5

60

Lat.

6

91

6

91

375

680

(68-1 180)

(490-860)

2700
900

900
1050
2190

Lumbarspine andlumbo-sacral
regionAP.I
Lat

Patients

Gonad dnrc pn r x a m i n a f i a

bra4

uolc

Years:
0- 2
2- 7
7-1 2

'68 kv, 200 m s
FFD = 90 cni
Stanford and Vance(1955)U.K.m

G o n a d ( 2 r flm

RcnuubNormaltechnique

2400

24

227

24

227

26.6

86

26-6

86

6

40

6

40

7

16

7

16

24
6-0

'AERE'ttechnique

1.0
0.5

95'

Gonad dart per $Zm

Technical &&Mcasurcmc~rfr
made onP-kt

61-65 Lv,3300-4300 m.u
FFD = 130-143 cm
16 films per esamination

Patients:
50 male50 female

AdultsAdults65-73 kv, 650-1700 mas
FFD = 130-143 cm
6 films per examination

Patients:
14 male8 female

Chiddenunder
15 years

Cord dare pa cxcrr.;naiion

hod)

Male

(mod)

Fcmak

Mole

Fern&

1820
(935-2680)

L~ammer-Jacobsen(1957)
Denmark4

LeFebvre and Serra(1957)

FranceLarssonSweden9I

Children:
3 months
3 >.ears
6 years

10 films
12 films
16 films

Patients

66120 kv, 95 n w
12-26 films pere-samination

Patients:
25 male17 female

Hospital
1790(141-21 60)

55 h-,
250-270 m s
5-1 1 fdms per
examination

Patients:
10 maleHospital
21300(22*-2500)

12-30 years
PyeloDP~Y

100-2000

200-1200

486

1290

Laughlin and
Pullman (1957)
US.A.10
Stanford and Vance(1955)

U.K.58
Ardran and Crooks(1957)

U.K.5

72 lw, 100 nus
FFD = 90 cm
6 films per examination
75 LC,80 m u
FFD = 110 cm
3 mm Al added

Patients
Male :
patients
Female:phantom

0.5*

95With lead rubber over the scrotum.

t Doses reduced to 1-3% by shielding of scrotum.

TABLE
VI.
Rcjercncc

HammerJacobxn(1957)
Denmark4
Laughlin and
Pullman(1957)U.S.A.10

RETROGRADEPYELOGRAPHY
Measrut

Technical datam n l s majc

63-67 kv, 4000 mas
FFD = 130--143 cm
7 films per
examination

Patients:
8 male9 femaleon

Rrmarks

12-30
Yea=
Pyelography

Gonad dose per eramination (n~od)'

Mole

Femak

100-2000

200-1200

TABLE
VII. URETHROCYSTOGRAPHY'71 kv, 3285 mAs

HammerJacobsen(1957)
Denmark4

Koren andblaudalNonvayBS

FFD = 137 cm
6 films per
examination

Patients:
7 maleUrethrography

4209(2700-8400)

63-87 kv,
2000-2850 mAS
FFD = 100-130 an
5 films per
examination

Patients:
2 male2 female

Cystography

5261(3500-7000)

Urethrocyst*' 102-109 kv,

357-476 AS
FFD =!W cm
9 films per
examination

Patients:
9 male9 femaleduringmicturition
A dults

7841
669(2400-17200) (200-1500)

79-86 kv,
256-341 AS
FFD =90 cm
8 films per,examination

Patients:
6 male5 female

Under 152314
(200-4700)

75 kv, 200 mAS
100 kv, 500 m ~ s
FFD =60 cm
1 +4 films per
examination

Phantom

80-100 kv

Patients:
26 maleHospital 1
16 female

100-200 mAS
5-15 films per,examination
Radiography
Laughlin and
Pullman(1957)
U.S.klo

460(350-560)

Fluoroscopy
iPatients:
5 maleWP~Y

205(120-330)

AP
Lat.

Hospital 2

4100
1000
(1000-1 1000) (550-1650)
760(320-1240)

Years:
12-30

100-300

200-1oOO

Years:
0-1 2
12-30

500-2000
500-6000

500-1000
500-3000

HammerJacobsen(1957)
Denmark'

Koren andhlaudalNomap

Gonad datep n flm

Gonad dose
pn cxuminalim

Tcrhnical
da!aLfcasurcmrnrs madeon

Remarks'81-85 Lv,
1354 mhs
FFD-100 cm
2-3 films per
examination

15 patients

A P f Lat.

738
(400-1400)

84-92 I;v,
1250 mAs_
FFD -97 cm
3-4 films per,examination

4 patients

Stereoscopic
APfLat.

906
K(650-1300)

II

Phantom

2 films: 90 LT
640 AS
1 film: 90 h i
95 AS
FFD = 90-100 cm-12 patients

Rrfhcra(mad)(m+ad)

fmak

fmak

,

LarssonSweden978 kv, 310 mas
FFD = 100 an

85 kv, 500 mAS
FFD = 90 cm

AP

!-86

86

Lat.

76

76

3
merentprojections

Laughlin and
Pullman(1957)U.S.A.10
Stanford and
120 kv,100 mAS
Vance (1955) 120 kv, 50 m ~ s
U.K.a
FFD =90 cm

Patients

AP
Lat.

240
840

TABLE
IX. SALPINGOGRAPHY

Hammer69 kv.
Jacobsen (1957) 1259 m u
Denmark'
FFD = 100 cm
2-7 films per examination
LarssonSweden9Laughlin and
Pullman (1957)
U.S.A.10

65-90 kv,
120-150 mAs
6-11 films per examination

7 patients
32 patients

TABLE
X. ABDOJIEW
Refntncc

Technirol &laII63-70 kv,600 mAs

FFD = 100-143 cm

HammerJacobsen(1957)
DenmarF

1 film per
examination

71 kv, 750 m&
FFD=100 cm
1-2 films per
examination

Koren and
Maudal
Norwap80 kv. 180 mas
F F D = 100 cm
3 films per
examination

LarssonSweden9

Female 4-13 films
per examination.
Male 3-7 films per
examination. Sometimes fluoroscopy,
1 -5-2 min.

Laughlin and
Pullman
1957)
U.S.A.10

Abdomen and colon
radiography

Stanford andVance (1955)

1

U.K.s
Ardran andCrooks(1957)
U.K.5

72 kv, 100 m4s
F F D =90 cm
80 kv, 150 mAs
F F D =90 cm

Measuremcnfs madeonRemorL

Patients:
5 male4 femalei\PPatients:
21 female

Gonad dose ficr examination (%rod)
JfoL

F e d

Obstetric

Phantom

Patients:
7 male7 femaleYears:
0- 2
2- 7
7-1 2
12-30

Patients

75 kv, 60 n ~ ~ s Male:patients
FFD-110 cm
Female:3 mm Al-filter
phantom
addedWith lead rubber protection.

TABLE
XI.
Technical data

Rcjc~cna

BARIUMENEUMCCMKC~ntsnurdc
an

LeFebvre andSerra (1957)
France15 films
7 films
9 films

Patients

LarssonSweden9

About 10 films:
mean fluoroscopy
time 7 min.

Patients:
31 male15 female

I

Children:
3 months
3 years
6 years

Abdomen& colon12-30 years

Radiography

Laughlin and
Pullman(1957)
U.SA.10

Gonad dare pn examinolia (mrad)
Remarks

Mak

Fcmak

450
700
900

400
455
800

255
(52485)2065(1075-2920)

140-200

420-500

0-750

420-1500

420-750

420-1500

Lower
4

G.I.T.

Fluoroscopy

13-30 years

I

Lower

G.I.T.

Fluoroscopy

Stanford andFluoroscopy:
Vance (1955) 50 kv, 2 ma
U.K.5J
3 min.

ChildrenPatients

40

20

TABLE
XII. BARIUM SWALLOW AND MEAL
Mconur-mcnls madeonChildren:
3 months
3 years
6 years

Conad dose pa exambarion (mrad)

Mlc

FrmoIr

220
496
220

20 films
16 films
20 films

Patients'75 kv, 6 0 m ~ s
F F D =60 cm
12 films per
examillation

Phantom

2 -9

144

Fluoroscopy:
70 LT, 3 mA, 3 min.
,FSD a 4 0 cm

Phantom

1.2

45

12.5
(2.7-29)(8.5-55)

4.3(2-1-13-6)

31(7.8-78)

60-200200-300

12-30 years

0-500

200-750

Upper
G.I.T.
Children

200-500

200-750

20

9LeFebvre andSerra (1957)
FranceKoren and
Maudal
Norwa?

Remarks

80-110 LC
40-80 mAs
10-15 films
Mean fluoroscopy
time 7 min.

Sweden9

Patients:
25 male25 female

Hospital 1

Patients:
25 male25 female

Hospital 2

I

33

Stomachh upper

G.I.T.

Radiography

12-30 years

Laughlin and
Pullman(1957)U.S.A.~"

Upper<

G.I.T.

FluoroscopyiStanford andVance (1955)

U.K.s

Fluoroscopy
70 L.-, 2 m a 3 min.

Patients

Fluoroscopy with
Ardran andimage intensifier
Crooks (1957) 75 L.-, 0.5 m a
U.IC.2j
5 min. 5 mm
-41-filter addedMale:patients
Female:phantom

Tcchn~cddata

mnlr ma&d.leasurc-

WncnccKoren and
Maudal
NorwapLarssonSweden980 hr,125 n u s
F F D = 1 0 0 cm
5 films per
examination'60-80 Lv
35-200 mAs
4-6 films perc examination.
Fluoroscopy
80 kv,3 mA,,1.2-2-5 min.

on

Phantom

70 kv, 150 mAS
F F D = 90 cm
3 films per
esamination

A fak

Female

6.i

260

3.1
(1 -3-6.5)

19(10-41)

Patients:
26 male25 female

Hospital 1

Patients:
16 maleHospital 2

7.1(4.3-11)

12-30
years

0-1 0

75-2001.8

15.6

Laughlin and
PullmanStanford andVance (1955)
U.KJE

Gonad dare p n uaminufion (tpzad)

RcmarbPatients

TABLE
XIV. CHEST-

Technical daIa

kftonrem~l;~~ra& onRernorh

G01:ad dose 9crJTlm(mrad)
liak

LeFebvre and Serra(195 7)
FrancePa tients

I

Children:
3 months

80 kv, 27 mas

Koren and Maudal
Nom~i?

FFD = 150 cm

5-5 films per esamination

Laughiin and
Pullman (1957)
U.S.A.10& fluoroscopy
70-80 kv,
2-2 -5m4
1-3 minI

Female

Jfak

FmaL

5

PA

<1

1-0

<1

1.0

Lat.

<1

1-5

<1

1-5

1-6
(0.9-2-7)

4-6(2-6-10.8)

0-450
0-5
0-1 -2

0-240
0-5
0-0-3

0-40

0-30

Patients:
78 male22 femaleYears:
0- 2
2-12
12-30

Radiography

Fluoroscopy

Sanford and V a n e(1955)(mrad)

Phantom

95 kv,60 m a s(FFD = 150 cm

LarssonSweden9G a a d darr per cxaminaiion

68 kv

Patients'Radiography
FFD = 180 cm
3 mm AI-filter added.

Male:patients
Female:phantom' Fluoroscopy with image
intensifier
75 kv, 0 . 5 m.4
3 min., 5 mm
\Al-filter addedMale:patients
Female:phantom

PA

0.36

0 -07

0.36

0 -07

PA

0-01

0.02

0.01

0 -02

3.0

3-0

U.K.a

Ardran and Crooks(1957)

U.K."

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Radiological Units and Measurements (ICRU),
Joint Study Group report on Exposure of man toionizing radiation arising from ntedical procedures.
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radiological data, UN document A/AC.82/G/R.102.
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5. Osborn, S. B. and Smith, E. E.: T h e geneticallysignificattt dose frowt the diagnostic use of X-rays
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G B . 5 1.
6. Reboul, J. and Istin, J.: Doses gonades en radiodiagnostic. Bordeaux (1958) U N document A/
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8. Nonvay: Report to the United Nations ScientificCommittee on the Effects of Atomic Radiation, on
radiological data, U N document A/AC.S2/G/R. 106
and i4/AC.S2/G/R.106/Add.1.
9. Larsson, L.-E.:
Radiation doses to the gonads o fpatients irt Swedish roetttgcn diagnostics. Acta
radiologica, Supplement No. 157 (1958), see also
UN document A/AC.82/G/R.182.
10. Laughlin, J. S. and Pullman, I. : Gonadal dose produced by the medical use of X-rays, U N document
A/AC.82/G/R.f 4.
11. Court-Brown, W. M. and Doll, R.: Leukwmia andapEartic anae?nia in patients irradiated for ankylosing spondylitis. Medical Research Council (U.K.)
Special Report Series. No. 295 (1957). See also
UN document A/AC.82/G/R.105.

12. Martin, J. H.: An estitttate of the potential leukae?nogenic factor i n the diagnostic w e of X-rays.
Medical Journal of Australia, in print.
13. International Commission on Radiological Protection (ICRP) :Recomtraendations, revised 1 December 1954. Brit. J. Radiol. Suppl. 6 (1955).
14. Clark, K. C.: Positioning i,t radiograplty. 7th ed.,Grune and Stratton Inc., New York and London( 1956).

15. Sante. L. R. :Manz~alof roentgenological techliiques,
15th ed. revised, Edwards Bros. Inc., Ann -Arbor( 1946).
: -ti;

16. Webster. E. W. and hilerril, 0. E.: Measltrefiletztsof gonadal dose i n radiographic examinatiotls, New
England Journal of Medicine, 257,811-819 (1957).
17. Ritter, V. IV., Warren, S. R. and Pendergrass,
E. P. : Roentgen doses during diagnostic procedz~res.
Radiology, 59, 238-249 ( 1952).
18. Ardran, G. M. and Crooks, H. E.: A corrtparisorrof radiographic teclzrriqz~eswith special referewe
to dosage. Brit. J. Radiol., 26, 352-357 (1953).
19. Ecyleshym, A. C. and Schoemaker, D. M.: A
cross-sectiotz anatotny. Appleton-Century Crofts
Inc., New York (1938).
20. Johns, H. E., Epp, E. R and Fedoruk, S. 0.:
Depth dose data, 75 k V p to 140 kVp. Brit. J. Radiol.,
26,32-37 (1953).
21. Jones, D. E. A. and Ellis, R. E. : T h e nteastcrelltent
of the dose-corrtribrctions frorlt the mairr treatment
fields. Appendix B to ref. 28.
22. Laughlin, J. S., Meurk, hi. L., Pullman, I. andSherman, R. S.: Bone, shirt and gonadal doses i nroutine diagnostic procedures. American Journal of
Roentgenology, 78, 961-982 ( 1957).
23. Lorentzon, L:Smne notes on skin doses arrd bonemarrtnu doses irr nmss rnitriature radiography. UN
document A/AC.82/G/R. 176.
24. Martin, J. H.: Radiation doses to the gonads i ndiagnostic radiology and their rclation to the longternz getretic Imard. Medical Journal of Australia,
2,806410 (1955).
25. Ardran, G. M. and Crooks, H. E.: Gonad rdiationdose frorrr diagnostic procedures. Brit. J. Radiol.,
30,295-297 ( 1957).
26. Ardran, G. M. : Dose reduction i n diagnostic radiology. Brit. J. Radiol., 30, 436-438 (1957).
27. Christensen, H.: Patienters udsaetteke for ioniserende strrOInitrg (The exposure of patients to ionizing radiation). Ugeskrift for Laeger (Denmark),
119.290-295 (1957).
28. Martin, J. H. :Radiation doses received by the skirtof a patient during routitre diagnostic X-ray examinations, Brit. J. Radiol., 20, 279-283 (1947).
29. Tubiana, hi. :Doses recues par les organes genitaux
au cours des examerrs radiographiques efectuhs
chez l'enfant. U N document A/AC.82/G/R.186.
30. Camerman, J. : Examens radiographiques ct danger
des radiatiorrs. Journal Belge de Radiologie, 39,
165-178 (1956).
31. Bacq, 2. M. :D u danger des examens radioscopiqxes
pour les trtalades (see also discussion followingtext). Journal Belge de Radiologie, 39, 687-695(1956).
32. BaiIy, N. A. : Patient exposure to ionizing radiation
irr dental radiography. Radiology, 69,42-45 (1957).
33. Trout, E. D.. Kelley. J. P., Cathery, G. : T h e w e offilters to cortfroi radiation exposure to the patient
in diagnostic roerttgertolo y. American Journal of
Roentgenology, 67. 946-9 2 ( 1952).
34. -4rdran, G. M. and Kemp, F. H.: Protection of themale gonads in diagnostic procedures. Brit. J.
Radiol. 30, 280 (1957).
35. Etter, L. E.: Radiation dose reduction by higher

4

voltage dental roentgenography. Journ. Amer.
Dental Association. j3.305-309 (1956).
36. Martin, J. H.: Necessity and fjzeatls of protectirtg
patients i n diagnostic and therapeutic radiology.
Proceedings of the College of Radiologists of Australasia. 1, 103-112 (1957).
37. Clark, S. H.: Genetic radiation exposures i n thefield of medicine. Bulletin of the Atomic Scientists,
12, 14-18 (1956).
38. Purser, P. R. and Quist, C. F.: An estinrate o f thegenetic dose from radiotherapy. Acta. radiol. 48,
267-272 ( 1957).
39. Chmberlain, R. H. : Gonadal radiation itt the genetically significant portion of the population derived
frotn the radioactive isotope procedures i n nzedicine.
Hearings before the special sub-committee onradiation of the Joint Committee on Atomic Energy,
U.S. Congress, Part 1, 885-888 (1957). See also
U N document A/AC.82/G/R 130.
40. Johns, H. E. and Taylor, R. hi. :Dose fronz unsealed
radio-nrcclides. U N document A/AC.82/G/R.129.
41. International Labour Office: Code of practice forradiatiotz protection i n lutitinizing zuork. Geneva(1957).
42. Hursh, J. B.. Steadman, L. T., Looney, W. B. and
Colodzin, hl. : T h e excretion of thorium and thorium
daughters after Thorotrast ad~nirzistratio~t.Acta
radiol., 47, 482-498 (1957).
43. Rotblat, J. and Ward, G.: The radioactivity fromThorotrast and its retention in tissue. Physics in
Medicine and Biology, 1, 125-137 (1956).
44. Service dJhygi2ne atomique et de radio-pathologie
du C.E.A. : Etude de l'irradiation professionelle en
France en 1955. U N document A/AC.82/G/R.16,
Part 111.4.
45. New Zealand: Report to the United Nations Scientific Committee on the Effects of Atomic Radiation.
on radiological data, UN document A / A C . ~ Z ~G/R185.
46. Medical Research Council (U.K.) : T h e hazards totnan of nuclear atdallied radiations, London ( 1956).
See also U N document A/AC.82/G/FL2.
47. Swedish government official report : StrrSIskydd(Radiation protection), Statens Offentliga Utredningar 1956:38, Stockholme ( 1956).
48. Australia: Report to the United Nations ScientificCommittee on the Effects of Atomic Radiation, on
radiological data, U N document A/AC.82/G/R.29.
49. Larrson, L. E. :Radiation doses to pafients and persottnel in jrrodern roentgen diagnostic work, Acta
radiologica, 46, 680-689 ( 1956).
50. Mayneord, W. V. :Some problems of radiation protection. Brit. J. Radiol., 24, 525-537 (1951).
51. U.S. Atomic Energy Commission : Occupationalradiation exposures i n U.S. atomic energy projects.
U N document A/AC.82/G/R.71.
52. Boulenger, R.: Doses wtoyenrres regues par le personnel d u C.E.N. Mol de 1954 d 1957. U N document
A/AC.82/G/R.210.
.53. New Zealand: Report to the United Nations Scientific Committee on the Effects of Atomic Radiation,
on radiological data UN document A/AC.~Z/
G/R.107.

Belgium : Rapport sur la protection salzitaire daru
Pexploitatioiz des r~tineraist~ranif2resau Kafanga,
UN document A/AC.82/G/R. 116.
International Labour Office : General code of practice for i~zdustrial radiation protection, Geneva(1957).
Libby, W. F.: Dosages fro~it nattwal radioactivity
atzd costtzic rays, Science, 122, 57-58 (1955). See
also UN document A/AC.82/G/R. 109.
Dyson, E. D. : Shoe-fittitig X-ray fitcoroscopesradiation nz earzcrenzertts and hazards. British hledical Journal, 2,269-272 ( 1956).
Stanford, R. W. and Vance, J.: The qttaniity ofradiation received by the reproductive organs ofpatients during routine diagnostic X-ray examinations. Brit. J. Radiol., 28,266-273 (1955).
Spiers, F. W.: Meancrement of the gorurdal dose
i n the medical use of X-~ays. Physics in Medicine
and Biology, 2, 152-156 (1957).
Turpin, R., Mille M. Dupire, Jammet, H. and
Lejeune, J.: Etude de la dose/gonade, lors desexantens radio-photographiques systemutiqtces. UN
document A/AC.82/G/8.2 11.

Hammer-Jacobsen, E. : Gonad dose ntearurements
irt Den~ttark,U N document A/AC,82/G@219.
Hammer- Jacobsen, E. :Risk of parentl~oodand ksk
of subseqztettt pareittlzood, Denmark 1955 and 1956,
UN document A/AC.82/G/R.220.
Verbal commtrnication by the delegation of theUnited Kingdom.
Kopp, H.: Stdlebeskadigelse fordrsaget af pedoskop. Overvejelser over foragelse af den totale
gonadestr2ledosis fra pedoskoper (Radiation damage from pedoscopes. Increase of total gonad dosefrom ped&cope) .'ugeskrif t for ~aege; 119, 766770 (1957).
Koren, K. and Maudal, S.: Gonad doses received
during the nredical application of roentgen radiation.
Acta radiol., 48, 273-279 (1957).
Numpar, J. :Physical aspects of protection irt roentge?t and radircrrt therapy. Acta radiol. et cancerol.
F~hemoslovenica,4, 152 (1949).
Hansen. P. B. and Madsen, C. B.: Tolerance dose
problent in radiological work. Acta radiol., 34, 519528 (1950).

Appendix

LIST O F SCIENTIFIC EXPERTS
The scientific experts who have taken part in the preparation of the report while attending Committee sessions
as members of national delegations are listed below. The Committee must also express its appreciation to the many
individual scientists not directly connected with national delegations whose voluntary co-operation and good willcontributed in no small measure to the preparation of the report.
ARGENTINA:
Dr. C. Nuiiez (Representative)
Dr. D. J . Beninson
Professor E. Favret
Dr. N. Nussis
Dr. J. A. Olarte
AUSTRALIA:
Dr. C. F. Eddy (Representative-first
Mr. D. J . Stevens (Representative)
Dr. A. R W. Wilson

Dr. A. Halawani (Representative)
Dr. H. T. Daw

session)BELGIUM:
Professor Z. Bacq (Representative)
Mr. R. Boulenger
Dr. M. Errera
Professor F. Twisselman
BRAZIL:
Professor C. Chagas (Repesetrtative)
Dr. B. Gross
Professor N. Libanio
Professor C. Pavan
Father F. X. Roser, S.J.
CANADA:
Dr. E. A, Watkinson (Representative)
Dr. R. K . Appleyard
Dr. P. M. Bird
Dr. W. E. Gnunmitt
Dr. Colin Hunter
Dr. G. H. Josie
Dr. C. A. Mawson
Dr. H. B. Newcombe
Dr. F. D. Sowby
CZECHOSLOVAKIA:
Professor F. Hertik (Representative)
Professor F. BEhounek
Dr. M. HaSek
Dr. L. Novik
Professor V. Sobek
Dr. I. Ulehla
Dr. V. Zelenf

Professor L. Bugnard (Representative)
Dr. A. Allisy
Dr. J. Coursaget
Dr. H. Jammet
Dr. J. Labeyrie
Dr. J. Lejeune

INDIA:
Dr. V. R. Khanolkar (Representative)
Dr. A. R. Gopal-Ayengar
Dr. A. S. Rao
JAPAN :

Dr. M. Tsuzuki (Representative)
Dr. Y. Hiyama
Dr. D. Moriwaki
Dr. K. Murati
Dr. M. Nakaidzumi
Mr. S. Ohta
Dr. N. Saito
Dr. E. Tajima
MEXICO:
Dr. M. Martinez Baez (Representative)
Dr. F. A. Andrade
Dr. H. Zalce

Professor R. M. Sievert (Representative)
Dr. B. A. A. Aler
Dr. R. G. Bjarnerstedt
Professor G. Bonnier
Professor T. 0. Caspersson
Professor C. A. T. Gustafsson
Dr. A. G. A. Nelson* Now in the United Arab Republic.

UNIONOF SOVIETSOCIALISTREPUBLICS:
Professor A. V. Lebedinsky (Representative)
Professor K. K. Aglintsev
Professor B. M. Isaev
Professor P. M. Kireev
Professor A. N. KraevsLy
Professor A. bZ. Kuzin

UNITEDKXNGDOM
OF GREATBRITAINAND
NORTHERNIRELAND
Professor W. V. Mayneord (Represetltativefirst session)
Dr. E. E. Pochin (Represelztative)
Dr. T. C . Carter
Mr. A. C. Chamberlain
Dr. W. G. Marley
Mr. N. G. Stewart

Dr. Shields Warren (Represe~rtative)
Professor G. W. Beadle
Dr. A. M. Brues
Professor J. Crow
Professor Th. Dobzhansky
Dr. C. L. Dunham
Mr. Merril Eisenbud
Professor Sterling Emerson
Professor G. Failla
Dr. J. H. Harley
Dr. J. S. Laughlin
Professor J. V. Nee1
Dr. M. Zelle