I fJ 7 ") ~ -: /;_;I(~r-~~~/h-1()N1Zl~G RADIATION:'lJi~;r~,~~rN/ (,J_,.} /~ /:·'/'~~!'----===·~D EFFECTS.

A report of the United Nations Scientific Committee
on the Effects of Atomic Radiation
to the Genera/ Assembly,
with annexes

..
...
;

. ,~

i1·

VOLUME I: LEVELS

.,,'
\

NOTE

The report of the Committee without its appendices and annexes appears as
Official Records of the General Assembly, Twenty-seventh Session, Supplement
No. 25 (A/8725).
In the text of each annex, Arabic numbers in parenthesis refer to sources
listed at the end.
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Annex B

DOSES FROM i\IEDICAL IRRADLt\.TION
CONTENTSParagraphs.••....................••....

1-16

I. DIAGNOSTIC X-RAY EXAMINATIONS ••.......
A. Growth of diagnostic radiology ..... .
B. Limitatiom of radiological surveys ... .
1. Frequency of examinations ........ .
2. Selection of patients or centres ... .
3. Gonad-dose measurements ........ .
4. Child expectancy ................ .
C. Genetically-significant dose .......... .
1. Description of surveys ........... .
2. Gonad dose .................... .
3. Genetically-significant dose by examination type .................... .
4. Genetically-significant dose by sex
and by age at examination ....... .
5. Other investigations ............. .

17-89

INTRODUCTION

D. Bone-marrow dose ................. .
1. Variation with type of examination
2. Determination of mean bone-marrowdose ......................... · ·3. fer .capllt mean marrow dose by exammation type .................... .
4. Dental radiography .............. .

Parcgraph.r

17-19
20-38
22-25
26
27-31
32-38
39-72
39-59
60-63

E. Dose to the skin and other organs ... .
F. Trends with extensive examinations ... .

84-86
87-88

G. Recommendations for the protection of
the patient in diagnostic radiology ....

89

II. DIAGNOSTIC USE OF RADIO-PHARt.L-\CEUTICALS
1. Organ dose from radio-pharmaceuticals ............................ .
2. Genetically-significant dose ....... .

94
95-97

Ill. X- AND GAMMA-RAY TREATMENTS

98-109t. Genetically-significant dose

100-102103-108

2. Bone-marrow dose ............... .
3. Doses to other organs ........... .

64-65

90-97

61Hi8
69-72

IV. THERAPEUTIC

73-83

V. CONCLUSIONSUSE OF RADIO-PHAR!.L-\CEUTICALS ....•.••.....••.•.••.....•.•....•.
.•....••••.•..•••.•••.....

109

110-113114-116

77-78
Page

79-80

APPfu",DIX

81-82
83

TABLES•••••••••••••••••••••••••••••REFERENCES

150
152

...•••..•.•.........•••....

168

cedures that contribute significantly to population doses
and the effects that changes in radiological practice or
technical advances will have on the magnitude of theradiation doses.

Introduction

1. The population exposure due to the medical
uses of ionizing radiation and of radio-isotopes waslast reviewed by the Committee in its 1962 report(148). The present annex summarizes the information published therein and reviews the data that havesince become available on radiation exposure fromdiagnostic x-ray examinations, from x- and gamma-ray
therapy and from the diagnostic and therapeutic useof radio-active materials prepared for administration as
radio-pharmaceuticals or used as sealed sources.
2. For each of these types of exposure, the following aspects have been considered:(a) The number of examinations carried out invarious centres and the gonad and genetically-significant doses arising from them;( b) The mean bone-marrow dose ( see howeverparagraphs 11 and 73) ;(c) The skin dose from the various x-ray examinations or the dose to the organ of reference in thecase of radio-pharmaceuticals.
3. The data are presented and analysed so as to
identify and assess the trends currently developing inmedical radiology and to suggest the epidemiologicalstudies to which particular groups of patients may
lend themselves. This requires determining the pro-

4. A number of groups of patients have alreadybeen identified as receiving high doses, and some ofthem have been shown to have an incidence of certain diseases higher than in comparable but nonirradiated groups. Similar groups of patients may be
identified as a result of particular radiation dose surveys. For example, guided by the findings of the
British survey of medical irradiation (25), Doll andSmith (33) studied women in whom artificial menopause had been induced for the treatment of metropathia and showed an incidence of leukremia aboutfour times as high as that in the control group.
5. The annexes of previous Committee reports(147-149) and annex H of this report contain the
results of studies on other groups of patients exposed
for medical reasons to x-rays and radio-active materials
who were studied to determine the incidence of longterm effects of radiation. These include studies ofpatients undergoing diagnostic examinations:(a) Children irradiated in wero (139-141);( b) Patients investigated using thorium products as
a contrast medium ( 46, 88); and133

( c) Patients rece1v10g multiple fluoroscopic examinations of the chest ( 8 5) .
The following groups of patients, who have undergone radio-therapy, were also investigated:(a) Ankylosing spondylitis;( b) Children receiving thymic irradiation;( c) Patients treated for metropathia ( 33);
( d) Patients treated for cancer of the breast ( 1);(e) Patients having stomach ulcers (23, 145);(f) Children irradiated for ringworm (150) ;(g) Children treated for retinoblastoma (125);and so were two groups of patients treated with radiopharmaceuticals:(h) Patients treated with 131 ! for hyperthyroidism (136):(i) Patients treated with 3 ~P for polycythremia vera.
6. All radiological procedures carried out on patients involve a certain degree of risk of harm whichmust be balanced against the value of the procedure to
the patients' state of health.
1. Genetically-significant dose. The same definitionof the ge.netically-significant dose ( GSD) given in the1958 (147) and 1962 ( 148) reports of the Committee
will be used here. The GSD is ··the dose which. if
received by every member of the population, would
be expected to produce the same total genetic injury
to the population as do the actual doses received by
the various individuals". This annual dose is theweighted population dose commitment from a year ofradiological practice. It is delivered at a rate considerably higher than that of any other dose commitment
received by the population from other sources.
8. The definition of GSD is based on the following
assumptions and considerations that will not be discussed here but are considered in greater detail inannex E:(a) The relevant tissue dose is that accumulated
to the gonads;( b) The dose-effect relationship is linear without
threshold:( c) The rate of delivery of radiation can be neglected:(d) Differences in sensitivity of the gamete with age
and sex are ignored.
9. The appendix to this annex gives the formulre
used to obtain the GSD from the frequency of theparticular examination in a certain age group of the population. the corresponding gonad doses and the appropriate weighting factors that take into account thechild expectancy of the individual. relative to the average child expectancy in the population. It is important to appreciate that many of the individuals
examined may have life and child expectancies quite
different from the population average, because of theeffect that the diseases for which they are being examined have on these expectancies.

10. Mean marrow dose. Observations on the induction of leukremia in the survivors of nuclear explosions. in patients treated with radio-therapy. and inchildren irradiated in utero have indicated a strong
correlation between the incidence of leukremia andthe mean dose received by the whole body or by theactive bone marrow. If it is assumed that active bonemarrow is uniformly sensitive and that the relationship between frequency of leukremias and dose islinear, doses to any part of the bone marrow can beaveraged over the whole bone marrow and the whole
population to give a per caput mean marrow dose(CMD).

11. Certain limitations in our present knowledge
should, however, be indicated:(a) While the induction of leukremia appears tobe associated with irradiation of the active bone marrow, neither the mechanism of induction nor the specificcells, or cell stages, at risk are known;( b) There is very little quantitative information on
the distribution of bone marrow in the skeleton. therelative proportion of active relative to fatty bonemarrow in the various bones and the variations of these
proportions with age. Most obs·ervations have been
only qualitative in nature and all the numerical irtformation on the total marrow distribution is based on
the 13 cadavers investigated by Mechanik (91) in the
1920s and the recent work of Hashimoto (54, 58, 95)
on 10 Japanese cadavers. In this review it is assumed
that the whole marrow is active in children and thatthe active-marrow distribution at age 40 applies toall adults (paragraph 75):(c) The relevance of the concomitant irradiationsof the 700 grammes of lymphocytes in the body is
unknown;( d) The effect of partial irradiation of the bonemarrow may be quite different biologically from a
uniform dose to the whole marrow in view of theprotective and regenerative capacities of unirradiatedtissue. The quantitative importance of this effect is
unknown in regard to the incidence of leukremia following irradiation in man. although it has been thoroughly
demonstrated in animals.
- 12. The mean marrow dose to an individual i froma certain exposure j of a given type of examination
x may be calculated as the average dose to the wholeof the active marrowdu.,,=:.fd,,owwhere ;lw is the mass element and W 1 the total massof the individual's active marrow. If the examination
type x comprises k:r exposures and involves N :r patientsof a total population of N individuals, the per caputmean marrow dose ( CMD) in that population is

1

Du:::

=N

N:r

k.T

I

I

i= I

duiJ=

j=l

13. In practice the individual mean marrow dose
d.u may be derived from the following relationshipdmJ.r= I( ;~) r Usds) r,.

where dM1ir is averaged over the total active marrow
M by summing for each fraction of marrow exposedr. the product of the fraction of active marrow ex-

posed m/M, the fraction of the dose to the skin reaching the element of marrow f,, and the actual skin dose d •.

134

~ per cent. per year during t?e 1960s. A useful study
m the Umted States ( 60) illustrates the chang:es inf~equency ~d age distribution of 10 diagnostic -radiat101;1 categones over the years 1963, 1966 and 1968.
Thi~ survey was c~ried out in 228 general hospitals
havmg patlents staymg for short periods. The averaoe
annual observed increment for each of the 10 cateoori~s
was I. 7 per cent and the total annual increment wasapproximately twice this value. This study emphasizes
the need to study over a period of years the variationin the age-specific frequency of a particular examination~nd t~e ~hanges in the over-all pattern of diagnostic
mvest1gat1ons, such as may be due to the increasing
popularity of a particular examination. Such studies
have been recommended by the World Health Assembly ( 122) to Member States and relevant data are
included in the report of an expert committee on the
medical uses of radiation ( 157).

14. In a survey conducted in Japan (58) a weighting factor was applied to the calculation of the bonemarrow dose to cive a "leukremia-significant" dose.
The weighting factors were based on the fact that theincidence of leukremia in the population exposed to
the nuclear explosions at Hiroshima was a function oftime after exposure (paragraph 7 6).
15. Radiation quantities. In the original papers
referred to in this review. various radiation quantities
have been used. namely, exposure, absorbed dose, anddose equivalent. For the sake of consistency these will
be converted throughout to absorbed dose on the basisof an absorbed dose of one rad corresponding to an
exposure of one roentgen and to a dose equivalentof one rem. For gonad-dose measurements in the!ange. of quali~es used in diagnostic radiology, somemvesugators ('::i7, 118, 119) have used a conversionof about 0.94 rad per roentgen.
16. The dosimetry of the radiation absorbed in thebone marrow is made complex by the need to take
into account the fact that the marrow is enclosed in
the spaces between bone trabeculre. Both the distribution of the sizes of these spaces and the thicknessof the trabeculre vary in the various parts of thes~eleto.n. The average dose to the marrow at any givensite will depend on the number and energy of thephoto-electrons emitted from the bone trabeculre and,
therefore. on the quality of the radiation. used. A conversion. factor from roentgen to rad units must be
based on a particular model of marrow distribution
and will be a function of radiation quality. Suchfactors have been used in some of the bone-marrowdose surveys (25, 58).

19. Services in developing countries. Valid statistics from developing countries are not currently available but every indication shows that there is a great
difference between the facilities provided in such countries and those available in the more technically advanced countries. Therefore such services need to be
expanded with appropriate emphasis given to modern
techniques and good patient protection (77). In developing countries, x-ray facilities are often only available
in the main cities and even in industrialized countries
there are often large but sparsely populated areas
where such services are very limited. It is likely thata large proportion of the world population does nothave easy access to modern x-ray facilities. It is obvious. therefore. that the rates of increase quoted inparagraph 18 are relevant only to countries in whicha highly sophisticated medical care system is alreadyin existence. In countries in which medical care andpreventive medicine are not as developed. the rate ofincrease is expected to be many times higher during
the next decade.

I. Diagnostic x-ray examinations
A. GROWTH OF DL.\GNOSTIC RADIOLOGY
17. The growth of diagnostic radiology must be
considered in relation to the chanoes in its contribution to population exposure. The £actors affecting thetotal growth are:(q) The number of examinations of each type being
earned out;(b) The types of procedure being carried out;(c) Changes in the complexity of the procedures;and( d) Changes in the technical facilities available,
viz. the use of irnae:e intensification, cine procedures
and biplane apparatuses.
However, the changes in the GSD and the CivID will
also depend on whether the doses received by thepatient during the particular procedures increase or
decrease. The awareness of the radiological staff ofthe importance of the protection of the patient is probably the greatest factor in the control of population
exposure.
18. The over-all increase in the number of radiological examinations has been assessed as 4 per centper year in New Zealand (1959-1963) (156), 6 percent per year in Sweden (1965-1969) (152), 2 percent per year in the United Kingdom (1958-1961)(99), whereas (21, 106) the increase was a little
over 3 per cent per year in the Un~ted States during
the 1960s. These figures, however, mclude the effectof increasing population. When this is excluded, therate of examination appears to have increased about

B. LIMITATIONS OF RADIOLOGICAL SURVEYS
20. The design of surveys for the estimation of the
GSD or of the CMD received by a particular population was considered by the International Commission
on Radiological Protection (ICRP) and the International Commission on Radiation Units and Measurements (ICRU) in 1955 (42) and 1959 (43) andinvolves the consideration of the following factors:(a) The method of obtaining- the data on the frequency of exa:minations and the size of the sample
required for that purpose;( b) The selection of the number of patients forwhom doses are to be measured or estimated and the
choice of centres at which this is to be done;( c) The actual method of measuring or estimating
the dose for each type of examination. Since examinations may involve a number of irradiated fields ofdiffering area, focal skin distance and radiation quality.
sufficient numbers must be studied to constitute a reliable average of each type of examination, particularly
for those that make the !!featest contribution to the~
GSD or the CIYID;(d) For the estimation of the GSD. the expectationof subsequent parenthood according to age within eachgroup of patients undergoing a particular type of examination; and135

ograpby by photofluorographic methods, do not takeplace. The consumption of film by month or quarterbas been used in a number of surveys ( 26, 80), in
relation to the number of examinations carried out during a sample period of the year. to obtain the yearly
number of examinations.

( e) For the estimation of bone-marrow doses, thedistribution of the active bone marrow.
21. Each of the above parameters introduces into
the final result some sampling error the magnitudeof which will decrease as the size of the sample increases. On the other hand, a systematic bias towards
lower doses may result from the presence of an observer or from the foreknowledge of the subsequent
dose estimation. An analysis of these factors is givenin the following paragraphs.

2. Selection of patients or centres

26. The hospitals and clinics at which the measurements of gonad doses or the collection of exposure
data are to be carried out are usually selected on thebasis of their size and geographical location. In somesurveys, however, only one or a few centres were utilized and this obviously is likely to have biased theresults since the particular hospitals selected were usually the largest or leading ones in the area surveyed
and hence can be expected to have a higher standardof radiological practice and of patient's protection thanis common in the area. In a number of surveys no
measurements were carried out and values of gonad
doses published in the literature were utilized. In the
United States in both the 1964 and 1970 surveys (21,106), the centres themselves supplied exposure dataon the patients selected in the frequency survey.

1. Frequency of examinations
22. It is important to determine with the greatest
accuracy the frequency of those examinations which
can be judged to make the greatest contribution to the
population dose. The frequency of such examinations
may be low. For example. in the 1957-1958 British
survey (26). obstetrical abdomen examinations contributed 24 per cent of the GSD though their frequency was only 0.6 per cent of the total yearly examinations. The main problem in comparing frequencies
from one country with those from another is that theactual procedures may be considerably different for
examinations similarly defined.
23. Two basic approaches have been used. The
vast majority of the surveys have entailed the collectionof the over-all numbers of examinations in age classes
from all, or a known fraction of. hospitals, clinics andprivate practices over a given period of time. This period has varied from a few days to 18 months. Typicalvalues of the percentage of the total year"s work inthese samples are 40 per cent in the Netherlands (14),8 per cent in Finland ( 67), 6.4 per cent in Czechoslovakia (80). 3.5 per cent in New Zealand (156), 2.5
per cent in the United Kingdom (26) 1957-1958. and2 per cent in Sweden (82). The numbers of persons
undergoing examination in the radiolocical departments
included in these surveys have been very large andtypical values are 254.000 in Czechoslovakia ( 80),
143.000 in Finland (67) and 40,000 in New Zealand(156).

3. Gonad-dose measurements
27. The need to establish reliably the mean gonaddose per examination is obvious. However, for any one
type of examination, the effort should be proportional
to the contribution of the examination to the total
dose. The difficulty, as far as sample surveys are concerned, is that, by altering the position of the edge ofthe beam by a few centimetres, the gonads of the patient may be just in or just out of the beam. This canchange the gonad dose by a factor of ten or a hundred(100). Similarly, the use of gonad shields greatly reduces the gonad dose when the gonads are in the
direct beam.
28. The determination of gonad doses may be direct or indirect. Direct measurements of male gonad
doses with the dosemeter in contact with the scrotum
have been made in a large number of surveys. A few
surveys (119, 132) have made measurements of female gonad doses by placing dosemeters in the vagina
or rectum but most surveys have relied on an abdominal skin measurement during an examination of female
patients and converted it by phantom measurements toan ovary dose. In one survey (69) a multiple regression method was utilized for the conversion. In theindirect method of g:onad-dose determination used in
the United States for both the 1964 and the 1970
surveys ( 21, 106), the radiological centre returned theexposure factors together with an exposed film providing the appropriate field size and radiation quality. The
data were then used in phantom experiments to derive
the gonad dose.
29. The objection to the direct method is that thepresence of the observer may tend to make staff use
optimal operational discipline and be more aware ofwhether the gonads are in the beam or not. The indirect method. -on the other hand. is retrospective by atleast three months. and staff cannot state accurately
the exact field size or precisely where the film wasapplied.
30. Typical numbers of actual gonad dose measurements made in the large surveys are 10,000 in
Czechoslovakia (80). 3.800 in New Zealand (156),

24. The second method whlch was utilized in the
United States 1964 survey ( 106), depends on the selection of householders by a multistage design that
permits a continuous sampling of the civiliarr population. After house-to-house interviews of some 31,000
people, about 3.600 of the 4,500 people who had
been radiographed in the ·past three months weretraced. Forty per cent of these. however. had beenradiographed for dental examinations. About 2,200
people. therefore, provided the data on the frequencyof examinations in radiological department. represent!llg some .0.002 per cent of the radiology carried out
m the Umted States in one year. In 1970, the UnitedStates repeated the national survey using the same
methodology that was employed in the 1964 survey
except that they doubled the sample size so that over
67 ,OOO persons were interviewed in the household interview survey ( 21 ) .
25. The consumption of x-ray film per year is notin itself a reliable method for estimatin!! GSDs. because
for a given film size used at a particular site, the g:onad
dose will depend on whether good or bad practice isfollowed. However. within any one institution. film
consumption will follow seasonal variations in the frequency of examination as long as changes in techniques. such as the replacement of conventional radi136

2.200 in Yugoslavia (94) and 1,700 in Bavaria (132).
Measurements of the gonad doses during examinationsof children are of particular interest as there are only
a few surveys which have taken these into account.
When careful techniques are used, the gonad doses are
smaller than those for adults. Children·s gonad doses
are given in a number of reports (26, 58, 134). The
measurements reported in Thailand (119) are of interest since they not only reflect the result of goodradiography but also show how the smaller size of thepatients requires reduced exposure factors resulting inlower skin, and therefore lower gonad. doses. as longas all other factors remain constant. Several hundred
measurements for a single type of examination usually
give reliable distributions of doses per examination.
In the Czechoslovak survey ( 80) the geometric meanrather than the arithmetic mean was used to correct
for the small size of some samples.
31. A completely different method of dosimetrybas been used in the Johns Hopkins survey (97) in
the United States. The dosemeter used consisted of atransmission ionization chamber fitted close to the
x-ray tube portal in the primary beam. The reading ofsuch a chamber was, for any exposure, proportional tothe integral of the area of the beam at the x-ray tube
diaphragm multiplied by the exposure in roentgens, andwas therefore proportional to the radiation energy projected onto the patient. This measurement was madefor a large number of patients. To derive the gonaddose from such a reading of projected radiation energy,
the fraction of the radiation energy falling on to theabdomen was determined for each examination type.
There are difficulties and inaccuracies in translatingthese measurements into actual gonad doses.

4. Child expectancy
32. In the calculation of the GSD it is required toknow (see appendix) (a) the child expectancy by sex
and age of the patients that undergo each particular
type of examination and ( b) the child expectancy of
the general population, also by age and sex. Data of

the first t¥pe .are practic~y uno~tainable except for a
few exammat1ons on which details are !riven in paragraphs 35-38. In the absence of such data. most surveys have had to assume that the child expectancy ofthe patient of a given age and sex is equal to the child
expectancy of the average person in the population of
the same age and sex. These latter child expectancies
are obtained from national statistics and representative
examples of them are given in table 1 for Czechoslovakia ( 80), Thailand ( 119). and New Zealand ( 118) .
33. The values for all European countries and Japan are similar to those from Czechoslovakia; the Thailand values are probably representative of South East
Asia, and the United States values are similar to thosefrom New Zealand. The New Zealand data in table 1
are given for four periods and indicate that child expectancy is changing with time. Such changes in absolute values of child expectancy do not make as muchdifference in the GSD as at first might be anticipatedbecause the same value of the indices appears in boththe numerator and denominator of the formul~ forthe calculation of the GSD of each irradiated person.
The exception to this is in the irradiation of the fcetus.
In this case the indices in the numerator will apply
to the fcetus and those in the denominator to themother. Hence any absolute change in child expectancy will be reflected in the contribution from thefretal exposure to the GSD due to the particularexamination.
34. In the New Zealand survey (118) the child
expectancy in various age groups has been expressed
as a percentage of the remaining child expectancy at
various ages. The probit plot of figure I shows that
this percentage follows a log-normal distribution andthat the values derived from Norway and Sweden lie
on the same line as those from New Zealand. This
may not be so, however, for countries with very different demographic structures.
35. Several surveys have utilized specific data forthe child expectancy of patients undergoing hysterosalpingography and for pregnancy examinations. A sur-

0-01 .-------.----~--,--i--,Parental' mortality
0•1 NOT allowed for
except N.Z. 1951/
X inserted for. comparison.1---1-1---+---1

Parental mortality
0:1. NOT allowed forI
except NZ 1951 X
Iinsertedforcomparison-1-...,...-1--t--i
1

>0
z
~

>0
z

10

u

w
a.
X
w

a

~

10 1-----1-----.---1----,r--1

arol----+---re-+---+--,r-i

0.01

0.1

>0
z<(
a.
X
w

u

u

't!T

(,!J

~

901-----t---1'.1>----+---1----,r--1

(,!J

~

001----+,'----t---+--r--t

<
::.

<
::;;

99 1-----Pt-----+---1----,r--1~
Xo 1960-2
99.9 1----+-----"t---" 1963·5

~

w

~

__ ___ _~~._10a 1965-7_.

...__.___._.

20

40

60

AGE OF PARENT, YEARS

80 100

50

C

..J

J:

w

z

z 90

<
::.
991----+---+---+--r-i~o 1960-2

w

~

~

99

1--------i---•o 1963·5
1965-799.9~~'----'-----'---'---'-'
1020
40
60 80 100

99.99
10·

99·9

AGE OF PARElff, YEARS

Figure I. Variation in child expectancy with age of parent ( 118)

137

I

'

t1

JO

I-

..J

J:

,-

I

n

..J

0

'·

Pantnt mortality
NOT allowed for

u
w

w
a.
X
w

ro1-----t---f-'-'--+---1----,,--i

VARIATION OF% REMAINING CHILDEXPECTANCY WITH AGE OF PARENT.
NORWAY, SWEDEN, NEW ZEALAND. MALESVARIATION OF% REMAINING CHILDEXPECTANCY WITH AGE OF,PARENT.
NEW ZEALAIJD FEMALESVARIATION OF% REMAINING CHILDEXPECTANCY WITH AGE OF PARENTNEW ZEALAND
MALES
0-01 . - - - - - - . - - - ~ - - , - - . . . - ,

!

,ll

/

I
j
!

• NEW ZEALAND 1965-7
o SWEDEN 1955
o NORWAj 1958 (

-

I

40

60

AGE OF PARENT, YEARS

80 100C. GENETICALLY-SIGNIFICANT DOSE

vey in Brno. Czechoslovakia ( 80), followed up 700
women who had had hysterosalpingography examinations and showed that 25 per cent of them gave birth
to live children after the examinations. This factor of
0.25 was applied to the average population statistics
for the particular age class. Other surveys used different factors-0.5 in the Netherlands (14), Sweden (82),and Texas (27), and 0.1 in the United Kingdom (26).

l. Description of surveys
39. The 1962 report gave detailed information on
surveys carried out in 12 countries or dist..--icts. The
resulting GSD due to diagnostic radiology ranged from
7 to 56 millirads. These surveys were carried out during the period 1950-1961 but most of them during thelast five years of that period. A summary of the results
is given in table 2 which is abstracted from the 1962
report of the Committee (annex G, tables I, XVII,XXI).

36. For examinations connected with pregnancy,
several surveys have utilized as the expected number
of offspring the average population statistics for theparticular age class concerned less 1 ( or less 0.99) inrecognition of the fact that the fretus must be considclass was derived which also resulted in a considerable
ered separately with its own child expectancy. In the
Dutch survey (14) a more detailed relationship by age
reduction in child expectancy. It is doubtful whether
this type of correction is appropriate, for it may beargued that a woman in a particular age class who iscurrently pregnant is more likely, rather than lesslikely, to have more children than the average woman
in the population of that age class. This was confirmed
in a survey based on the 1951 British census (98)which showed the following expectations in the different age classes:

40. Since 1962. a considerable number of investigations in other countries and large districts have beenreported. The results of these surveys are given intable 3 and the details of each study in paragraphs
47 to 59. The GSDs range from 5 to 75 millirads andare therefore similar in magnitude to those reported
in the previous decade.
41. The frequencies of radiographic examinations
per year excluding mass surveys of the chest, given intables 2 and 3 are plotted in figure II against the year of
survey. This figure gives an over-all impression of thevariation in the numbers of radiographs carried out
in different areas of the world but attention must be
drawn to the fact that different diseases and radiological techniques will alter the relative contribution of
any one procedure to the over-all frequency of examinations. However, comparisons within any one country
or region will be a reasonably valid indication of thegrowth of radiological services. Examples of this are
given by the curves for New Zealand (156) and theUnited Kingdom (99) in figure II.

Child exputaney
Age dass(years)15-19 .. - ·- ...............
20-24 .... - ...............
25-29 ....................
30-34 ....................
35-39 ....................
40-44 ....................

Now

Averagepregnant

in population

2.78
2.23
1.84
1.60
1.47
1.38

2.207
1.733
1.017
0.462
0.157
0.030

42. The frequency of radiological examinations insome industrialized countries is about one examination
per person per year. From the GSDs reported in tables
2 and 3 and the annual frequency of radiolrntical examinations in figure II a projection of the GSD has
been made for each country or region assuming thatthe practice has increased to a frequency of one examination per person per year. These projections areshown in figure III against the year in which the original survey was conducted. This shows the variationin the GSDs arising from differences in the prevalent
types of examinations in different countries. in radiological procedures and in the standards of patient protection. The main uncertainty in the value of the normalized GSDs lies in the total number of examinations
reported.

37. A correction (9 per cent) for multiple pregnancies, twins, etc. was included in the British survey(26), as multiple pregnancy is one of the clinical indications for x-ray examination. The correction increased the number of offspring per pregnancy x-ray
examination by 9 per cent.
38. The contribution from fretal irradiation during
examinations not apparently connected with pregnancy,
or before the pregnancy was determined, was assessedin some survevs on the basis of the number of womenin the population that are pregnant at any given time.
This was estimated to be 6 per cent in Finland (67)
and 9 and 3 per cent in the 15-29 and 30-49 age
groups. respectively. in the United Kingdom (26). In
New Zealand (156) the same contribution variedwith age as follows:

43. The increase in the number of examinations
need not necessarily lead to higher GSDs if the increaseis accompanied by procedural improvements. Of thesurveys reported in table 3. the regional survey (89)that was carried out in the United Kingdom sevenyears after the national survey showed a drop in the
GSD from 14.1 to 8.6 mi!lirads. The 1969 New Zealand survey ( 118) yielded a value not significamly
higher ( 5 per cent) than that obtained by the 1963
survey despite an 11 per cent increase in the frequencyof examinations.
44. The Dutch survey of 1967 (14) included ause~:il study of the dependence of the GSD on theparticular values of the parameters used in the calculation. The parameters studied were the gonad dose andthe frequency of the examinations. The values of gonad
doses per examination used in this study were thosedetermined in four surveys carried out in Leiden ( 13),

Percrnta.fle

A11e groJCp(years)

15-19
20-24
:!.5-29
30-34
35-37
40-44
45-49

pregnant
at a,iy
onL" time

3.59
19.70
20.22
11.95
5.84
1.72

0.12

In the f,;etherlands (14). however. a further correction facror of 2h was appiied to take into account the
reluctance of clinicians to request x-ray examinationsof pregnant women.
138

2000

1800

1600

1400
0

z

<(
tll

:>
0

::.::

1200

l-

a:

w

c..

tll

z

0

~
z

•

1000

28

:E

<(

X

w

..J
<(

u

5

a 27

800

0

•S'

..J

•·26

0

0
<(
a:

a13

• 25
a20

600

1!129,

.s
II 6

•12

•2

•9

_,.,.,,.,

400

• ,s

14

L-----"".:"--------~--

---~

----?

--

.,s

a24

_,,.,..,..,,.,• 17...:--------a 15i==--"'."""-::::""'4~----==·!.:"-=·=:.:-====-==------- _..--.:---- D 7 1123_,...,

19_

El. 22
3

21

4

1956

1954

1960

.1958

1962

1964

1968

1970

1980

YEARS
1. Argentina (Buenos Aires)
2. Czechoslovakia (Bohemia)
3. Denmark
4. Egypt
5. Federal Re;,-.;blic of
Germany (Bavaria I
6. Federal Republk ofGermany (H cmburg)

7. Finland

8. France•

17. Puerto Rico (Southern
Region)18. Puerto Rico (Western

9. Italy (Rome)
10. Japan
11. Japan

Region)12. Netherlands (Leiden)
13. Netherlands
14. New Zealand
15. New Zealand

19. Sweden
20. Switzerland

21. Thailand
22. United Kingdom

16, Norway

24.
25.
26.
27.
28.
29.

United States (National)
United States (Nation~!)United States (New York City)
United Stata (Ne-.N Orl,eans)
Yugoslavia
Union of Sa,liet Soci~list
Republics (Russian Republic)

23. United Kingdom (Sheffield)

UnitedKin(}<:lom - - - -_____----New Zealand_Sweden _ _ _ _ _ _ _ _ _ _ _• lncludi:s mass chest survey

Figure 11. Annual frequency of radiological examinatiors in t]1e population excluding mass chest surveys

139

2CO

180

160

a: 140

R 1

<(

UJ

>

a:

• 19

...z
UJ

Q 120
I<(

z

:E
<
X

•3

UJ

• 24

a: 100

...z
UJ

• 10

0

• 18
026

<I)

a:

...
... 80

• 17

o9

UJ

a:

UJ

• 8

<I)

0

<(

a:

:i

c25

..J

~
60

•7

• 22

• 28

40
• 14

•20

• 15

06

• 11

c23

•5

• 13

• 16

20·
0

12

• 27

1954

1956

1958

1960

1962

1964

1966

1968

1970

1972

YEARS
1. Argentina (Buenos Aires)
2. Czechoslovakia (Bohemia)
3. Denmark
4. Egypt
5. Federal Republic of
Germany (Bavaria)
6. Federal Republic of
Germany (Hamburg)
7. Finland

9. Italy (Rome)
10. Japan·11. Japan
12. Netherlands (Leiden)
13. Netherlands
14. New Zealand
15. New Zealand
16. Norway

17. Puerto Rico (Southern·
Region)18. Puerto Rico (Western
Region)19. Sweden
20. Switzerland
21. Thai land
22. United Kingdom
23. United Kingdom (Sheffield)• Includes mass chest survey• National surveys

c: Local surveys

8. France•

24. United States (National)
25. United States (New York City).
26. United States (New Orleans)
27. Yugoslavia
28. Union of Soviet Socialist
Republics (Russian Republic)

Figure lll. Normalized GSD for populatio:i receiving one examination per person per year140

in Denmark (53) and in Texas (27) by the same physicist ( 14) and in the United States national survey of1964 (15). These were combined with one of two
sets of examination frequencies obtained in the Netherlands on 1 million people (survey A) and on 5 million
people (survey B), respectively (see paragraph 50).
Six values of the GSD were determined using thefollowing selections from the above data:
Selection I using Leiden gonad dose data and survey A
Selection 2 using Texas gonad dose data and survey A
Selection 3 using Leiden gonad dose data and survey B
Selection 4 using Texas gonad dose data and survey B
Selection 5 using Denmark gonad dose data and survey B
Selection 6 using U.S.A. gonad dose data and survey B

45. The six estimates of the GSD together with theirmale and female components were as follows:
Male

Female

GSD

7.8
5.6
7.6

10

4
5

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

6.............

9.4
30.6

17.8
13.4
16.7
12.8
17.0
39.5

Stlution

1
2

3

5.4

7.8
9.1
7.4
7.6
8.9
Mean

19.5

Comparison of 1 with 3 and 2 with 4 shows that there
was little difference between the two sample populations. Comparison of 3, 4, 5 and 6 shows the difference produced by using different sets of gonad doses
per examination. The four female contnbutions to thetotal were similar. but one of the male contributions
was far higher than the others as a result of examinations, included in the United States national survey( 106), in which the testes were exposed in the directbeam.
46. The main details of the actual surveys referred
to in table 3 are presented in the following paragraphs.
The results of most of the surveys are given in tables
4-17. In each of these tables the 10 examinations
making the greatest contribution to the GSD are presented, with the exception that pelvimetry and obstetrical abdomen are included even though they might
not rank among the top ten. In these cases they replace
the ninth and tenth types of examination. The frequencyof these examinations and the gonad doses are also
given for each examination.
47. Czechoslovakia, Bohemia, 1965-1966 (table 4)( 80). The survey covered three (population 4.341,000
or 30.5 per cent of the country total) out of the 11
regions of the Czechoslovak Socialist Republic. The
number of examinations carried out in all radiologicaland fluoroscopic units over a one-year period werecollected, together with those carried out during athree-month period in all mass chest survey units andduring two one-week periods in 219 out of 570 dental
x-ray departments. A breakdown of the examinations
by age was obtained for 253.853 examinations. i.e.
for 6.4 per cent of the annual number of examinations(2.2 million radiographic and fluoroscopic; 1.4 million
mass chest; 0.4 million dental). Central-axis skindose and gonad-dose measurements were carried out on
5,602 patients in 70 departments at 28 industrial andagricultural localities. To obtain the ovary dose,
phantom measurements were carried out on eachmachine immediately following each exposure. The
national average child expectancy in the population
was used in the calculation of the GSD ( table 1 )141

except for hysterosalpingography (paragraph 35). It
sJiould be noted t?at pelv!metry examinations are practically never earned out m Czechoslovakia.
48. Finland, 1963-1964 (table 5) (67). All medical institutions. hospitals and private physicians inFinla~d '_Vere aske~ to supply. details of all radiological
exammauons earned out dunng four weeks in 1963.
together with the total number, or estimated total
number, of x-ray examinations during 1963. A second
survey was instituted to complete the required information. The frequency of dental examinations wasestimated from film consumption. Total examinationsfor 1963 were 2.7 million plus 80,000 dental examinations. 143,000 examinations were recorded in the
study period. Gonad dose measurements were obtainedby using 1960 fluoroglass dosemeters sent to 124
hospitals. In the case of males, fluoroglass rods werein contact with the testes; in females the dosemeter wasplaced on the back, near the ovaries. The ovary dose
was obtained by phantom measurements using a calibration factor dependent on the type of x-ray unit
used. National child-expectancy figures were used in
the calculation of the GSD. Six per cent of the women
examined were assumed to be pregnant and a fcetal
dose equal to the female gonad dose was assumed.
49. Federal Republic of Germany, Bavaria, 19561958 (table 6) (130-132, 134). Statistical data regarding the admission of patients to hospitals in Bavaria
were obtained in 1956. The classification by type of
examination, age and sex was obtained for a population of 0.75 million. Gonad-dose measurements weremade on 1,759 patients in 10 different types of hospitals and private practices. Some 705 measurements onchildren and 700 on adults were also carried out at
the University of Munich. The gonad doses of adultfemales were measured in the vagina and for female
children in the rectum. The comparison of gonad
doses in various clinics and hospitals and for various
ages showed a wide variation depending on the procedures observed. The national child-expectancy figures
were used in the calculation of the GSD.
50. Netherlands, 1967 (table 7) (14. 107). The
radiological examinations carried out in one year on
4.9 million people covered by 53 insurance companies
were used to derive the annual total number of examinations. A subsample of nine companies which covered
1 million people was used to obtain the breakdownby age and sex. Both samples were geographicallyscattered. The two samples were cross-checked andfound to be in reasonable agreement. The gonad-dose
measurements were those obtained in a previous survey
in Leiden ( 13) on patients and on a phantom, butother gonad-dose measurements (some by the sameauthors working in Texas) were used to compute
various estimates of the GSD ( see paragraph 44).
National child-expectancy figures were used. except for
the examinations of pregnant women (paragraph 35).
An increase in the GSD has been reported (154) on
the basis of further gonad-dose measurements at two
hospitals in 1971 and on the 7 per cent per annum
increase in the frequency of examination.
51. Japan, 1969 (table 8) (57). The frequenciesof examinations were obtained during 30 consecutive
days from a number of hospitals of various sizes (number of beds) and from I.OOO physicians. Answers giving the numbers of examinations and the physicalconditions used were received from 60 per cent of
the hospitals approached. Gonad doses were measured

on four phantoms using x-ray units from different
manufacturers operating at the particular conditiocs
used for each examination type in the various hospitals
included in the survey. The phantoms represented 8month, 5-year and 10-year-old children and the adult.
The output of some 54 x-ray generators was surveyed
to obtain a mean output per unit. The child expectancies were derived from national statistics.
52. New Zealand, 1963 and 1969 (table 9) (118,156). Annual figures from the Department of Healthshowed an increase of over-all frequencies of 21.6 percent during the years 1963-1970. During the sametime the population of New Zealand increased from
2.5 to 2.8 million. A survey in which details of 40,000
examinations were collected and analysed, sampled 3.5
per cent of the annual number of examinations. A
field survey was conducted in which the gonad or skindoses were measured in 1,400 examinations and 2,460
technique forms were used to derive the gonad dose.
The male measurements were carried out directly andthe ovary dose was calculated from the data used in
the British national survey of 19 57. Child expectancies
were derived from national statistics ( table 1 andfigure I). The 1970 survey utilized the same gonaddose measurements and the distribution of examinations by age and sex as in the earlier survey but
current data on the total frequency of examinations
and child expectancy were used. The most notablechanges in the frequency of examinations that took
place during the 1957-1963 period regarded pelvimetry
examinations, which dropped to 40 per cent of the1957 frequency, and obstetrical abdomen examinations, which dropped to 60 per cent of that frequency.
53. Thailand, 1970 (table 10) (4, 119). The total
number of patients radiographed in all centres was
requested for the month of January 1970 and the 56
per cent return obtained represented some 45 per centof the estimated number of examinations carried out.
A very low total frequency of 30 examinations per
year per 1,000 persons was reported. Gonad-dose measurements were made in one hospital during fluoroscopic procedures using thermoluminescent dosemeters
placed on the scrotum of male patients and in thevagina of female patients. Phantom measurements were
undertaken in five hospitals utilizing the exposure dataof patients. The lower gonad dose due to the smaller
size of the patients is to be noted ( paragraph 30).
As data were insufficient to make possible an accurate
estimate of the GSD. a "most probable·' value wasderived. As this value seems exceptionally low. an
upper limit bas been estimated, referred to as "themaximum" GSD based on the "maximum'· average
gonad dose. The female child-expectancy data derived
in 1966 by the Ministry of Public Health was used
and the male fertility was deduced from it, using as
a basis the relationships observed in New Zealand<figure I). It was considered that the pattern forfemales might be changing since the median age of themother at childbirth had dropped from 27 years in1966 to 25 years in 1970.
54. United Kingdom. Sheffield.. 1964 (table 11)( 89). The frequencies of the examinations in the
Sheffield area (population 4.5 million) were collected
in all the x-ray departments during a one-week period.
This showed an increase in the frequency of radiography of 33 per cent compared to that reported in
the 1957 sun,ey. The population increase was 6.2 per
cent. showing a 26 per cent increase in the frequency of142radiography per caput. Fluoroscopic examinations had
decreased by 36 per cent per caput and mass chest
surveys increased by 42 per cent. Gonad doses were
measured using ionization chambers placed at thescrotum in males and at the level of the iliac crest infemales. Over 2,000 measurements on 800 patients in
30 hospitals were made. The ovary dose was calculatedusing the conversion data measured on a phantom in
the 1957 British survey (26, 38, 39). For changes
indicated by analyses of the two surveys. see paragraph 61. The same child expectancies, based onnational statistics, that were used in the earlier survey( 26) were utilized in the later one.
55. United States, 1964 national survey (table 12)(21, 51,104.106, 108). The national survey was conducted on the basis of interviews of 9,653 completehouseholds in 1964 and 21,667 in 1970. selected bya multistage sampling programme used for sampling thecivilian population of the United States. The first division consisted of 357 geographically-defined primary
sampling units. Within each, the ultimate subdivisions,called segments, consisted of a cluster of nine neighbouring households. Each week a random sample ofapproximately 90 segments ( 800 households) was
drawn from the whole country. Interviews of theseselected households over a three-month period covered just over 31.000 people of whom 4.525 bad had
an x-ray examination during the previous three months.
(For details see paragraph 24.) The follow-up consisted of an approach to each clinic or hospital atwhich a selected person had had an. x-ray examination,with requests for details on the examination together·with a film from which the x-ray quality and the fieldsize could be determined. The gonad doses were determined on the basis of these exposure factors by processing the results of comprehensive scatter measurements made on a phantom. These were checked by inviva thermoluminescent dosemeters applied to 360 patients undergoing a variety of examinations. The mean
"system-calculated'' male-gonad doses ranged for particular examinations from + 170 to - 71 per cent of
the mean dosimetric measurements. For examinations
with the ovary expected to be in the direct field, the"system-calculated'' values ranged from +57 to -30
per cent of the dosimetric measurements. For data regarding field size variation. see paragraph 61. Child
expectancy figures were derived from national statistics.
56. United States, Puerto Rico, southern and western regions, 1968 ( table 13) ( 44, 45). The average
number of patients radiographed per week over theyear 1968 was presented from all hospitals in the tworegions of Puerto Rico. These statistics were broken
down into types of examinations. An earlier investigation had been carried out in the western region in1967 ( 44). The majority of the dosimetric work was
carried out on one unit. Thermoluminescent dosemeters
and ionization chambers were used for a limited number of in virn dose measurements at one centre andagreed reasonably with phantom measurements. The
average gonad doses were derived from the returns
from the 47 facilities with one or more x-ray units inthe southern region and from 65 facilities in rhe w~stern recion. The-recions had a total of 83 and 75 x-ray
units, respectively.~In the southern region the numberof x-ray units excluding dental units ,vas 13 in 1940,
28 in 1950. 57 in 1960 and 83 in 1968. indicating adoubling period of about 10 years. The difference in the
GSD estimates in the two regions may be accounted
for by technically sounder practices in the southernIregion. For instance, 60 per cent of the 83 units inthe southern region had variable collimators comparedwith 22 per cent in the western region. The childexpectancy figures were derived by the Department of
Health but not published.
57. United States, other local surveys. Four surveys have been completed in lo~al areas of the {!nit~dStates since the 1962 report, m New York City m1962 (102). in New Orleans in 1962-1963 (69), at
the Johns Hopkins Hospitals in 1965 (97) and in
Texas in 1963 (27). Each of these surveys have had
to depend on the national child-expectancy figures. The
results at the Johns Hopkins Hospitals and the survey
in Texas were expressed in terms of the national frequency rate in 1960 of 8.9 10 7 exa!ninations per y~ar.
The detailed results of the surveys m New York City,New Orleans and Texas are given in tables 14-16, respectively. In the New York City survey 68 out of
234 institutions took part and each reported the annual number of x-ray examinations and a breakdownby age and type for a period of a few days. Physicians'
offices reported over a four-week period. In New Orleans 262 x-ray units and 144 physicians' offices, 73
per cent of those in the area. reported data for a sixmonth period and the details of the exposure of 8.000
patients comprising 9.000 examinations and 18.000
projections were collected and used to derive the gonad
doses using relevant phantom data ( 41). The Johns
Hopkins survey was based on the radiographic examinations of 100.000 patients and the details of the determination of the GSD is given in paragraph 31. The
220.000 examinations at the hospitals of the University of Texas over a 30-month period were used together with gonad and skin dose measurements to derive the GSD.
58. Union of Soviet Socialist Republics, Russian
Republic (1964) (75). The results of surveys at the
Moscow X-ray Radiology Research Institute concluded
that 65 million x-ray examinations were carried out
annually on the 82 million people in the Russian Republic (14 million radiographies, 36 million. fluoroscopies and 15 million chest photo-fluorograph1es). The
total number of fluoroscopic examinations included 10
and 22 million examinations of thoracic organs forprophylactic and clinical reasons, respectively, and 3.~
million for gastro-intestinal tract examinations. Rad~ography included 2.1 million investigations of thorac.1corgans, 0.8 million gastro-intestinal tract and 10 million examinations of knee and joint systems. Measurements of the skin dose, gonad dose and the integral
dose were made for a number of x-ray examinations.
The total exposure to the gonads received each year
in these examinations was 220 104 man-roentgens. The
per caput gonad exposure was calculated to be 27 milliroentoens per year of which 10 per cent was due toprophylactic examinations and the remainder to clinical examinations. The total integral dose was 845 106
kilogramme-rads of which 91 per cent was from fluoroscopy. 6 per cent from photofluorography and 3 percent from radiography. The per caput annual i.,tegral
dose was 10.3 kilogramme-rads which was 1.5 times
natural background ( 150 millirads).

dose survey was biased towards those examinations
which contribute most to the GSD. The centres to bevisited were deduced on the basis of the 1960 workload. Some 2.000 gonad-dose measurements were
made. The gonad dose was measured at the scrotum
for male patients and at the iliac crest for female patients. The data from the British survey and some
additional data were used to convert iliac crest doses
to ovary doses. The child-expectancy figures were derived from national statistics. For examinations unconnected with pregnancy, the fcetal contribution was
taken into account, by assuming the proportion ofpregnant women of a particular age group in the population and reducing this by a factor of 0.75 to take
into account the reluctance of staff to subject women
known to be pregnant to x-ray examination.

2. Gonad dose
60. The gonad doses received in a variety of examinations were reported in tables XVIII, XIX and
XX of annex G of the 1962 report. The gonad doses
reported in more recent surveys are summarized herein table 18 which shows the median of the nationalmean values and the range of the mean gonad doses
per examination. The examinations have been clas.sified in three categories, according to whether they involve high. medium or low gonad doses. It will be
noted that, although the mean gonad doses from thesame examinations tend to be lower than those reported in 1962, their range is still wide. The rangeof the gonad doses reported for a. particula: cxami1!-ation reflects to some extent the difference m pracucein different countries, e.g. the number of radiographsthat are usually taken and the physical factors used
for a particular examination type. However, improvements of practice such as those recommended by Ardran ( 8) will ensure that the mean value for an examination approaches the lower end of the reported range.
61. The importance of strict field-size limitation,of the use of gonad shields and of filtration of the incident beam in the reduction of the gonad dose havebeen illustrated by the analyses presented in some ofthe surveys. The excess of field area over film area
shown in figure IV was taken from the United States

HCSPITALSo,-PAIVAT£

GFOUPS! ,:_ '31970
PRIVATEOFFICESRADIOL•
OGlSTS
3.3

PFIVATEOFFICES0".HER

H:"ALTH

AGENCIESANDOTHERS

59. Yugoslavia, Slovenia, 1960-1963 (table 17)(94). During 1960, the total number of radiographic
and fluoroscopic examinations was determined for all
the institutions in Slovenia. Information on a 25 percent sample of these examinations was obtained interms of age, sex and type of examination. The gonad-

ME.o.H RATIO

Figure IV. Estimated mean ratio of beam area ~~ film_ ~reafor radiographic examinations by t ~ of fac1hty,_ Umte~
States, 1964 and 1970 (21, 106) show~g the reducuon taking place during that penod

143national surveys (106). The 1964 survey indicated that
if the :field area had been equal to the film area. thenthe GSD would have been reduced from 55 to 19 millirads. Similarly, in the United Kingdom survey at
Sheffield (89) in 1964, 67 per cent of the examinations had :field sizes larger than film sizes and 8 percent had field sizes larger than twice the film sizes.
For examinations of the chest in 1957 (26) 10 per
cent of males and 51 per cent of females had gonads
in the direct beam but in 1964 this had been reduced
to 4 and 10 per cent, respectively. In New Orleans(69), 12 per cent of the examinations were takenwith units with no beam-limiting device and 30 per
cent had only one large cone available. The British
surveys (26, 89) indicate that gonad shields were usedin examinations of 11 per cent of the male patientsand 4 per cent of the female patients in 1957 but in
28 and 12 per cent, respectively, seven years later. In
19 57, 24 per cent of the units had no added filtration
but this was so in only 0.8 per cent of the units in
1964.
62. The radiation dose to the fcetus bas been studied in several surveys. In Poland an extensive survey
has been carried out by Jankowski and Liniecki (70)in the city of Lodz. Reekie, Davison and Davidson(116) have also reported the doses to the fcetus resulting from x-ray investigations. These surveys indicate doses to the centre of the fcetus in the range of
0.1-6 rads.
63. The estimated accumulated mean gonad doses
per caput from diagnostic medical radiology in the
United States ( 106), assuming that examinations anddose rates were to remain constant for 30 years at the1964 rate, would. at 15 years of age, be 160 and 50
millirads for males and females. respectively: 2,770
and 490 millirads at 30 years and 6,600 and 1,490
millirads at 45 years.

Thus, the survey by Brown and Nelson in 1963 (19)indicated that 9 per cent of all pregnancies had eithera pelvimetry or obstetric abdomen examination. These
examinations provided 58 per cent of the female contribution to the genetically-significant dose at New
Orleans (69) in 1962-1963 and 24 per cent in New
York ( 102) in 1962. This contribution from examinations during pregnancy is not apparent in the nationwide survey carried out in the United States (104, 106)
in 1964.

4. Genetically-significant dose by sex and by age at
examination
66. The contributions of examinations of males
and females and of fcetuses to the GSD as shown by
the recent surveys are given in table 20. The foetal
contribution has not always been assessed for examinations not connected with pregnancy, and sometimes
that contribution is included in the female contribution. In general, the male and female contributions areabout equal but in the United States 1964 survey(106) a very high male contribution, due principallyto the examinations of the lumbo-sacral and lumbar
spine, was recorded, 25 per cent of the male gonad
doses from these examinations being in excess of fiverads. The corresponding contribution to the GSD would
have been reduced from 22 to 1.3 millirads, had thefield sizes been reduced to the size of the films.
67. The contributions of the various age groups
to the total GSD is illustrated in figure V. The factthat the examinations of the 20-30 years age groupcontribute about 50 per cent of the total GSD is important when considering the age group for which both
gonad-dose reduction and reduction in the frequencyof examinations is particularly desirable.
30

3. Genetically-significant dose by examination type
64. The contribution of the various examinations
to the GSD was reported in table XXI of annex G of
the 1962 report and the values reported since are contained in table 19 of the present annex in terms of
their percentage contributions to the GSD. The examinations contributing most are those that involve irradiation of the pelvis and abdomen, namely. urography,
lumbar spine, lumbo-sacral spine. hip and pelvis, barium meal and barium enema. The age groups contributing most to the GSDs are considered in paragraphs
66-68. The practices that are recommended to ensurethat the minimum dose is received. consistent withgood radiology, are referred to in paragraphs 61 and89.
65. Particularly significant is the small contribution
from examination carried out during pregnancy insome countries, e.g.. in Czechoslovakia (80). In connexion with the reduction of doses by the evolution of
improved techniques it is noted that in France fluoroscopic examination of the chest for mass surveys is not
now allowed and that therefore radiography or photofluorography must be used for the chest examinationsof pregnant women. In the United Kingdom (89) the
number of examinations of pregnant women has greatly
decreased since the 1957 survey and similarly in New
Zealand (118) (paragraph 52). However, a high contribution of examinations during pregnancy is stillshown by the local surveys made in the United States.

NEW ORLEANS

20·~===-MALE

10
0

Fo«UI

0

10

20

30

40

SO

80

40
30
20
10
0
40
FEM
OA L
10 E ~ F t a l

5(!.

30

! ~

BOTH

0
60

40 ~ s o

60

40
UNITED1

STAT;cs!.\ALE===='
0

20

40

10

so

60
40

20

I

Foetal

0

10

20

30
Age !ycar,J

40

so

60

Figure V. Contribution of age groups to the geneticallysignificant dose

144

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8
10 ...
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68. Children. The importance of reducing the gonaddose when examining children has been emphasizedin several reports (26, 28, 74, 80) which have shownthat such radiography needs to be carried out using
careful techniques to ensure that doses smaller thanthose for adults are received (see paragraph 30). Otherwise gonad doses several times greater than theadult gonad doses will be received particularly fromexaminations of the hip, femur and of the abdomen.

ocytes or the immune response of the bodv or someother factor may each have to be considered. It is
impo1:tant t~at, in considering the detailed informationthat 1s available on the dose to the bone marrowthese other factors should not be imored. Further inves~tigations of the bone-marrow dose delivered durino
particularly extensive examinations are required bothas to the range of individual mean marrow doses andtD their frequency throughout a population. The resultsof these investigations will not only help draw attention
to the need to use the minimum dose consistent withgood radiology but will also indicate groups of patients
who may provide epidemiological information.

5. Other investigations

69. Estimates of the GSD have now been madeover a period of two decades and it is important toconsider the contributions that further studies might
make. Probably the most important contribution madein any country or region by the conduct of a survey is
educational. Increased awareness of the need toprotect the patient develops among the staff and many
country-wide and regional surveys have been undertaken for this reason. Surveys have the additional
advantage of bringing to light the specific practices
which may be important contributors to the GSD.
However, the repetition of such investigations should
aim more at determining the order of magnitude ofany changes in the GSD that may have taken place
over. say, a 10-year period than at obtaining highly
precise estimates of the GSD.
70. In countries where resources of both trained
staff and finances are limited. the determination of
the GSD should not rank high in the order of priorities
but effort should be placed on the improvement of
the facilities and on training of staff. Estimates of the
GSD can be made on the basis of the studies in othercountries and of data on the frequency of examination
which . do not require highly skilled staff for theircollect1on.
71. As medical radiological practices change andnew techniques are introduced estimates should bemade of the doses to the gonads, to the skin and toother organs in the direct field. From the frequencyof these investigations in a few broad age groups it
should be possible to determine the importance of
these practices to the GSD. Such estimates should be
included in the description of the techniques in thescientific literature.
72. A number of investigations are known to be inprogress, e.g., in Australia (138). In particular, a prospective survey of 20,000 patients is being undertaken
in Canada ( 34) in which ill effects in progeny arebeing recorded together with radiation-dose estimates.
A survey of dental radiology in the United States (30)
has shown that the GSD from dental radiology isless than 0.01 millirad per year. Investigations on thedoses to the body in mammography examinations (50,101) have shown the vaginal dose per examination
to be Jess than one millirad.
D.

BONE-MARROW DOSE

73. In paragraphs 10-13 of the introduction thebasic criteria have been stated for the study of thedose to the bone marrow. However, paragraph 11
emphasizes particularly the deficiencies in our present
knowledge of the role of radiation in the induction ofleukremia. Only further study will elucidate whether
the bone marrow is the most important organ to study
or whether the reticulo-endothelial system, the lymph-

74. When the 1962 report was assembled, measurements of bone-marrow doses from only a few diagnostic x-ray examinations had been made. Since thenthe results of three comprehensive surveys havebecome available. Weber (153) published data for the
Leiden district in the Netherlands giving a per caputmean marrow dose (CMD) of 30 millirads, in the
United Kingdom (25) the result of the national survey
for diagnostic radiology gives a figure of 32 millirads,
and in Japan (58) a national survey has reported a
CMD of 189 millirads. Estimates of the CMD in
Czechoslovakia ( 81) amounted to 68 and 184 millirads, depending on which of two different approaches
based on the British results were used. Other measurements were made in Japan (6, 7, 56, 127) utilizing
some published data (37, 41).
75. The basic data on bone-marrow distribution
which have been used in most of the surveys are very
limited and are mostly derived from the figures established by Mechanik (91) in 1926 on 13 cadavers andsubsequently modified by Ellis (37) to give the activebone-marrow distribution in a 40-year-old adult. This
modification utilized the measurements made by Custer (29) on the distribution of the active bone marrowin the adult and its change with age. Hashimoto et al.
(54. 58, 95) have investigated the marrow distribution
in 10 Japanese cadavers by weighing each bone before
and after the chemical removal of the marrow. The
percentage cellularity at each site and the resultant
active bone-marrow distribution were determinedTable 21 shows the percentage distribution of active
bone marrow obtained by Ellis and by Hashimoto
et al. The distribution of active marrow in children
was derived by Hashimoto et al. from the adult distribution by taking into account the presence of active
marrow in the extremities of children. The amounts ofactive marrow in Japanese were 765 grammes in theadult. 583 grammes in children at 8-14 years of age.
329 grammes at 3-7 years. and 162 grammes at 0-2(derived on a body-weight basis). The corresponding
adult active bone-marrow derived from the Mechanik
data was 1.046 grammes. Further studies on the variation of the distribution of the active bone marrow withage are needed, and determinations of the quantitative
distribution of the active bone marrow by means ofradio-active tracer studies would provide a useful checkof the values being currently used.
76. The use in the Japanese report (58) of a weighting factor to give a leukremia-significant dose (paragraph14) takes into account the shape of the time-incidence
curve of radiation-induced leukremia. and also the survival statistics for the different age groups in the population. When applied to the CMD, these factors give a"leukremia-significant" dose of 169 millirads, about 10
per cent lower than the uncorrected CMD ( table 22).

145

1. Variation with type of examination

OBSTETRIC ABDOMEN

77. The bone-marrow doses from the various examinations as obtained in the Netherlands (153). theUnited Kingdom (25) and Japan (58) are given intable 23. The examinations giving the highest doses arethose involving irradiation of the trunk and particularly
those, such as barium meals and barium enemas. that
require long fluoroscopic exposures.
78. The active bone marrow is widely distributed in
the body and therefore the factors which mainly determine the magnitude of individual mean marrow dose
are the extent of the examination in terms of field area
and the incident skin dose (25, 65). The latter isincreased by high screening currents and long screening
times during fluoroscopic examinations and by the number of radiographic exposures made. The radiation quality used has only a minor effect on the mean marrowdoses received. A study of these factors and their effecton the mean marrow dose was undertaken in the British
survey (25). The variation in the individual mean
marrow doses for particular examinations is shown infigure VI. The variation in the fretal marrow dose dur-...............

AO
V)

z

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~3

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er

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FOETAL MARROW DOSE (R)~030

uicc»ooPELVIMETRY

z~

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~
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Figure Vil. Variation in the fretal bone-marrow dose due to
two types of examinations (25)•-.........

particular exposure conditions was calculated at eachsite within the element, using the results of the physicalmeasurements and the proportion of the total active
bone marrow present at that site. The doses to each element were then totalled to give the mean marrow dose.
The computer programme ~sed for these computations
is available on decks of Fortran IV cards ( 40). A
similar aproach was followed in the Japanese survey(124).

Figure VI. Histograms showing variation in bone-marrowdose with various types of x-ray examinations (male) (25)(the white triangle denotes the mean value)

ing obstetric abdomen and pelvimetry is shown in figureVII. Fc:etal dose studies have also been reported by
Jankowski and Liniecki ( 70).

3. Per caput mean marrow dose by examination type2. Determination of mean bone-marrow dose

81. Table 24 indicates the contribution of the various examinations to the CMD in the Netherlands(Leiden) (153) and the United Kingdom (25). Table
22 provides the information for Japan (58). The contribution of the various radiological techniques to the
C:MD and the Jeuk:Emia-significant dose in the Japanese survey (58) are given in table 25.

79. The values of the bone-marrow dose for particular investigations have been determined by extensive
phantom measurements. In the British survey (25), thepercentage of the radiation at the skin was measured
with a very small ionization chamber at 12 bone-marrow sites in a speciallv constructed phantom containing a human skeleton impregnated with wax undervacuum. For each site the doses were measured forseven radiation qualities with different focal skin distances and field areas, and for the anterior. posterior
and lateral projections of the incident beam.

82. According to the British survey (25). the examinations contributing most to the population dose weremass surveys of the chest (24 per cent), barium meals( 18 per cent) and barium enemas ( I O per cent). The
examinaticns that were the 2:reatest contributors in the
Dutch survey (] 53) were -fluoroscopy of the chest,
mass surveys of the chest and descending urography(27.0. 12.8 and 12.3 per cent, respectively). In Japan
fluoroscopic examinations of the stomach contribute
55 per cent to the CMD. Their high frequency is dueto the mass surveys carried out because of the high

80. The calculation of the bone-marrow doses was
based on the size of the skin field. The active bonemarrow was subdivided into elements by means of agrid superirnpo~ed _over the body in anterior, posterior
and lateral pro1ect1ons. For each element so obtained.
the dose contribution to the marrow arising from the146

r
incidence of stomach cancer in that country (58).
These results are good examples of the contributionthat bone-marrow dose surveys can make in identifying
those groups of patients of importance for the epidemiological studies recommended by the ICRP /ICRU reports (42, 43) and by the ·uN/WHO seminar (144).

F. TRENDS WITH EXTENSIVE EXA::,.,IINATIONS
87 .. Th~~ ma~ trends in diagnostic radiology havebeen 1dentmed m paragraph 17. The doses received
during the use o~ image in~ensificati?n .and cine procedures have received attention. The mc1dent skin-dose
rate during non-intensified fluoroscopic examinations
may be about 4-10 rad min-1 . The ICRP (114) recommends that it should not exceed 5 rad min-1. When theconditions under which imaQe intensification is carriedout are optimised. for example by dark adaptation of
the operators, and technical problems are overcome.
the dose rate may be reduced to about 0.5-1 radmin-1 . However, reports indicate that when the imageintensifier tube deteriorates. the higher screenine: current necessary to obtain a good image may increase theskin-dose rate above that for non-intensified fluoroscopy.
With cine-fluorography. very much higher skin-dose
rates are used, rates of 50-100 rad min-1 being deliveredon thick patients. Gough. Davis and Stacey (52) report
the following doses delivered during cardiac catheterization of 85 patients in the United Kingdom:

4. Dental radiography
83. Few data are available on the individual mean
marrow dose from dental radiography. This dose wasestimated in 1959 to be 1.8 millirads in the United
Kingdom which, with an annual examination rate of
2 million dental examinations in a population of 50
million, corresponds to a CMD from dental radiographyof 0.1 millirad (25. 26). However the practice in somecountries is tending towards the use of wider fields andmore frequent dental x-ray examinations so that the
CMD from dental radiography is likely to increase.
When radiographs of the whole mouth are required
the use of intra-oral x-ray tubes may reduce the doses
received.

.Mean dose
rad

E.

Skin
Marrow ............... .
Male gonads ........... .
Female gonads .......... .

DOSE TO THE SKIN Ai'ID OTHER ORGANS

84. The dose to the skin in the primary beam andthe area of the beam are two important parametersthat determine the total dose to important organs suchas the bone marrow. Significant radiation may also bereceived by other organs and tissues of particular groupsof patients. For example, young children with orthopredic conditions may receive many radiographs ofparticular bones over a number of years. Such groupsof people may lend themselves to epidemiological studies
and the ICRP /ICRU reports ( 42, 43) have drawn
attention to the necessity to ensure accurate dose estimates for these groups of patients.

mrad

47
1.4

1-fa.rinrn m dose
rad

mrad

140

3.9
25
39

80
100

Ardran (9) reported similar doses in another series ofpatients in the United Kingdom. Even higher radiation
doses were reported by Gough. Davis and Stacey (52)as being delivered during pacemaker insertion-an
emergency procedure. An average skin dose of 132
rads per patient was received in a group of six patients.
Other surveys of the doses received during fluoroscopy
have been published by Seyss (135) on 5,000 cases,
and by Schoen (128).
88. The irradiation of children both for cardiac
catheterization and for such examinations as voiding
urethrocystography may lead to high gonad doses.
Typical measurements by Kaude. Lorenz and Reed(74) give average male gonad doses of 105 millirads
and ovary doses of 270 millirads. with maximum valuesof 570 and 690 millirads, respectively.

85. Variations in the skin dose from radiographic
examinations reflect the type of film and screen used
and the amount of initial filtration inserted in the
primary beam. For most examinations the fastest filmscreen combination may be used. but where fine detailis required, as in bone radiography, fine-grain screensor no screens are often used. Table 26 gives for anumber of examination types the median and the rangeof the average skin doses in the primary beam reported
in seven surveys (8, 25, 63, 80, 123, 126. 156). Ardran( 8) has drawn attention to the need to reduce theoff-focus radiation and thus reduce the incident skinand gonad doses. The skin dose due to any particularexamination may be much less or much more than the
average values reported in table 26, depending on thenumber of exposures and on the exposure factors used.
For example, in the British survey (25) the mean valueof skin dose was 2.1 rads for pelvic examinations. but
values up to 33.4 rads were recorded. In the investigations on the skin doses received during mammography examinations, local doses up to 35 rads were
measured (50).

G.

RECOMMENDATIONS FOR THE PROTECTION OF
THE PATIENT IN Dl.\GNOSTIC RADIOLOGY

89. Because of the increasing use of diagnostic
radiology (for example. an estimate in the UnitedStates (24) indicates that 50 per cent of all diagnoses
are made or confirmed by diagnostic radiology), the
ICRP ( 65. 114) and other international and national
bodies have made recommendations for achieving theminimum patient dose consistent with good radiology.
Similar recommendations regarding special aspectsof radiology have also been published (93, 155). forexample, for the examination of children ( 4 7) andfor dental examinations (35).
II. Diagnostic use of radio-pharmaceuticals

86. The doses to the skin. thyroid, hypothalamus
and the lens of the eye from dental radiography are
not negligible. The doses delivered to the lens will
be considerably reduced by the use of protective diaphragms and centring techniques. When radiographsof the whole mouth are required the use of intra-oral
x-ray tubes. if correctly applied, will reduce the irradiation of the patient.

90. In many countries the increase in the diagnostic
use of radio-pharmaceuticals has been extremely rapid
during the 1960s. The procurement of radio-pharmaceuticals has been relatively easy and their dispat~hby air freight has enabled many clinics and laboratones
to use radio-pharmaceuticals manufactured in a few
centres. Both the number of patients investigated by147

such well-established tests as the use of radio-active
iodine for the study of the thyroid function and thenumber of radio-pharmaceuticals available for use havebeen increasing. This has been particularly noticeable
since the column generators of short-lived radionuclides have been available. In industrialized countries, the introduction of large numbers of scanners
into departments has also stimulated the use of radiopharmaceuticals. The use of radio-pharmaceuticals inthe developing countries is increasing and is likely to
expand at a fast rate during the next decade.
91. The increase has to be judged from data thathave been reported differently in various countries, e.g.,comprehensive estimates of radio-nuclides distributed,
but not necessarily all administered, number of orders
for radio-pharmaceuticals or, better from a populationexposure viewpoint, number of patients to whom thevarious diagnostic radio-pharmaceuticals have been
administered. Typical data are available in the reports
from Australia (5), Denmark (15, 79), France (96),Japan (36, 73, 146), New Zealand (90), the United
Kingdom (I 17) and the United States (142, 143).
The basic trend observed from these data indicates adoubling of the number of investigations every three
years or so. A typical growth pattern is shown byWest Berlin (population 2.2 million) with a 100 per
cent increase from 1963-1968 (10) and is shown infigure Vlll for various radio-pharmaceuticals.
92. The information currently available on the total
number of each type of investigation carried out per
year is summarized in table 27. Data on the use of
three main radio-pharmaceuticals in West Berlin ( 61)
are also included in table 28. General reports from
India ( 68) and Argentina ( 12) are available.
93. Even though a three- or four-fold increase in
the frequency of persons exposed to diagnostic radiox1o312___,.. 13 \ (lod;dt)

11~ 131i (H1ppuranl
10-o,. •••• ,o...

57co?'co-+ _ ..,_ 1321 (Iodide)9-o---o- 198Au (C<Jlloidol)
899-<>--<>- . Tc
7
6

5

4

3

pharmaceuticals has taken place since 1958, the GSD
from this source is unlikely yet to approach one rnillirad per year. This conclusion is based on the assumption that the average gonad dose per investigation has
not radically changed. Even though increased activities
of short-lived radio-nuclides have been used, those
have generally replaced investigations utilizing lower
activities of nuclides with longer half-lives so that thetwo effects on the total gonad dose have tended tocancel out.

1. Organ dose from radio-pharmaceuticals
94. A knowledge of the radiation dose to particularorgans following the administration of a radio-pharmaceutical is necessary to judge the activity that may be
administered to any particular patient. Useful publications giving this type of information are the bookletof the Swedish National Institute of Radiation Protection ( 49), Publication 17 of the ICRP ( 64), theseries of reports produced by the Medical Internal Radiation Dose Committee ( 16, 20, 31, 32, 84) andother reports (78. 92, 115). These publications emphasize the fact that the dose delivered by a radionuclide is dependent on the metabolism of the chemical compound in which it is incorporated and that theestimates of dose per unit activity administered thatthey provide are mostly those for normal individuals.
Variations in the doses may be caused by the particular disease of which a patient is suffering.
2. Genetically-significant dose
95. Tables XXXII and XXXIII of the 1962 report gave details on the GSD from radio-pharmaceuticals used in medical diagnosis. The GSDs varied from0.01 to 0.03 millirad per year for Canada (72), theFederal Republic of Germany (Hamburg) (62), theUnited Kingdom (26) and the United States (22) inthe years 1956-1958.
96. Estimates of the GSD that were made subsequently gave a value of 0.015 millirad for New Zealand in 1966 (90), 0.05 millirad for Japan (2) in1965. 0.13 millirad for West Berlin (10) in 1968
and 0.4 millirad for Sweden ( 49) in 1968. The meanannual gonad dose in the Swedish survey (49) was 70
millirads. This latter dose is the average gonad doseto the population regardless of child expectancy. It islarge compared with the GSD because most of thepatients are in older age groups with small child expectancies. Reports from the United States ( 143) andthe Soviet Union (103) indicate that assessments of
the level of exposure of patients and of the activities
administered have been made.
97. Data from New Zealand and \Vest Berlin provide a useful breakdown of the contribution of eachtype of investigation. The New Zealand data (90) are
given in table 29. Where more than one radio-pharmaceutical was used for a particular investigation. amean gonad dose was derived on the basis of the frequency of use of each individual radio-pharmaceutical.
The percentage contribution to the total GSD. including therapy with 131 I, in West Berlin (10) is giYen intable 30.
ID. X- and gamma-ray treatments

1953

54

SS

55

57

58

59

60

61

62

63

64

65

66

67

Figure VIII. Number of patients in West Berlin investigatedusing radio-pharmaceuticals ( 10)68

98. In the treatment of neoplastic disease, large
doses of radiation may need to be given over a periodof weeks to a limited volume of the patient. The aim
148

of the treatment is. of course, to restore the health ofthe patient yet it , is also necessary to consider thesmall probability of causing, during the lifetime of thepatient, some deleterious effect due to the radiation,either to the individual or to any subsequent offspring.
For the treatment of non-neoplastic disease alternative
forms of therapy not involvfng radiation have been
recommended for some disorders (26) so as to reducethe incidence of somatic effects over the long subsequent life expectancy of these patients.
99. In many industrialized countries about one-halfof the new cancer cases arising each year are treatedwith radio-therapy. This proportion has not changed
appreciably even though the use of chemotherapy has
been increasing. Technological developments in theform of linear accelerators, betatrons and telecurieunits and 14-MeV neutron therapy units are likely tomaintain the current regimes of radio-therapy in theindustrialized countries. Elsewhere, the treatment ofcancer will rise in importance as other causes of deathsuch as malnutrition. malaria and tuberculosis aregradually eliminated by the improvement in living
conditions and the availability of medical care.
1. Genetically-significant dose
100. Tables XXV to XXVIII of annex G of the
1962 report showed the average gonad doses received
by patients during treatment for non-neoplastic diseases, together with the GSDs arising from thesetreatments.
101. These were 2.2 millirads in the Federal Republic of Germany (62), 3.1 millirads in France(110), 3.1-12.1 millirads in the Netherlands (129)
and 4.47 millirads in the United Kingdom (26) withadditional contributions from the treatment of neoplastic disease of 0, 2.5, 1.0 and 0.52 millirads,
respectively.
102. In Japan (95) in 1962 the GSD from therapeutic irradiation was estimated to be 0.9 millirad. A
further survey in 1971 (59) has been carried out andutilizes a range of child-expectancy factors for p~ti~nts
by age and disease. A value of GSD of 0.97 millirad
was obtained. From unpublished reports in the United
Kingdom it appears that the frequency of treatmentsof non-neoplastic diseases has tended to decrease andthat the use of x-rays of lower kilovoltage for thetreatment of many skin diseases has tended to reduce
the GSD.
2. Bone-marrow dose
103. The results of the British survey (25) onbone-marrow doses from the treatment of non-neoplastic diseases and on the subsequent contribution to the
population dose in terms of man-rads were issued in
1966. The method of calculation of the bone-marrowdose was based on that described in paragraphs 79
and 80.
104. Table 31 gives the mean marrow dose pertreatment course in those patients who were treatedon the head and trunk only, and also the average forall patients treated for a particular condition, including
those that were treated on the limbs and whose bonemarrow was therefore: not exposed since no active
marrow is present in the adult limbs. The first set ofdata can then be used for calculating marrow doses
to individuals or populations known to have beentreated on the head and trunk, the second set to obtain
population doses in groups of patients treated for aparticular condition, assuming that the distribution oftreatment sites is the same in the study population as
in the British survey ( 25) .
105. Table 32 gives the total annual radiation loadin man-rads from radio-therapy of non-neoplastic disease. This is 617,000 man-rads per year in the United
Kingdom ( 25). The authors of the original reportconsidered that this radiation load to the population
could not justifiably be expressed as a per caput mean
marrow dose ( C!vID) since only 1.2 persons per thousand in the population receive such treatment in any
one year. However, expressed as CMD, it would
amount to 11 millirads.
106. The three procedures making the greatest contributions to the total radiation load are the treatmentof skin conditions (41 per cent), that of ankylosing
spondylitis (25 per cent) and the induction of artificial
menopause (20 per cent). The contribution from thetreatment of skin conditions arises from a large number of irradiated patients receiving each year mean
marrow doses of about 3.3 rads. On the other hand,
the treatment of anlq1losing spondylitis and the induction of artificial menopause are carried out on relatively small populations, each receiving mean marrowdoses of 50-100 rads.
107. The marrow doses resulting from the treatment of neoplastic disease were also considered in the
British survey (25). Estimates per treatment course
for the main conditions are given in table 33. The estimates were made for treatments carried out at 250
kVp (2mm Cu HVT). No estimates seem to havebeen made of the bone-marrow dose received fromtreatments by supervoltage equipment. It is estimated,
however, that such treatments will not appreciably
increase the bone-marrow doses since similar integral
doses are received from 250 kVp therapy and supervoltage therapy for the 100-400 cm2 fields that areused in the treatment of neoplasms 6 to 9 centimetres
deep.
108. An extensive survey of the bone-marrow dosefrom the radio-therapy of neoplastic disease has been
carried out in Japan in 1971 (59). The CMD for the
population amounted to 206 millirads. Utilizing aweighting factor to give a "leukremia-significant" dose(paragraphs 14 and 76) a value of 37 millirads was
obtained.
3. Doses to other organs
109. The radiation: dose received by the skin, or,in the case of supervoltage radiation, by the tissues
lying just beneath the skin surface, will be of the sameorder as the doses to the main treatment volume. By
increasing the number of fields the superficial doses
can be reduced. Nevertheless, significant radiation may
be received by organs such as the lung, the kidney andthe tissues of the nervous system and the gastro-intestinal tract which are in a direct beam. The radiation
doses received by stomach, pancreas and cesophagus
during the treatment of ankylosing spondylitis are currently being estimated in the United Kingdom as partof a study of the cancers occurring in these organs,which are heavily irradiated during the treatment of
the spine.

IV. Therapeutic use of radio-pharmaceuticals
110. The two most important radio-nuclides administered to patients for therapy are 131I for thyroid
149

treatment and 32 P for polycythremia vera. 198Au and
DOY are used in the local treatment of effusions and
131I-lipidiol for endolymphatic therapy.
111. GSDs due to the therapeutic use of radiopharmaceuticals were presented in table XXXII ofannex G of the 1962 report. The annual doses were0.40 millirad in Canada ( 72). 0. 18 millirad in theFederal Republic of Germany (Hamburg) (62), 0.15
millirad in the United Kingdom (26) and 0.24 milliradin the United States (22). The only further information available is from New Zealand (90) where thedose in 1966 was estimated to be 0.047 millirad, from
West Berlin (10) where the use of 131 I for therapy
contributed 0.014 millirad in 1968, and from Japan(2) where 131 I was estimated to contribute 0.047 millirad in 1965.
112. Typical values of the gonad doses per millicurie administered for therapy are 0.45-0.6 rad for
131 I (17) and 2.6-7.0 rads for 32 P (90). The bonemarrow doses per millicurie in the treatment of thyroid cancer has been estimated as 1. 7 rads ( 83) andfor intravenously administered 32P the bone-marrowdose is 30 rads per millicurie ( 64). The use of colloidal gold in malignant diseases and rheumatoid arthritis leads to local doses at the site of injection but
to insignificant gonad and bone-marrow doses as longas there is no transport away from the injection site.
Endolymphatic therapy is a relatively infrequent formof treatment and the dose to the lung per millicurieadministered is about 10 rads (64).
113. Sealed sources of radio-nuclides are also usedin the treatment of patients. These sources emit either
beta rays. as with 00Sr surface applicators, or gamma
rays as with 1a1cs tubes and needles inserted into thepatient. The gonad and bone-marrow doses received
will depend on the distance of the gonads or the bonemarrow from the area under treatment, the radionuclide used and the total dose delivered. For a typicaltreatment of cancer of the cervix using sealed gammaray emitters the gonad dose will be 1.800 rads andthe individual mean marrow dose about 260 rads (25).

V. Conclusions
114. The aim of medical radiology being to provide maximum benefit to the population served. any
increase in frequency of radiological examinations mustbe justified. particularly in the developing countries.
The Committee has examined data on the frequency of
diagnostic radiological examinations and noted that in
the 10 years since its last review of the subject (148)there has been an increase by a few per cent per year
in this frequency in a number of technically advanced
countries and that considerably larger increases may
have occurred in developing countries. The Committee
has also reviewed information on the attendant doses
and concluded that an increase in the frequency of
x-ray examinations need not be accompanied by a proportionate rise of the population dose.
115. The results of surveys carried out in the various countries are sufficiently in agreement to make itpossible to assess within an order of magnitude theaverage doses resulting from particular examinations.
It therefore appears to be questionable whether emphasis should continue to be placed on the need tocarry out dose surveys alone or whether more attention should not be given to other means of achieving
the minimum practicable dose to the patient commensurate with the needs of diagnostic radiology.
116. Three basic approaches can contribute variously to this improvement depending. in any particular case, on the availability of funds and trained staff--educational programmes, surveys of the frequencyof examination and of the doses received, and administrative control measures. Educational programmes
can be aimed at (a) the radiation staff in the conductof their day-to-day work; (b) the clinical staff thatprescribe investigations involving radiation; ( c) the
development in the general public of an awareness ofthe need for radiation protection. The provision of educational training programmes and the establishmentof some administrative control may be much more
important than dose surveys, particularly where resources are limited.

APPENDIXn
1. A general definition of genetically significant dose has
been given in paragraph 9 above.b 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*:::; :::; (N(F) w<') d<')
; k

D-

;k

Jk

Jk

wfk

individual of age-class k subsequent to a class i
exposure.
future number of children expected by an average
individual of age-class k,
dfk gonad dose per class j exposure of an individual of
age-class k.
(F) and (M) denote "female" and "male" respectively.
2. For the practical work, formula 1 can be simplified
considerably, the first step being to replace the denominator by
w·N, where
N,w,
N(F}

+ N<"') w<") dC•1> )jk;k+ N<">k w("))
k
k

JI,

(1)

:::; (N(F) w(F)

k

k

where

= (annual) geneticalJy significant dose,= (annual) number of individuals of age-class k, sub·jected to class ; exposure,
Nk = total number of individuals of age-class k,

D
N 11:

a Reprinted= future number of children expected by an exposed

\I'

- N

\\'(F}+ -,:r-111 1,11

(2)

and

w•

from annex G of the 1962 report of the Com-mittee (148).
b This definition is reproduced in paragraph 7 of the present
annex B.
• The degree of approximation involved in the use offormula I depends on the definition of classes ;. In theory,
there need be no approximation since the classes may bemade so restrictive as to include only one individual per class.

I= N• t w•k N*k(3)

In the last expression, * denotes the sex. N is the total
number of individuals of the population. It should be noticed
that w·N is about twice the future number of children
expected by the present population even though the value of
w may be as low as 0.8.

150

r
3. As formula 1 has w" in both the numerator anddenominator, the numerical value of w has no direct relevance,
and all terms 7an be expressed by help of the ratio w;,,.lw.
For understanding of the demographic background, however,
it is valuable to re:ilize that w must be calculated from thesum of the age-group products w* N* for a population, whichkkme::ins that an assumption has to be made regarding the
expected fwure number of children (w*) of an individualkin any specified age-group.

.,

w* =:::: c*
'l=Cl

t

k

age-specific annual birth rate, i.e., annual ex-

number of years included in age-group t.
-

9. The necessarv information to make ii possible to calculate D" by help of formula 8 is:
(a)

d*

-

the mean gonad dose per individual under-Jgoing class j examination;= the relative frequency of class j examination,( b) N* IN
Ji.e., the number of examinations per caput,
per year;-the relative child-expectancy of the average

The formula is applicable also to fretal exposure (w;which must not be overlooked.

= W)

10. Often d, varies considerably from hospital to hospital.
Most of the uncertainty in estimates of D 1 is probably due tothe difficulty of estimating a reliable average of d1 for a
population.
11. If there are no data on the child-expectancy of thepatients, an approximate estimate of D* may be made, under;
the assumption that the child-expectancy is not influencedb~· the nature of the condition for which the patient is
examined. w* can then be calculated from the age-distribution

pected number of children of an individualof age-group t,

P* (t)(8)w

individual undergoing class j examination.

group k can be calculated,

b,.t

J

N

wbicb is the expression for numerical calculations.

Cl

a

c*

J

J

expected future number of children of an individual of age a. With knowledge of the function
w* of age, the average w* for any age-a;( c) w* lw(4)M • P* (1)

where
w*

D* = d* ·;4. The assumption could be that the average individual
will have a future annual child-expectancy expressed by thepresent specific annual birth rate. This makes it possible tocalculate, by summation, the total future expected number ofchildren of an individual of any age, and hence also themean for any age-group. If significantly less than unity, theprobability of an individual of age a to reach age t should
also be considered. This gives

Cl

specified sex to the genetically significant dose. This again canbe written asN*w*probability of an individual of age a to reachjaof the patients and the normal child-expectancy for eachage-group,

age (group) t.
5. It must be noted that c* may have a tendency to change

~

t

k

considerably before an average individual of a specified age
has reached the age-group in question. As it is, however,difficult to predict the values for the future, c* has been:::: w* N*

w* N*

k

jk

}7;

k

;,,

(9)

w*

N*

N*

J

j

j

t

assumed not to vary with time.

6. W* = w*

where w* can be taken from formula 4. If w* lw is not giveniin the primary material, it may be recalculated from N*/N. d*is the number of children expected by

J

a->O

and this approximation of D*, but will in that case reflect

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 mostdeveloped countries. The ratio W /w ranges from 1.5 to 3.

J

only variations in the age-distribution of the patients examined
and not indicate any dependence of child expectation on typeof examination.

7. The female and male contribution to the geneticallysignificant dose can both be written1

D* = - - : : "' N* w* d*
wN i k Jk Jk Jk
8. If the gonad dose due to an examination of typenearly uniform for all age-classes k, thend* = d*f/;

12. In the case where the age-distribution in an examination
class is not known, a yet more simplified assumption may be
used, namely(5)w* = W* for all persons below mean age of child-bearing,isi:w* = 0 for all persons above mean age of child-bearing.
i:

(6)

;

If II is the total number in the population below the mean ageof child-bearing, it follows from formula 3 thatapproximately for all k, and formula 5 reduces to1
D* = - - : : d* :::: N* w*
wN ik;1, 11.

11*

(7)

w*

which is also, indirectly, a definition of the "mean age ofchild-bearing". Formula 8 reduces approximately to1
D* = d* · - - :!: N* w*
i

wN

k

Jk

(10)

N*

or

i

= - · W*

Jk

11*

J

where D" is the contribution from type j examination of the

D* -

J

j

151

11

N

11*
j

d* = - ·
j
N
n

d*
i

(11)

TABLE 1. CHn.o EXPECT....."s'CY IN THE POPUL>.TION BY AGE A.1'1> SEX
Ne-,., Zealand (118)
1960-1962

1951

Male

Female

Malt

3.171
3.185
3.010
2.364
1.457
0.744
0.325
0.128
0.02

3.396
3.332
2.785
1.767
0.863
0.314
0.068
0.005

3.710
3.686
3.385
2.487
1.390
0.652
0.270
0.101
0.013

Age group-- ......

Fcetus

0-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49

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

.. - ......
.........

.. - ......
.........

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

so+ ..........

1963-1965

Femalt,\falc

4.084
3.967
3.213
1.913
0.871
0.303
0.062
0.004

3.420
3.39)
3.077
2.229
1.248
0.588
0.239
0.089
0.012

3.897

0-1
1-5
5-10
10-15
15-20
20-25
25-30
30-35
35-40
40-45
45-50
50-55
55-60
60-65
65-70

Male

3.776
3.631
2.880
1.696
0.786
0.282
0.060
0.004

3.109
3.075
2.773
1.978
1.077
0.493
0.194
0.068
0.004

Female3.598

C,:cc/u,slovakia 1965 (80)
Age grm,p

1965-196i

Female

3.271
3.432
3.272
2.557
1.473
0.662
0.237
0.052
0.004

Tluzilar.d 1966 (119)Male

Female

2.37
2.41
2.42
2.43
2.43
2.42
1.85
0.98
0.43
0.16
0.06
0.02
0.004
9.6 104
1.4 1Q-4

2.32
2.34
2.35
2.35
2.35
2.14
1.17
0.50
0.17
0.04
0.002

Age group

0-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49

so+

...................
·- ........ - ........
...................
........... -· ......

...................
...................
- ....... ' ..........
..................
............. -- .....

Male

Female

4.58
4.53
4.18
3.34
2.29
1.42
0.76
0.30
0.03

4.93
4.65
3.73
2.61
1.55
0.61
0.15
0.0

Male values estimated on basis of female values

TABLE 2. ANNUAL FREQcJENCIES OF X-RAY EXAMINATIONS(Sun•eys reviewed in the 1962 report)
Annual n,unber of :r-ray e:ramina.tions

per 1,000 of total population

Di,Jg,w.rtic

Cou11tr)1 or crea

Argentina
Buenos Aires .........
Denmark ..................
Egypt
Alexandria .............
Cairo .... -···· ........
Federal Republic of Germany
Hamburg .............
France ... . . . . . . . . . . . . . . . . .
Italy
Rome .................
Japan ...............
Netherlands
Leiden ..............
Norway . . . . . . . .
SwedenSwitzerland .......
United Kingdom .......

Genetico/ly-si3!'.ificant

Mass sur::cysdose 1·n mi lirod.1

Diagnostic
examinations

SUMJCj'S

Reference

140

37.0
27.5

1.90
0.05

105
53

36
40

4
5

7.0
7.0

0.09
0.07

86
87

1.8
42

560
150

130
40

17.7
58.2 40.05
62
O.Q2b 111-113

1957
1958-1960

1.9
90

500
410

80
320

43.4

39.0

0.93
0.08

121

1959-1960
1958
1955-1957
1957
1957-1958

0.1
3.5
7.3
5.2
50

350
390
290
310
280

6.8
10.0
37.8
22.3
14.1

0.02
0.08
0.40
0.12
0.01

48
82
158
26

Population(millions)Radiograp/iy

1956-1958

6
4.5

270
'.:60

1956-1960
1955-1961

1.4
2.6

1957-1958
1957-1958

Year

1950-1959"From radiographic mass survey.
b Includes iluoroseopic mass survey.

152

Fluoro,copy

Radio·
grapl,yFluoro·
scopy

80

200

330

130
210
140
130
95

570

60

Mass

18

13

If""

1
T.\BLE 3. AN!-.'lH.L FREQUENCIES OF X-RAY EXA:'.;!JNATIONS .U,'1) GENETICALLY-SIG:--IFICANT DOSE

(Recent surveys)
A m::ta/ ,rn mber of .:-•r=y 1.~.1.·an:i,:at:·011s

per 1,000 of total populationD£ag~1osti,:Fear

Po:iulation(111i!/i,,i:s)Radiograp/iy

Filloro-1965-1966

4.3

517

79

Co11r:!•·)• or areu

Czechoslovakia
Bohemia ..............
Federal Republic of Germany
Bavaria ...............

1956-1958

9.6....................

1963-1964

4.5

Finland

1969

105

610

. . . . -· ....... ..

1967

12.6

810

l 1969f 1963

2.5
2.8

366
400

1968
1968

0.5
0.4

1970
1964

Netherlands
New ZealandPuerto Rico
Southern region
Western region .........
Thailand ..................
United Kingdom
Sheffield ...............
United States
National surveys ........

Local surveys
New York City ... 'New Orleans .. - ...
Johns Hopkins .....
Texas .............
Unionof Soviet Socialist
Republics
Russian Republic
Yugoslavia
Slovenia ...............

scopy

Radio- Fl11oro•graph:; scop:;

331

601"
334

Japan .....................

191

Diagnos:ic
c.raminationss:,r;.:cys

37.0

0.44

80

0.05

132, 134
130, 131

Jfou

267

13.7 (15.l)b

266

16.8

628

25.7

Rr,crmce

66, 67
0.8

57

20.0

14, 107

13.1
13.7

156
118

414
512

36.4
48.6

45
44

34.7

39

5.2-1.3

4,119

4.5

310

8.6

89

55.0

51, 104,
106, 108
21

50.0
75.3
20.3
16.0

102
69
97
27

27.0"

75

9.1

94

113
113

1964

187

475

56

87

1970

200

580

65

45

1962
1962-1963
1965
1963

8
0.9

630
825

100

1964

82

171

439

1.5

594

436

1960-1963

Ge1:e:ica!!::•s:·gnificant dosemil!frads per c:J.put :,.•J

J.fass s:,r:•ey.s

183" One examination in this case= one radiograph.
b Later figure to include special children's clinics.
"Mean gonad dose per year rather than GSD.
TABLE 4. GENETICALLY-SIGNIFICANT DOSES IN CZECHOSLOVAKIA, 1958-1966 (80)Frequc11cy

Gonad dose ((N •IN) 1,000
Type of exami11<1tio,1Male

Female:Male

Hip ....................

13

17

Lumbosacral spine .......

9

8

2

1

15

10

Femur

...

Upper gastro-intestinal tract
Urograpby ( descending)J')J

GSD (D•)

Total GSD

J

mrad

J

(Ij )

mrad

mrad
Fa,talTotal

Percc,:tagc

Feme/eMale

Female

430

200

4.24

2.46

6.70

18.3

490

1,580

2.63

3.80

6.43

17.6

2.430

930

4.55

0.43

4.98

13.6

18

670

0.29

3.43

3.72

10.2
10.0

4

4

380

1,110

2.14

1.52

3.66

...... -· ..........

2

2

1.770

700

2.01

0.58

2.59

7.1

Abdomen ...............

5

5

130

540

0.64

0.88

1.52

4.2

Cholecystography ....

3

8

100

380

0.72

0.80

1.52

4.2

Thorax ....... - - .....

11

6

35

65

0.51

0.40

0.91

2.5

1
371

0.06

0.06

0.2

424

PelvisObstetrical abdomen
Other examinations
Fretal contribution

330.......

8.3

1.39

l.39

3.8

1.39

36.52

4~,,
:J-

488
TOTAL

3.04

18.74

920

153

16.39

100

TABLE 5.

GENETICALLY·SIGNrFICANT DOSES IN FINLAND, 1963 (67)

Frtqsuncy

J

J

Type of ,.rcminalion

Abdomen .............
Lower gastro-intestinal tract
Lumbar spine ...........
Pelvimetry ..............
Chest . . - ..... .........
Fluoroscopy .............
Urography (descending) ..
Obstetrical abdomen ...
Lower leg and foot ......
Dorsal spine ... ' .. ' ....
Other examinations .. - ...

mrad

i

J

F~n:alr

Male

FemaleMale

FerialeFtrtolTotal

P~rcc-ntage

8
3
5

8
4
5

44
100
200

0.13
0.27
0.40

56
17
2

54
15
3
2
14
5

13
18
320

790
1,140
730
520
20
93
270
113
13
110

0.41
0.30

1.62
1.20
1.08
0.60
0.53
0.67
0.53
0.22
0.18
0.18

0.72
0.45
0.36
1.03
0.12
0.15
0.08
0.40
0.02

2.47
1.92
l.84
1.63
1.17
0.99
0.84
0.62
0.61
0.55
4.16

14.7
11.4
11.0
9.7
7.0
5.9
5.0
3.7
3.6
3.3
24.7

4.23

8.69

3.88

16.80

100

17
5

302

29
150

0.52
0.17
0.23

O.Q7

299
601

GENETICALLY·SIGKIFJCANT DOSES IN THE FEDERAL REPUBLIC OF GERMANY (BA\'ARU.), 1957 {130-132, 134)

Frcq,.ency

Gonad t!ose ( d •)(N. /N) 1,000
1FemalePelvis ..................
Orography ( descending andascending) -·· .........

FemaleMale

Femal~

12

1.020

710

2.88

7

740

470

1,100

54

Total

Pcrcrntooe

1.65

4.53

33.1

1.07

0.91

1.98

14.4

350

1.76

0.14

1.90

13.9

16

120

0.31

1.23

1.54

11.2

39

65

73

0.69

0.54

1.23

9.0

6
8

550
480

1.200
57

0.44
0.92

1.23
1.03
0.03
0.23

9.0
7.5
0.2
1.7

10

TOTAL

mrad

Male

,nd """" hall th,}

Hip
of
femur
Middle and lower half ofthe femur
Stomach and small intestine
Sacrum lumbo sacral spine}
Dorsal spine
Large intestine ..........
Abdomen ...............
Obstetric ................
Other examinations

498

0.13

0.79
0.11
0.01
0.10

634

8.20

5.48

Freq"'"•:!
(N. /NJ 1,000

0.02

0.02

GSD (D•J

Gonad t!ose ( d ·)

13.70

100

Male

Fenialt

M al,FemaltMale

FemaltHip, upper femur .......
Urography (descending) ..
Lumba sacral spine ......
Lower gastro-intestinal tract
Pelvis
Stomach and duodenum ...
Urethrocystography ......
Lumbar spine ..........
Obstetrical abdomen .... 'Pelvimetry ..............
Other examinations

5
13
19

6
11
15
13
14
21

1,200
290
240
230
190
88
330
250

180
600
560
750
110
180
1,390
230
370
700

4.06
1.90
1.05
0.48
0.71
0.57
0.14
0.47

I

6
I

<1
278

345
444

J

mrad

mr-ad

"11'CJd

Tyre of f'raminatio,i

11
12
31
<1
8

Total GSD (D )

J

J

J

TOTAL

FtrtalGESETICALLY·SIGN!FJCANT DOSES IN IBE NETHERLANDS, 1967 ( 14, 107)

TABLE 7.

••••••••••••••••

Total GSD (D )
J

J

mrad

mrad

,lfaleT:. pe of examination

GSD (D'J

J

J+

Total GSD (D

J

mrad

m.-ad

Male

TOTAL

T ..\BLE 6.

GSD (D.)

Gonad dose ( d ·)(N./N) 1,000

FaetalTote/

Percentaoe

0.62

0.14
2.10
2.15
2.33
0.54
0.54
0.74
0.30
0.40
0.03
0.73

4.20
4.00
3.20
2.81
1.25
1.11
0.88
0.77
0.40
0.03
1.35

21.0
20.0
16.0
14.0
6.2
5.6
4.4
3.9
2.0
0.2
6.7

10.0

10.0

20.0

100

366
810

154

,..
TABLE

8.

Frcq:,ency

Gonad dose (d•)
I

(N-/N) 1,000
IType of c.i-a,,,footio;zIntestine ........... - ............
Stomach ........................
Hip joim .......................
Lumba sacral spine ..............
Lumbar spine ...................
' ...................
Bladder
Pelvis ..........................
Chest ................... - ......
Obsteu·ical abdomen ..............
Pelvimerry . . . .............. - ....
Other examinations ..............

GSD (D)

Total GSD (D. )mrad

11:rad

J

mrad

;

Male

Female,11 al,Fen:aleJlale

Fe,,:ale

Total

Pcrccn:aae

10
157
7
5
19
3
2
484

8
96
7
3
10
2
2
408
2
I
76

SOO

400
130
120
180
220
160
200
0.6
250
460

3.9
0.96
2.0
2.0
0.84
1.2
I.I
0.73
1.38

2.7
5.5
0.32
0.26
0.88
0.12
0.20
0.43
0.67
0.25
1.10

6.6
6.46
2.32
2.26
1.72
1.32
1.30
1.16
0.67
0.25
2.43

24.9
24.4
8.7
8.5
6.5
5.0
4.9
4.4
2.5
0.9
9.3

14.l

12.4

26.5

100

127
814

11

460
530
70
990
830
0.2

615
1,429

TOTAL

TABLE 9.

1969 (57)

GENETICALLY-SIGNIFICANT DOSES IN JAPAN.

GEKETICAJ.LY-SIGNIFICANT DOSES IN NEW ZEALAND, 1963 (156), 1969 (118)

GSD (D•)
Frcquc11c:y/(N •IN) 1,000
IType of c.ramination

Male

Gonad dose (Total GSD (D )
J

mrad

mmd

Male

mrad

FemaleFa:tusFemaleJ!afoFemale

1963

1969

1963

1969

1963

1969

Total
i963

Total Pcr~entage
1969
1969

280

1.70

1.78

1.16

1.20

0.13

0.11

2.99

3.09

22.5

1.11
0.75n
0.13

1.14
0.78
0.14

1.33
0.05
0.03
0.09
0.56

0.04
0.02

0.03
0.01

1.78
1.79
1.10
1.07
0.72
0.46
0.44
0.67

2.02
1.84
1.14
1.08
0.90
0.48
0.44
0.70

14.7
13.4

0.42
0.05
0.55

0.69
0.65
0.33
0.85
0.34
0.06
0.36
0.14

1.11
0.06
0.03
0.11
0.39

0.40
0.05
0.52

0.67
0.62
0.32
0.83
0.33
0.06
0.35
0.13

4.66

4.86

4.47

4.62

1.89

2.21

11.02

11.69

85.2

1.92
0.10
0.02

J.92b
O.!Ob

0.02

14.0
0.7
0.1

13.06

13.73

100

Pelvis}....... 16
Lumbar spine
Lumba sacral spine
Obstetrical abdomen ........
Urography (descending) .....
4
7
Abdomen .................
2
Barium enema .............
Pelvimetry .................
2
Hip, upper femur ..........
10
Barium meal ..............
Other examinations ......... 165

32

220

2
8
15
6
I
5
18
107

390
140
380
380
130
310 1,260
590
630
110
19
252

206

194

TOTAL

J

d°J )

400

Chiropractics ..............
Dental radiography .........
Mass miniature radiography ..
GRAND TOTAL

8.3

7.9
6.6
3.5
3.2
5.1

n Corrected 1963 figure.
b Upper limits.
TABLE 10.

GENETICALLY-SIGNIFICANT DOSES IN THAILAND, 1970 (4. 119)Frequency(N ·1 N) 1,000

GSD ma.i-imum (D ·)J
mrad

Gonad dose (l)
J

mrad

J

,

GSD most probable ( D )mra.d

TsPe of cscmination

Male

FemaleMale

FemaleMale

FemaleTotal

Perccntage},[aleFemaleTotal

Plain urological ...............
PelvisLumbar spine.........
Lumbo sacral spine}
Urography (descending) .......
Abdomen ....................
Hip, upper femur .............
Upper gastro-intestinal tract
Pelvimetry ...................
Obstetric abdomen ............
Other examinations ...........

1.4

0.8

300

300

0.86

0.37

1.23

23.8

0.26

0.11

0.37

29.6

0.5

0.4

300

420

0.64

0.27

0.91

17.6

0.10

0.08

0.18

14.4

0.3
0.6
0.4
0.5

0.2
0.6
0.2
0.3
<0.1
0.1
14.6

400
100
700
30

900
200
200
60
600
300

0.56
0.16
0.40
0.23

0.75
0.56
0.48
0.36
0.14
0.08
0.66

14.5
10.8
9.3
7.0
2.7
1.5
12.8

0.06
0.04
0.28
0.01

0.39

0.19
0.40
0.08
0.13
0.14
0.08
0.27

0.03

0.09
0.08
0.03
0.01
0.02
0.01
0.04

0.15
0.12
0.31
0.02
0.02
0.01
0.07

12.0
9.6
24.8
1.6
1.6
0.8
5.6

3.24

1.93

5.17

100

0.78

0.47

1.25

100

TOTAL

17.9

21.6
17.2
38.8

155

Per,:entaae

TABLE 11. GENETICALLY-SIGNIFICANT DOSES IN THE U1'TIED KINGDOM (SHEFFIELD). 1964 (89)FrtqtttHC}'

GSD (D•)

Gonad dose ( d ·)( N• IN J 1,000

Total GSD (DJ)

J

J

J

mn,d

mrad

mrad

Type of cxami11atio11

Male

FcmaltMale

Fcm1/cFa!IUSltf aleFcma.'c

Fa:tal

Total

Percentage

Hip, upper femur .......
Pelvis. Jumbo sacral joint,
lumbar spine .........
Abdomen obstetrical ....
Urography ( descending)Pelvime1ry .............
Abdomen ..............
Barium enema .........
Barium meal ...........
Urography (retrograde)
Others . . . . ............

3

3

1.220

250

250

2.04

0.29

0.08

2.41

28

6

6

150

1

460

3

0.2
3

3
0.1

2
0.20

470
200
310
710
180
690
200
390

0.58

3

470
230
310
440
180
690
200
390

0.27
0.62
0.05
0.40
0.05
0.12
0.07

173

0.06
0.03
0.01
0.13
0.33

1.22
0.30
0.29
0.16
0.27
0.20
0.12
0.03
0.34

0.03

2.07
0.92
0.87
0.56
0.38
0.35
0.20
0.16
0.70

24
11
10
7
4
4
3
2
7

310

3.71

3.22

1.69

8.62

100

TOTAL

31
95
5
730

0.53

TABLE 12. GENETICALLY·S1Gl'<"1FICANT DOSES IN THE UNITED STATES OF AMERICA, 1964 (51, 104, 106. 108)
Frcqucu::,•(N./N) 1,000

Gonad do;c ( l)GSD (D•)

mrad

mrad

Typt of e.rami11ation

Lumbar spine}.......
Lumbo sacral spine
Barium enema ....... ·····.
( retrograde
deUrograpby
scending) ................
Pelvis .....................
Abdomen .................
Lower extremities
Upper gastro-intestinal tract ..
Pelvimetry .................
Obstetric abdomen ..........
Other examinations..........

.........

TOTAL

Total GSD (DJ)

J

J

J

Mali, Ftmalc

Mali,

Fem,IeFa!ttU

Jfalt

Female

15

2.550

420

240

11.4

23

1,585

810

810

24

2,090
720
250
96
140

410
40
290

450
80
290

560

540

mrad
Total

Percentage

0.6

22.0

40.3

6.5

2.9

9.4

17.2

5.1
3.8
2.0
2.6
1.0

1.4
0.4

0.1
0.2
0.5

6.6
4.0
2.9
2.6
2.4

12.1
7.3
5.3
4.8
4.4

364

3.0

1.6

0.1

4.7

8.6

531

45.4

8.3

0.9

54.6

No data21
54
30

No data
No data

Fa:tal1.4

No data
No data100

aDcduced by Committee.
TABLE 13. GENETICALLY-SIGNIFICANT DOSES JN PUERTO RICO, 1968 (44, 45)
Frcq11c,1cy(N. IN) 1,000

Southern region

West"" ugi(mGonad dose ( l)GSD (D•)

GSD (D•)

mrad

mrad

J

J

J

J

mrad
Perunt·T::,pe of c.rami111nion

Lumbar spine ..............
Gastro-intestinal tract .......
Urography ( descending) .....
Abdomen . . . . ..............
Barium enema .............
Pelvimetry
Hip
Pelvis .....................
Cholecystography
Chest .....................
Other examinations.................
......................
...........

.........

.UalirFemaleMale

FemaleMale

Fema/i,

Total

13
7
6
11
1

7
9
6
16
2
1
2
4
7
109
64

160
180
1.150
360
1,240

1,190
690
760
530
880
1,030
280
64
190

2.0
1.1
2.1
1.7
1.4

1

0.1

7.5
5.7
4.5
3.0
1.5
1.1
0.4
0.2
0.9
0.1

9.5
6.8
6.6
4.7
2.9
1.1
1.9
1.6
0.9
0.2

11.2

25.0

36.2

2
3
3

104
64
214

TOTAL

780
760
9
1

1.5
1.4

Pcrccntage

age

Male

Female

Talal

26.3

0.8
0.5
3.1
1.3
7.6

8.7
7.9
10.7
3.8
9.9
<O.l
2.6
3.8
1.0
0.2

17.9
16.9
22.0
7.8
20.4

1.6
3.3
0.1
0.1

7.9
7.4
7.6
2.5
2.3
<0.1
1.0
0.5
1.0
0.1

18.3

30.3

48.6

100

18.8
18.7
13.0
8.0
3.0
5.3
4.4
2.5
0.5

5.4
7.8
2.1
0.4

227
441

156

100

TABLE 14.

GE.'iETIC\LLY·SIGNlFICANT DOSES IN NEW YORK, 1962 (102)

Freq11e11cy(N,IN) 1,000

Go11ad dose ( i)GSD (D)

mrad

mrcd

I

I

Type of e.ramillation

Male

Hip
............ .
Lumbo sacral spine ........ .
Pelvis ................... .
Lumbar spine ............. .
Upper gastro-int~stinal tract ..
Barium enema ............ .
Urography ( descending)

Male

1
2
1

1
2

1,330
2,020
890
190

7

65

4

350
17

No data73
No data

Pelvimetry}
Obstetrical abdomen···· ···
Other examinations . . . . ...

No data

TOTAL

Total GSD (D )I

FemaleMale

Female

580
1,780
350
930
830
1,110
690
1,010

13.7
9.1
9.6
1.1
0.3
0.4
0.4

1.6
3.1
1.0

I

F(J!ta/Total

Percentage

1.7
1.3
1.3

15.3
12.2
10.6
2.2
2.0
1.7
1.7

30.6
24.4
21.2
4.4
4.0
3.4
3.4

3.6

3.6

7.2
1.4

1.1

701

0.3

0.4

0.7

730

34.9

15.1

50.0

100

TABLE 15. GENETICALLY-SIGNIFICANT DOSES IN NEW ORLEANS. 1963 (69)Frequency(N./N) 1,000

Gonad dose r/J

GSD (D•J

mrad

mrad

T :,pt of e.ramination

Ftmali!

Malt

Pelvimetry}
Obstetrical abdomen
Urography descending, retro.
grade, cystography . . . . .
Lower spine .......... }Pelvis . . . . . . . . . . . . . . . }Hip . . . . . . . . . . . . . . . . .
Barium enema . . . . . . . . . . .
Upper gastro-intestinaJ tract
Chest, including mass miniature radiography . . . . .
Other examinations . . . . . .

Male

6

25

25

Femalemrad

FemaleTotal

Pcrc:ntage

23.3

23.3

31.0

580

5.97

9.00

660

11.36

3.58

14.97
14.94

19.9
19.8

400

10.76

1.39

12.15

16.1

1.70
0.59

2.74
1.63

4.44
2.22

5.9
3.0

L26
0.90

1.98

0.40

1.30

2.6
1.7

31.5

43.8

75.3

35
480
13
18

25
10

380

19

90

670
230

240
124

182

3

9

103

455

Male

1,600

750
580

Total GSD (DJ)

I

J

J

0.72

370
825

TOTAL

TABLE 16.

GENETICALLY-SIGNIFICANT DOSES IN TEXAS. 1963 (27)

Freq1<ency(N.JNJ 1,000

I

mrad

RegionLower abdomen
7e.g., Lumbar spine
Pelvis . . . . . . . . . . . .
4
Urography . . . . . . . . 12
Abdomen . . . . . . . . .
8Barium enema . . . . . 11
Pelvimetry ....... .
Hysterosalpingography ........... .
Upper abdomen ......... .
Upper gastro-intestinal
tract . . . . . . . . . . . . . . . . 14
Chest . . . . . . . . . . . . . . . . . . 113
E""Ctremities, hip . . . .
6
Other examinations . . . . . .
75

a Assumed

Male

7
4

230
260
260
260
120

8

11

mrad

FemalePercentage

6.8

12.3

68.0

1.7

2.3

4.0

22.0

0.3
0.4

0.9

1.2
0.5

7.0

0.1

7.9

10.1

18.0

Femaltt

5.5

F<Etal

180

850
630

1

2,700

12

Total

Maltt

340
300

1

113
5

55
1

170

520

360

2

3.0

75

2504
TOTAL

Female13

Total GSD (D )1
mrad

Gonad dose (a")

I

Male

100

2504

500

equal.

157

100

TABLE 17.

GENETICALLY•SJGNJFICANT DOSES IN YUGOSLAVIA (SLOVENIA), 1960-1963 (94)

Frcq,uncy
Gonad aose ( d ')(N./NJ 1,000

Male

FemaleMale

Pelvis}Lumbo sacral spine
Urography, descending retrograde . . . . . . . . . . . . . . .
Femur . . . . . . . . . . . . . . . . .
Chest (not mass miniatureradiography) . . . . . . . . . .
Hand and wrist . . . . . . . . . .
Cystography ............ .
Hysterosalpingography ... .
Pelvimetry ............. .
Other examinations ..... .

17

19

200

5
4

5
2

227
38

Female

200

3.27

2.37

5.64

62

220
230

290
30

0.60
0.48

0.88
0.05

1.48
0.53

16

188
18

1.4

2.7

6

2

1

520

61
150

0.12
0.14
0.07

0.34

0.28
0.01
0.06
0.13
0.01
0.32

0.40
0.15
0.13
0.13
0.01
0.66

1
8

5.02

4.11

9.13

100

500

237

558

1

tnrad

llfale2267

Total GSD (D )

J

,nrad

Type of esa,,u"niuum

TOTAL

GSD (D')

J

J

Fatal

Total

Percentage

6

4
2

1

472
1,030

TABLE 18.

MEAN GONAD DOSE PER EXAMINATION IN RECENT SURVEYS

MaleMedianFemalevalue
mrad

Range ofmean values
mradMedia"
mrad

Rangt ofmean values
mrad

30
430
580
250
300
300
210
300
920

5-230
15-2.090
150-2,090
12-48095-1,590
100-1,020
26-2,27065-2,019
230-1,710

340
590
520
210
870
230
410
340
240
300
620
1,270

60-830270-1,160
85-1,390
57-790460-1,750
40-710230-1.190
73-1.780
58-680110-1,600
230-1,600
275-2,700

Cholecystography ..... .
Femur lower two thirds

892

1.3-39
1.1-290120
114-380
1-13

Low gonad dose group
Mass survey chest .... .
Chest, heart, Jung ..... .
Head ............... .
DentalExtremities
Mammography

0.4
0.7
Less than lQn
0.6
Less than 10a

0.2-1.3
0.1-133
2
Less than 10a
0.06
Less than 1oa
Less than 10b

0.9-11
0.2-8

value

High gonad dose group
Barium meal ......... .
Urography (descending)
Retrograde urography ..
Abdomen ............ .
Colon, barium enema ..
Pelvis ............ .
Lumbar spine ........ .
Lumbo sacral spine ... .
Upper femur ...... .
Obstetrical abdomen .. .
Pelvimetry ........... .
Hysterosalpingography ..

Medium gonad dose groupa Reference 65.
b Reference 50.

158

0.5-0.7

0.03-0.1

TABLE 19. PERCENTAGE CONTRIIJUTIONS TO THE GENETICALLY-SIGNIFICANT DOSE"'..........

..,

"'"
.;

...,
-:;

i

.
::

.::
t:'
ll"

;;
~
....

I!

"
E

.~

~
f...

;::

~

..,.

t:

......"...

t:i

l\.)

Ii
V)

:::,

~

{l
..,

Cl::

Czechoslovakia .....
0.4
1.2
Finland ........... 0.9
7.0
Federal Republic of
Germany, llavaria
Netherlands
1.4~ Japan ............. 3.0
New Zealand (1969) 0.1
Puerto Rico
Southern region
0.5
Western region
0.4
Thailand ..........
United Kingdom
Sheffield .........
United Slates ......
New York City ..
New Orleans ..... - 2 . 6 Texas
7.0
Yugoslavia, Slovenia
I
4.0

4.2
2.7

10.2
0.6

10.0
5.0

r
=
...

5
:.i

i

.,"'

-;;

~

2.5
2.1

...........

n Plain urological examinations.

'-

~

i'

"...

;;"

i:

..,..,ii

t:'

~

~

"";;;

t;

1

c

i'.'

.:i

"-

9.7

2.7
11.4

7.1
2.8

I 1.0

17.6
2.2

18.3
3.1

13.6
0.6

0.2
0.9
6.6

9.0
14.0
24.9
7.9

33.1 - 9 . 0 6.2
3.9 16.0
4.9
6.5
8.5
---22.5----13.921.0
8.8
J.4

8.0
20.4

4.4 26.3
7.8 17.9
--14.

5.3
5.4
24.8

- - - 24--7.3 --40.34.4 24.4
21.2
] 6.1 -19.8-

28

4.2
14.7

0.2
3.7

11.2
5.6
24.4
3.2

-14.420.0
4.4-6.613.4

7.5

0.2
2.0
2.5
14.7

18.8
16.2
1.6

18.2
22.0
12.0

13.0
7.8
9.6

3
4.4
4.0
3.0
22.0

JO
2
-12.13.4-19.9-16.0-

4
5.3

~

\.)

0.4
1.0

29.6n

...
:,

:.:,

~

2.6
8.3

"

....;:;...

j

0

E

::

.:-

..,"

~

~

]

..,

..,"...

...
~•g·;::

"'~

~

-~..,

...
..,"

~

..,-:;"

"

·t

.::"

·=~"

3.0
0.8

1.6

11

7

-7.2-31.068.0

..."
.§

"

4
17.2
3.4
5.9

.:,
~

...

E

"

E

...
........

..,....,.,
"...
"'"
"
~

1.0

..........

.."".
t
t!..,
~

...

I

"

·~
~

....
...

:.;"
\.)

0.3
3.0

t;"
"3.8
(23.1)

14.0

3.5

30.6

6

..,
~
;;=

]
h

"

~

0.3
5.5
0.01 21.6

100
100

36.52
16.8

J.7
6.7
3.6

100
100
100

5.1

JOO

20.0
26.5
JJ.73

5.6

100
100
100

36.2
48.6
1.25

JOO
100
100
100
J.00
100

8.6
54.6
50.0
75.3

::!

;;;
Cl

c

7
13.4
1.4
1.7

3.0
--62--.

-" "".

0.7

(5.1)
(0.9)

";:;""'-'.......

II

IU

18.0
9.1

TABLE 20. GENETICALLY-SIGNIFICANT DOSES BY CO'CJN!RIES AND SEX CONTIUBUTIONS
GSDmradMale

F1111a/e

Czechoslovakia, Bohemia

18.74

Finland ..............

4.23

GSD Percentage

Ftrtal

Total

.Male

FtmaleFa:tal

Total

16.39

1.39

36.52

51

8.69

3.88

16.80

25

45

4

100

52

23

100

0.02

Federal Republic of Germany. Bavaria ...

8.20

5.48

13.70

60

40

...... ...
'

10.0

10.0

20.0

50

50

100

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

14.1

12.4

26.5

53

47

100

New Zealand (1969)

4.86

4.62

13.73 ..

42

39

Netherlands
Japan

Puerto Rico

2.21

100

19

100

...

Southern region ....

11.2

25.0

36.2

31

69

100

Western region

18.3

30.3

48.6

38

62

100

Thailand .........

3.24

1.93

5.17

63

37

100

United Kingdom,
Sheffield ........

3.7

3.2

1.7

8.6

43

37

100

United States ........
New York City ....

45.4

8.3

0.9

54.6

83

15

34.9

15.1

50.0

70

30

2

100
100

New Orleans .. - - ..
Johns Hopkins ......

31.5

43.8

75.3

42

58

100

11.9

11.2

23.1

52

48

100

Texas -- ...........
Yugoslavia, Slovenia

7.9

10.1

18.0

44

56

100

5.02

4.11

9.13

54

46

100

n Includes 2.04 mrad not allocated.

TABLE 21. PERCENTAGE DISTRIBllTION OF ACTIVE BONE MARROW
Adult,
40 :!}tOFS(Ji)

Child,(5i)

J.7 years
(57)

Adult

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

13

7

7

Upper limb girdle .................... .

8

7

6

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

2

3

3

Ribs ................................ .

8

14

13

Cervical vertebrre

4

3

3

Thoracic vertcbrre

14

13

12

Lumbar vertebra:

11

11

10

14

9

8

33

31

Sternum

Sacrum... ...... . .

. ....... .

26

Lower limb girdle .................... .

7

Extremities . . . . . .. .
TOTAL

100

160

100

100

TABLE

22. Per caput MEAN BONE-MARROW DOSE (JAPAN) (58)

(mrad per person per year)!Juk~mia-sig,,ificant dou

J.fi:an boue•marrow dJse

Male

FcmaltTotal........ . . . . .. . . . . . .

0.49

0.25

Cervical spine ..... - ........

0.55

0.28

F

0.38
0.30

R
F

R

Skull

ShoulderR. . . . . . ......

ThoraxChest ....

FPF
CEsophagus ... . . . . . . . . . . . .

Perce11taqe

Male

Female

Total

Ptr~entagt

0.74

0.4

0.42

0.14

0.64

0.4

0.83

0.4

0.50

0.26

0.76

0.5

0.17
0.19

0.55
0.48

0.3
0.2

0.35
0.39

0.16
0.18

0.51
0.57

0.3
0.3

0.22
0.44

0.16
0.24

0.38
0.68

0.2
0.4

0.20
0.43

0.15
0.24

0.35
0.67

0.1
0.4

1.6
5.4
10.2

0.90
2.2
10.0

2.5
7.6
20.2

1.3
4.0
10.7

1.4
4.4
9.4

0.82
2.0
9.5

2.22
6.4
18.9

3.8
11.2

1.3

0.68

0.49

1.7

0.9

0.57

0.4

1.0

0.6

11.4
60.0
3.6

6.1
40.6
3.0

17.5
100.6
6.6

0.3
53.2
3.5

10.2
53.2
3.0

5.5
36.5
2.7

15.7
89.7
5.7

9.3
53.0
3.4

0.59
3.8

0.5
2.2

1.1
6.0

0.6
3.1

0.52
3.5

0.42
2.1

0.9
5.6

0.5
3.3

0.41

0.34

0.75

0.4

0.35

0.30

0.65

0.3

0.66
4.7

0.58
4.4

1.24
9.1

0.7
4.8

0.59
4.05

0.53
4.00

1.1
8.05

0.7
4.7

Dorsal spine . . . . . . . . .

0.50

0.46

0.96

0.5

0.45

0.41

0.86

0.5

Lumbar spine .........

2.9

1.5

4.4

2.3

2.5

1.4

3.9

')

Lumbo-sacral spine - ........

0.49

0.32

0.81

0.4

0.43

0.28

0.71

0.4

....................
Urography. -- .......

0.16

0.15

0.31

0.2

0.14

0.13

0.27

0.1

0.44
0.34

0.33
0.12

0.77
0.46

0.4
0.2

0.39
0.30

0.31
0.10

0.70
0.40

0.4
0.2

0.12

0.057

0.13

0.1

0.10

0.05

0.15

0.1

0.13

0.13

0.1

0.10

0.10

0.1

0.042
0.37

0.042
0.37

0.1

0.36

0.36

0.2

0.17

0.17

0.1

0.16

0.16

0.1

0.2

0.19

0.39

0.1

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

StomachR

F
Cholecystography..........

R

F
Abdomen.............

Barium enema

R

F

PelvisR
F

Bladder ......... . . . . . . . . . .
Pelvimetry... ' ............
R
F

Hysterosalpingography
Obstetrical abdomen
Hip

. ..

....

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

0.22

0.21

0.43

. .. . . . . . . . .

0.013

0.007

0.02

0.01

0.01

0.01

0.01

Femur ........

Lower leg .................

0.008

0.005

0.013

Other examinations . ' ..

1.40

0.73

2.13

TOTAL

112

77

189

= radiography.
= fluoroscopy.
PF = pbotofluorography.
R

F

161

1.1
100

0.20

1.0

0.76

99

70

1.7
169

~

~·-'

1.2

100

TABLE 23. BONE-MARROW DOSE (mrad) PER EXAMINATION
Epp(37, 41)

Uuited Kingdom
Japan
(St)

Anll!f'o-(25)

LateralNctwlands - - - - - - posterior
(153)
Male
Female projection p,ojectio"

Head

29

90

32

Cervical spine

43
140

8

54

50

1.300

39
49
590

38
200

F 40

Barium swallow

10

3

220

30

90

12

13

1.3d

4.5

70

180
180

Arm and hand .....
Clavicle and shoulder

18

Dorsal spine

140

105

Whole chest

9

R 10

81

Thorax (ribs and sternum)

34

6

Barium meal ............ .

210
73
59

80
36
93

180
510
150
120

37
800
150
130

Abdomen (obstetric) ... .

72

Descending urography ... .

110

56
433
257

580
440

450
330

50

282

Cholecystography
Abdomen.............. .

Retrograde urography
Salpingography

210•

210

Placentography

Barium enema

170
37
210

Pelvis70

Lumbar spine

150

Pelvimetry
Cystography .....

Lumba-sacral joint......... .

168
359
138
140
651
47

92

Hip and upper femur {upper ¥.i) ..

43

Rest of femur ............... .

8

170

530
130
270
290
57

280b
940
1,060
140
270
220

60

Leg and foot . . . ....... .
1.8

Dental ..... .

1.8

..

130

I3QC

Angiography (abdomen)

38Qe
360
190C
31
61

380
390
190

Angiography (head)

Tomography (chest) .. .
Cardiac catheterization ......... .
Bronchogram.......... .

Mass survey chest ..
:Mass survey stomach ..... .

35
60

47

n Fcetal contribution 500 mrad.
b Fcetal contribution 1.100 mrad.

c Assuming equal frequencies of male and female examinations.
d Postero-anterior projection.

RF= radiography.
= fluoroscopy.

162

50

31

101

35

TABLE 24. Per caput MEAN BONE-MARROW DOSE CONTRIBUTION FRO:>,! EXA:l-1L's.\T!O!i TYPE
(mrad per person per year)
Netl,er/a,ids (153)

U11itcd Kingdom (25)

Total male and cen:female (mrad) age•

Head
Cervical spine ................ .
Barium swallow ............... .
Arm and hand ................ .
Clavicle and shoulder .......... .
Dorsal spine ................. .
Whole chest: (a) Fluoroscopy ... .
( b) Radiography
Thora..ic (ribs and sternum) ..... .
Barium meal .................. .
Cholecystography ............. .
Abdomen ..................... .
Abdomen (obstetric) ........... .
Descending urography .......... .
Retrograde urography .......... .
Salpingography ................ .
Placentography ................ .
Pelvimetry ............. .
Cystography ............. .
Barium enema ................ .
Pelvis ........................ .
Lumbar spine ................. .
Lumba-sacral joint ............. .
Hip and upper femur (upper Y.i) ..
Other examinations ............ .
General diagnostic radiology ..... .
Other hospitals ................ .
Mass miniature radiography
TOTAL

Ptr•

Male
{mrad)

Female(mrad)

Total(mrad)

0.275
0.155
0.752

0.258
0.089
0.450

0.533
0.244
1.202

0.097
0.250

0.153
0.342

0.250
0.592

1.010
0.329
2.394
0.192
0.375
0.400d
1.375
0.143

0.827
0.046
3.580
0.326
0.395
0.729
0.915
0.133
0.043

1.837
0.375
5.974
0.518
0.770
1.129
2.290
0.276
0.043

0.210d 0.315
0.021
0.067
0.569
1.590
0.214
0.057
0.999
0.046
0.645
0.080
0.107
0.172
0.593
0.445
11.105 11.478

24.2

100

1.14
0.06
0.12

3.8
0.2
0.4

0.3
8.1
1.11
0.03
2.52
0.48
0.57

1.0
27.0
3.7
0.1
8.4
1.6
1.9

3.69
0.27
0.09

12.3
0.9
0.3

0.24
3.12
0.9
1.05
2.19
0.18

0.8
10.4
3.0
3.5
7.3
0.6

3.84

12.8

0.525
0.088
2.159
0.271
1.465
0.725
0.279
1.038
22.583
1.9
7.8

30

100

32.3

cent-

ageb

3.7

5.7
18.5

3.5
7.1

6.7
4.5

a Mean value of HVL and kV determination.
b Contributions greater than 3 per cent.
c Negligible.
d Fretal contribution.

TABLE 25. Per caput MEAN BONE-MARROW DOSE (mrad y-1) IN JAPAN (58)Male ....
FemaleRadiograp/1::,,

Photofluorograph::,,Fl11oro•scopy

TV·/luoroscop::,,Total. ............

23

14

56

19

112

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

14

13

35

15

77

TOTAL

37

27

91

34

189

TV·fluoro•
scopy

Total

Leuk~mia-significant dose (mrad y-1 per person)
Radiograph::,,Photofluorograph::,,Fluoroscopy..... ' .......

20

13

49

17

99

Female .... ' ...... . . . . . . . .

13

12

32

13

70

TOTAL

33

25

81

30

169

Male

163

TABL£ 26.

AVERAGE SKIN DOSE (rad) IN PRIMARY BEAM

Per exposure
Medianvalue

Per examinati'on

Ra11ge ofa:veragc

ttalues

Range ofMedianavcragt

value

valuesHigh skin dose group
Barium swallow R ..............
Barium swallow F ..............
Barium meal
R ... - ..........
Barium meal
F . ' ............
Barium enema R ..............
Barium enema F ..............
Whole chest
R ..............
Whole chest
F ..............
Mammography ................
Pelvimetry . ' ..................
Lumbo sacral spine .............
Lumbar spine..... . . . .
Cardiac catheterization ..........

6.4a
0.9
4.4a
0.7
4.9•
0.02
2.0•

0.9-2.2
0.4-1.0
0.006-0.09

2
2.7
1.5

0.8-3.8
0.5-2.9
0.7-2.9

0.4
0.3
0.9
1.8
0.4
0.8
0.2
2.0
1.2

0.3-1.5
0.03-0.8

1.4
8.5
1.7
2.1
1.5
20
0.14
12
15
8
5
4.5
47

6-25
5-26
0.07-0.15
3-22
10-22
6-10
5-6

Medium skin dose group
Head ...................... .
Cervical spine ............... .
Clavicle and shoulder ......... .
Dorsal spine ................. .
Thorax.................... .
Cholecystography ............. .
Abdomen............ .
Abdomen (obstetric) .......... .
Urography ( descending) ....... .
Urography (retrograde) ....... .
Salpingography R ............. .
Salpingography F ............. .
Placentography ............... .
Cystography .................. .
Pelvis ....................... .
Hip and upper femur . . ... .
Dental .... , ... , ............. .
Angiography (head) ...... .
Angiography (abdomen) ..... .
Tomography (chest) ...... .
Mass survey chest ........... .

0.2
1.4
I.I

0.2-1.2
0.15-1.3
0.4-3.9

0.4-1.7
0.4-1.7

0.4

1.5
1.5
0.3
2.8
0.8
2.2
1.2
3.2
3.2
2.9
1.2
3.4
3.0
3.1
3.3
1.4
2.5
1.0
3.3

1.4-1.9
0.6-1.9
0.3-0.4
2.0-4.7
0.6-0.9
1.5-2.8
1.0-1.4
2.7-3.8
1.7-5.0
1.4-2.4

1.1

0.8-1.4
0.6-1.4

2.1-4.5
1.1-3.0
1.6-3.4

1.0

0.9

Low skin dose group
0.1
0.02
0.03
0.1

Arm and hand ............... .
Chest............ , ..... .
Femur (lower two thirds) ...... .
Leg and foot ................. .
a R

0.006-0.09

0.3
0.14
0.4
0.4

0.1-1.7
0.07-0.15
0.3-0.4

min-1.

= radiography.
F = fluoroscopy.

R

TABLE 27.

ANNV,\l, NUMBER OF 11'.'VESTIGATIOSS WITH RADIO-PHARMACEUTICALSPER 1,000 PERSONSYear

I1111cst,'gations
ptr thousand

Rcfere11u

1967-1968
1966-1967
1968
1967
1968
1966
1968
1970
1966
1960
1968

5.6
3.3
7.1
5.7
1.7
2.4
6.1
7.2
9.2
1.9
10.1

5
5
79
79
73
90
49
152
22, 142, 143
10, 11, 60
10,11,60

Cortirlry

Australia
D:nmarkJapan
New Zealand .
Sweden .....
United States
West Berlin

164

TABLE 28. ANNUAL NU).!BER OF DL\GNOSTIC INVESTIGATIONS WITH RADIO·PIIAR).IACEUTICALS BY AGE A~D SEX
L"I WEST BERLIN (60)Percc11lage
total
pop11/atfon

Age group(years)

0-6
7-14
15-20
21-25
26-30
31-35
36-40
41-45
46-50
50

Nmnber of fovutigotfo11s per 1,000 persons

mJ Thyroid>"'.fo Colloid<

UJ/ Hippuran•

Male

FemaleMale

FemaleMale

FemaleJlal,•

F,•r;afr

3.6
3.5
3.0
4.0

3.4
3.2
2.9
3.5
4.1
3.0
2.7
3.2
3.3
27.4

0.09
0.10
0.64
2.68
2.92
1.46
2.56
3.38
3.99
2.71

0.10
0.49
7.05
12.0
15.1
13.7
15.7
14.4
12.2
5.96

0.09
0.27
0.53
1.22
1.07
1.16
2.18
2.08
1.83
3.01

0.88
l.35
l.30
2.15
1.93
2.36
2.03
2.51
2.56

0.11
0.08
0.28
0.94
0.26
0.97
1.00
2.24

0.08
0.11
0.47
1.12
1.07
1.59

57.0

2.28

7.90

1.77

2.11

1.04

4.5
3.1
2.5
2.0
1.9
15.4
TOTAL 43.0
GRAND TOTAL

5.5

100

1.96

" Thyroid function test.
b Kidney function test.

c Liver function test.

TABLE 29. ANNUAL GENETICALLY-SIGNIFICANT DOSE (microrad) DUE TO DIAGNOSTIC USE
OF R..\DIO·Pf!ARMACEUTICALS IN NEW ZEAL\ND (90)Test

Thyroid uptake and scan
Brain scan ............. .
Liver scan . . . . . ..... .
Kidney scan ........... .
Schilling test ........... .
Renogram ............. .
Blood volume ........ .
Red cell survival ........ .
Bone scan ............. .
Lung scan ............. .
Exchangeable sodium .. .
Miscellaneous ....
TOTAL

Male

FemaleFll'tus

Total

Percentaoe

2.4
3.3
0.23
0.04
0.024
0.003
0.012
0.032

1.8
1.4
0.76
0.056
0.044
0.88
1.7

0.16
0.22
0.04

29.0
32.2
6.8
0.7
0.5
7.5
19.0
0.2
0.3
0.2
0.2
3.4
100

0.008
0.012
0.044

0.052
0.024
0.028
0.45

0.024

4.4
4.9
1.03
0.096
0.072
1.13
2.9
0.032
0.052
0.032
0.040
0.52

6.1

7.2

1.9

15.2

0.004
0.25
1.2

TABLE 30. GEKETICALLY·SIGNIF!CANT DOSE DUE TO RADIO-PHARMACEUTICALSIN WEST BERLIN 1968 (10)Percentage

Product
131I

therapy .................................................. .
diagnostic ................................................. .
7~Se methionine ........................................... · · .. · · - · · ·lOSAu colloid ................................................. .
131! macro-aggregate of human serum albumin
57Co 5SCo B-12 vitamin ............................... .
197Hg 20:iHg neohydrin ..................... .
131! Hippuran ...................................................... .
90mTc
51Cr
59Fe
131J

1321

10.0
23.5
23.2
11.6
9.9
5.3
4.6
4.0

2.7
2.5
2.4
0.3
100

GSD=0.14 mrad

-165

0.95
0.99

TABLE 31.

RADIO·TIIERAPY OF NON•NEOPLASTIC DISEASE: MEAN MARROW DOSE PER TREATMENT COURSED (25)All,·11.,aHead ,111d lr1111/1 only
Atfolts

Ch,'/J,·eu
Males

0\
0\

I. Skin conditions
Growths ..................

27

14.6

21

10.0

52

4.8

80

Allergic and inflammatory

10

10.8

13

23.3

201

10.4

230

.................
Others ...................

5

92.0

I

62.5

2

36.0

49.0

I

5.6

38

6.9

No.

Mean
dose
rad

No.

Mairs
Mean
Jose

No.

Ringworm

Mean
dose
rad

Femal,s

Mrau
dose
rad

Condition
frcatcd......

Males

Females

Arfolts

Cl1ildl'e11

No.

ra<I

7.6
7.9

lllea11
dos,
No.

91
26

6
38

4.3

Females
Mean
dose
rad

rrJd

No.

4.3
4.2
76.0
49.0

125
18

2

FemalesMales.,rcan
No.

Mean
dose
rad

2.3

185

3.3

3.5

578

J.2

18.0

3

18.0b

65

4.0

115

No.

dose
rad

1.7

110

16.8

600

31.3

4

5.6

7

5.5

I

7

5.5

3. Ankylosing spondylitis

70

83.6

14

59.5

70

83.6

14

4. Arthritic and rheumatic

23

27.1

29

22.0

33

18.9

42

15.1

74

51.5

74

51.5

2. Glandular enlargements....
6. Deafness ......... ' ........
7. Other non-malignant ' .......

2

6.2

5. Artificial menopause

11

5

9.4

2

8.6

7

3.5

10

3.7

1

2.6

2

282.0

15

20.9

35

27.6

2

5

6.2

1.4

5.9

59.5

9.4

2

8.6

7

3.5

10

3.7

2.6

2

282.0

23

13.6

37

26.2

The computer programme was adapted to make an approximate estimate of the bone-marrow dose from small treatment areas which receive high doses.

11 Assumed male value in absence of data.

5.9

TABLE 32. RADIO-THERAPY OF NON-NEOPLASTIC DISEASE:TOTAL PATIENT·RADS EXPOSt:RE PER YEAR (25)aPatient rads per year (XlO')
C ,mtrib,tio,:
Malt
X•ray Jrtatmrnt1

1. Skin conditions(a) Growths. etc.

Ft malt
Ptr·

Cliildre11

Ad1</ts

Children

Ad11/t,Total

ctutag;:

9.8

5.5

6.1

12.2

33.6

5.4

(b) Allergic and inflam-

matory etc.

4.3

72.6

14.6

80.5

172

27.8

(c) Ringworm

20.8

1.8

1.2

3.7

27.5

4.5

(d) Others ...........

4.3

8.5

1.2

3.7

17.7

2.9

n

n

2. Glandular
etc.

enlargements.................

nb

3. Ankylosing spondylitis
4. Arthritic and rheumatic.
etc. .................

133
n

16.5

n

5. Artificial menopause ...

n

n

n

22

155

25.1

17.1

33.6

5.5

126

126

20.4

6. Deafness .............

2.4

D

1.8

n

4.2

0.7

7. Any other non-malignant
conditions ............

n

9.8

12 8

25

47.6

7.7

617.2

100

a This total exrosure in patient-rads per year is obtained by multiplying the mean marrowdose per treatment course with the number of patients treated per year.
b n=less than 103 patient-rads.

TABLE 33. RADI0•TIIERAPY 1 OF NEOPLASTIC CONDITIONS:MEAN MARROW DOSE PER TREATMENT COURSE (25)},[ arrow dost(rad)3falig11anl conditions

114
Buccal cavity and pharynx ......................................... .
320
CEsophagus ...................................................... .
157
Stomach ......................................................... .
77
Small intestine ............................. , ..................... .
70
Large intestine .................................................... .
31
Rectum ............................................................
106
Other digestive ................................................... .
Nose, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
47
Larynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40
Trachea, etc. . ................................. : . . . . . . . . . . . . . . . . . . .
- 399
Other respiratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
392
Breast: male ............................... , . . . . . . . . . . . . . . . . . . . . . .
10female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . .
19
fRadium 260l
Cervixa ................................................. .
468
rays 208f
Other uterus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
276
Ovary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
198
Prostate
94
Testis476
Kidney79
Bladder
223
Eye ............................................................. .
13
109
Brain ...................................... · · · · · · · · · · · · · · · · · · · · · · ·Thyroid ........................................................ .
62lX

a For the treatment of the cervix uteri a standard Manchester technique irradiation of
9100 mghrs has been assumed in addition to two supplementary fields to the parametrium.
The marrow dose from the radium treatment was deduced from Holodny et al. (61a).

167

REFERENCES
1. Andrews, P. S. Radiation induced basal cell

2.

3.

4.

5.
6.

7.

8.

9.

10.

11.

12.

13.

14.
15.

16.

17. Berman, M., D. V. Becker and R. S. Benna. The
use qf !1 33 in the treatment of Graves' disease.
J. Clin. Endoc. 17: 1222-1228 (1957).
18. Biagini, C., M. Barilla, A. Montanara. Zur genetischen Strahlenbelastung der Bevolkerung Roms
durch die R6ntgendiagnostik. Strahlentherapie
113: 100-109 (1960).
19. Brown, M. L. and A. B. Nelson. Medical x-ray
visits and examinations during pregnancy, U.S.
Department of Health. Education and Welfare.
National Center for Health Statistics Series 22
Number 5.
20. Brownell, G. L., W. H. Ellett and A. R. Reddy.
Abs.orbed fractions for photon dosimetry. Medical
Internal Radiation Dose (MIRD) Committee.
Pamphlet No. 3. Journal of Nuclear Medicine( 1968).
21. Bureau of Radiological Health, Department of
Health, Education and Welfare. Information
provided by J.·c. Villforth.
22. Chamberlain. R. H. Gonadal radiation in thegenetically significant portion of the population
derived from radioactive isotope procedures inmedicine, p. 885-888 in The nature of radioactive
fallout and its effects on man. Hearings. 85th
Session, U.S. Congr. Jt Cttee. Atomic -Energy.
Spee. Subcttee Rad. (May 1957). vol. 1.
23. Cocco, A. E. and A. I. Mendeloff. Effects ofgastric irradiation in duodenal ulcer patients:
gastric secretary response to maximal histamine
stimulation during a three-year period. Johns
Hopkins Med. J. 126. 2, p. 61-68 (1970).

squamous carcinoma. M.D. thesis, London University, 1958.
Anno, Y., A. Takeshita and M. Iwamoto. Medical use of radio-isotopes in Japan, especially fortreating hyperthyroidism and evaluation of theconsequent radiation risk. Gann Monograph 9:241-253 (1970).
Annual Report for the year 1968. R.P.S. AR.2.
Ministry of Public Health, Bangkok, Thailand,
1968.
Annual Report for the year 1969. RP.S. AR.3.
Ministry of Public Health, Bangkok, Thailand,
1969.
Annual Report of the National X-ray and Radium Laboratory, Melbourne, 1968.
Antoku, S. and R. C. Milton. Dose to bonemarrow and gonads from chest examinations.
Atomic Bomb~ Casualty Commission. Technical
Report 4/67 (1967).
Antol.'11, S., H. Yoshinaga and W. J. Russell.
Bone marrow and gonadal dose in roentgenography excluding posteroanterior chest examinations. Atomic Bomb Casualty Commission, Technical Report 5/68 (1968).
Ardran, G. M. and H. E. Crooks. A comparisonof radiographic techniques with special reference
to dosage. Brit. J. Radial. 26: 352 (1953).
Ardran, G. M., J. Hamill, E. Emrys-Roberts etal. Radiation dose to the patient in cardiac radiology. Brit J. Radial. 43: 391-94 (1970).
Aurand, K. and G. Hinz. Erhebungen liber die
Entwicklung der Anwendung offener Radionuklide in Diagnostik und Therapie. Bundesgesundheitsblatt 13: 30-33 (1970).
Aurand, K. and G. Hinz. Paper presented at the
7th Congress of the Intern. Society for Nuclear
Medicine, Zurich, 25-27 Sept. 1969.
Baro. G. B., J. G. Flegenheimer. Survey of Radioisotope applications in Latin America. Isotop.
Radiat. Technol. 7: 465-468 (1970).
Beekman, Z. M. Genetically significant dosefrom diagnostic roentgenology (A study concerning a defined population in the Netherlands).
Leiden, Neder. Inst. v. Praevent. Geneesk. 53(1962).
Beentjes, L. B. An estimate of G.S.D. in the
Netherlands (1967). Thesis. Utrecllt. 1969.
Beretning om Laboratoriets Virksomhed for tiden
1 April 1966-31 Marts 1970. Radiation Hygiene
Laboratory, Copenhagen (1970).
Berger, M. J. Energy deposition in water byphotons from point isotropic sources. Medical
Internal Radiation Dose (MIRD) Committee.
Pamphlet No. 2. Journal of Nuclear Medicine(1968).

24. Coll, W. S. The judicious use of diagnostic
radiation in the healing arts. Amer. J. Public
Health 59: 1199-1203 (1969).
25. Committee on Radiological Hazards to Patients.
Final report of the Committee. London. H.M.
s.o. (1966).
26. Committee on the Radiological Hazards toPatients. Second report of the Committee. London, H.M.S.O. (1960).
27. Cooley. R. N. and L. B. Beentjes. Weighted
gonadal diagnostic roentgen ray doses in a teaching hospital with comments on x-ray dosages to
the general population of the United States.
Am. J. Roentgenol. 92: 404-417 (1964).
28. Cox. D. W. An investigation of possible genetic
damage in the offspring of women receiving
multiple diagnostic pelvic x rays. Am. J. Human
Genet. 16: 214-230 (1964 ).
29. Custer. R. P. Atlas of Blood and Bone Marrow.
p. 29. W. B. Saunders Co., New York (1949).
30. Diagnostic dental x-rays and the patient-an
overview. Bureau of Radiological Health. Rad.
Health Data. Jan. 1970.
168

47. FendeL H. Radiation problems in roentgen examinations of the chest. Prag. Pediat. Radial.
1: 18-32 (1967).
48. Flatby. J. Genetically significant dose in x-ray
diagnosis in Norway. In press.
49. Garby. L.. B. Nosslin and S. Lofveberg. Data on
dose to organs/JLCi administered and statistical
data. Swedish Institute of Radiation Protection.
.
1969.
50. Gilbertson, J. D., M. G. Randall and A. G. Fmgerhut. Evaluation of roentgen exposure in mammography. Radiology 95: 383-394 (1970).
51. Gitlin, J. N. and P. S. Lawrence. Population exposure to x-rays, U.S. 1964. A report of the
Public Health Service X-ray Exposure Study.
United States Department of Health, Educationand Welfare. PHS Publication No. 1519 (1966).
52. Gough, J. H., R. Davis and A. J. Stacey. Radiation doses delivered to the skin, bone marrowand gonads of patients during cardiac catheterisation and angiocardiography. Brit. J. Radio!. 41:
508-518 (1968).
53. Hammer Jacobsen, E. Genetically significant radiation doses in diagnostic radiology. Acta Radiologica, Suppl. 222 ( 1963).
54. Hashimoto, M., K. Yamada et al. Distributionof red marrow and its weight. (Estimation of
population dose due to diagnostic x rays inJapan.) Annual Reports of Scientific Research
Grants 1963 ( 1964).
55. Hashizume, M. Reduction of patient dose. Proc.
17th Japanese Med. Congress V: 801-839(1967).
56. Hashizume, T. and Y. Kato. Bone marrow dosein photofluorography in Japan. Nippon Acta
Radiolog. 25: 991-7 (1965).
57. Hashizume, T., Y. Kato, T. Maruyama et al.
Genetically significant dose for diagnostic medical x-ray examinations in Japan, 1969: United
Nations document A/AC.82/G/L.1388.
58. Hashizume, T., Y. Kato, T. Maruyama et al.
Population mean marrow dose and leukremia significant dose from diagnostic medical x-ray examinations in Japan 1969; United Nations documents A/ AC.82/G/L.1389 and A/AC.82/G/
L.1389/Corr.1.
59. Hashizume, T., Y. Kato, H. Yamaguchi et al.
Population doses from teleradiotherapy in Japan
1971: United Nations document A/AC.82/G/
L.1396.
60. Hemphill, F. M., F. B. Locke and R. D. Hesselgren. Diagnostic radiation utilization in selectedshort-term general hospitals. U.S. Department of
Health, Education and Welfare, BRH/DBE 70-8
(1970).
61. Hinz, G. Unpublished.
61a. Holodny, E., H. Lechtman and J. S. Laughlin.
Bone-marrow dose produced by radioactive isotopes. Radio!. 77: 1-11 (1961).
62. Holthusen, H., H. H.-K. Leetz, W. Leppin. Die
genetische Belastung der Bevolkerung einer Grosstadt (Hamburg) durch medizinische Strahlenanwendung, Schrifteoreihe des Bundesministers fiir
Atomkemenergie und Wasserwirtschaft. Strahlenschutz, Heft 21 (1961).

31. Dillman. L. T. Radionuclide decay schemes andnuclear parameters for use in radiation-dose
estimation. Medical Internal Radiation Dose(MIRD) Committee. Pamphlet No. 4 (1969).
32. Dillman, L. T. Radionuclide decay schemes andnuclear parameters for use in radiation-dose estimation. Part 2. Medical Internal Radiation Dose(MIRD) Committee. Pamphlet No. 6. (1970).
33. Doll, R. and P. G. Smith. The long-term effects
of x·irradiation in patients treated for metropathia
haemorrhacica. Brit. J. Radial. 41: 362-368(1968). 34. Duggan, H. E. and G. L. Olde. Radiation doseto the skin and to the gonads from diagnostic
x-ray procedures. Canad. Med. Assoc. J. 89:
1144-7 (1963).
35. Eleven recommendations of radiographic examination in oral diagnosis. N. Y. J. Dent. 38:
101 (1968).
36. Eleventh annual report 1966-1967, p. 59-60.
Atomic Energy Commission, Japan.
37. Ellis, R. E. The distribution of active bonemarrow in the adult. Phys. Med. Biol. 5: 255258 (1961).
38. Ellis. R. E. The estimation of ovary dose received
during diagnostic x-ray examinations from measurements of the iliac crest dose and skin dose.
Adrian Committee Internal Report, 9/5/60/S(1960).
39. Ellis. R. E. The use of a computer to carry out
the computation of ovary dose in the Adrian
Committee Survey. Adrian Committee Internal
Report, 10/5/60/S (1960).
40. Ellis, R. E. and M. Healey. Unpublished.
41. Epp, E. R.. J. M. Heslin. J. S. Laughlin et al.
Measurement of bone marrow and gonadal dosefrom x-ray examinations of the pelvis, hip andspine as a function of field size. tube kilovoltage
and added filtration. Brit. J. Radial. 36: 247265 (1963).
42. Exposure of man to ionizing radiation arisingfrom medical procedures. Report of the ICRP
and ICRU. Phys. Med. Biol. 2: 107-151 (1957).
43. Exposure of man to ionizing radiation arisingfrom medical procedures with special reference
to radiation induced diseases. Report of the ICRP
and ICRU Phys. Med. Biol. 6: 199-258 (1961).
44. Evaluation of health hazards due to unintentional
irradiation of the gonads during routine abdominal x-ray examinations of male and female
patients in Puerto Rico. Report No. l. Western
Region. Nuclear Center Department of Health,Commonwealth of Puerto Rico (1969).
45. Evaluation of health hazards due to unintentional
irradiation of the gonads during routine abdominal x-ray examinations of male and female
patients in Puerto Rico. Report No. 2. Southern Region. Nuclear Center Department ofHeal~, Puerto Rico (1970).

46. Faber, M. A follow-up of 1,000 thorotrast casesin Denmark, Proc. 1st Intern. Congress of Radiation Protection, 1966, p. 1521-1524, Pergamon
Press, 1968.
169

82. Larsson, L.-E. Radiation doses to the gonads ofpatients in Swedish roentgen diagnostics: studies
on magnitude and variation of the gonad doses
together with dose reducing measures. Acta
Radiol.. Suppl. 157: 7-127 (1958).
83. Lewallen, C. G. Some observations on radiationdose to bone marrow during l1 31 therapy ofthyroid cancer. Am. J. Roentgen. 89: 618-623(1963).
84. Loevinger. R.. M. Berman. Schema for absorbeddose calculations for biologically-distributed radionuclides. Medical Internal Radiation Dose(MIRD) Committee. Pamphlet No. 1. Journalof Nuclear Medicine (1968).
85. Mackenzie, I. Breast cancer fo1lowing multiple
fluoroscopies. Brit. J. Cancer 19: 1-8 (1965).
86. Mahmoud, K. A., M. M. Mahfouz. I. R. Atiyah
et al. Report on genetically significant dose fromdiagnostic radiology in Cairo and Alexandria.
U.A.R. Scientific Committee on the Effects ofAtomic Radiation on Man, Vol. 4-2 (1962).
87. Mahmoud K. A .. M. M. Mahfouz, M. E. Mahmoud et ~I. Gonadal and bone marrow dose in
medical diagnostic radiology. U.A.R. ScientificCommittee on the Effects of Atomic Radiation
on Man. Vol. 3-1 (1961).
88. Marinelli. L. D. Dosimetry in relation to epidemiology: its implications in radiogenic leukemias
and bronchial carcinoma ( thorotrast). Annual
report July 1966-June 1967. Radiological Physics Div., Argonne Nat. Laboratory, ANL-7360,
37-44 (1967).
89. Matthews, J. C. and H. Miller. Radiation hazards
from diagnostic radiology. A repeat survey overa small area. Brit. J. Radial. 42: 814-817(1969).
90. McEwan. A. C. Unsealed radioisotopes in medical practice in New Zealand. Publication NRL/
PDS/1967.
91. Mechanik N. Untersucbungen Uber das Gewicht
des Knochenmarkes des Menschen. Zeitschrift filr
die Gesamte Anatomie 79 (Abt.I): 58-90

63. Hunt, A. B. et al. Cancer cervix in 3rd trimesterof pregnancy. Clin. Obstet. Gyn. 6: 964-974(1963)
International
Commission on Radiological Pro64.
tection. Protection of patient in radio-nuclide investigations. ICRP Publication 17. Pergamon
Press (1971).
65. International Commission on Radiological Protection. Protection of the patient in x-ray diagnosis. ICRP Publication 16. Pergamon Press(1970).
66. Isola, A. On the extent of X-ray examinations inFinland. Proc. 1st Intern. Cong. of Radiation
Protection. 1966, p. 1321-1324, Pergamon
Press. 1968.
67. Isola. A and 0. Ojala. The genetically significant
dose from roentgen examination in Finland in
1963. Acta Radiologica, 254: 120-130.
68. Iya. V. K.. R. G. Deshpande. Radioisotope program in India. Isotop. Radiat. Technol. 7: 452457 (1970).
69. Izenstark. J. L. and W. Lafferty. Medical radiological practice in New Orleans: estimates and characteristics of visits, examinations and geneticallysignificant dose. Radio1. 90: 229-242 (1968).
70. Jankowski, J. and J. Liniecki. The frequency ofradiography of the pelvic region in pregnant
women in the city of Lodz and the province ofLodz and the exposure of the fretus to x raysconnected with it. Zdrowie Pub. 8: 707-716(1970).
71. Jayerwardene, R. P. Unpublished.
72. Johns. H. E., R. M. Taylor. Gonadal dose in
Canada arising from the clinical use of unsealed
radioactive isotopes. J. Can. Assn. Radiologists
9: 55-58 (1958).
73. Kakehi, H. Nuclear medicine in Japan, past, present and future. XII Intern. Cong. Radial.,
Tokyo, 1969.
74. Kaude. J. V., E. Lorenz and J.M. Reed. Gonad
dose to children in voiding urethrocystography
performed with 70-mm image-intensifier fluorography. Radio!. 92: 771-774 (1969).
75. Konganz, A. N., L. N. Gorelova and V. Ya.
Gotlib. Radiation doses to patients and criterion
for maximum permissible dose. Med. Radial.
11.8: 77-84 (1966).
76. Koren, C. and S. Mandal. Genetically significant
dose following radio-therapy. Abstract 305. 11th
Intern. Cong. Radiology. Excerpta Medica International Congress Series No. 89, p. 166 (1965).
77. Krishnamoorthy, P. N. Radiological protection
problems in the developing countries, HealthPhys. 21: 163-171 (1971).
78. Kriss, J.P., R. Barran, R. Greenberg et al. Guidelines and criteria for a Committee authorizing
the use of radioactive isotopes in humans.
J. Nucl. Med. 8: 70-73 (1967).
79. Kristensen. K. Nuclear medicine in Danish hospitals, 1969.
80. Kunz. E. and V. Michal. Exposure of the population of the CSSR to ionizing radiation in x-ray
diagnostics; United Nations document A/ AC.82/
G/L.1322.
81. Kunz, E. Unpublished.

(1926).
92. Medical radionuclides: radiation dose and effects.
( Cloutier, R. J.. C. L. Edwards a;1d W. S.
Snyder, eds.). United States AtoDll~ Energy
Commission. Div. Technical Information. AEC
Symposium Series 20 (1970).
93. Memorandum on implementation of the second
report of the Adrian Committee on radiologicalhazards to patients. Brit. J. Radial. 37: 559-561(1964).
94. Milhailovic, M., M. Pavlic, M. V. Milha~ovic
et al. Radiation doses to the gonads of patientsfrom diagnostic radiology in Yugoslavia. Proc.
XL International Cong. Radiol. Excerpta Med.
ICS No. 105: 1547-1561 (1967).
95. Miyakawa, T. Population dose from medical
exposures in Ja pan (bone marrow dose andgenetically significant dose). Proc. XI Intern.
Cong. Radio!. Excerpta Med. ICS No. 105:
1574-1579 (1967).
96. Moroni, J. P. and M. L. Remy. Doses delivrees
lors des examens medicaux mettant en cause desradioelements osteotropes. Rapport SCPRI
No. 131 (1971).

170

97. Morgan, R. H. and J. C. Gehret. The radiantenergy received by patients in diagnostic x-ray
practice. Am. J. Roentgenol. 97: 793-810(1966).
98. Osborn, S. B. A study of radiation hazards tolarge populations with special reference to diagnostic radiology. Ph. D. Thesis. University of
London. 1960.
99. Osborn, S. B. The implication of the reports of
the Committee on radiological hazards to patients( Adrian Committee). I. Variations in the radiation dose received by the patient in diagnostic
radiology. Brit. J. Radiol. 36: 230-234 (1963).
100. Osborn, S. B. and R. E. Ellis. Protection fromionizing radiation. Chapter 29. The science ofionizing radiation (Etter. L. E., C. Thomas, eds.),
Illinois, USA, 1965.
101. Palmer. R. C., R. L. Egan and B. J. Barrett.
Preliminary evaluation of absorbed dose in mammography. Radiology 95: 395-397 (1970).
102. Pasternack. B. S. and M. B. Heller. Geneticallysignificant dose to the population of New York
City from diagnostic medical radiology. Radiology 90: 217-228 (1968).
103. Pavlov, A. S. The principles of regulation andof reducing the levels of irradiation of patients
examined with the use of radioactive preparations with diagnostic aims. Paper to WHO
group, 1969.
104. Penfil, R. L. and M. L. Brown. Geneticallysignificant dose to the United States populationfrom diagnostic medical roentgenology, 1964.
Radiology 90: 209-216 (1968).
105. Placer, A. E. Dosis geneticamente significativa
debida al radio-diagn6stico medico. Republica
Argentina, Comisi6n Nacional de Energfa At6mica, Informe No. 49, Buenos Aires, 1961.
106. Population dose from x rays, U.S. 1964. Estimates of gonad dose and genetically significant
dose from the Public Health Service X-ray Exposure Study. United States Department of
Health. Education and Welfare. PHS Publication
No. 2001 (1969).
107. Puylaert, C. B. A. J. De Expansie van de Rontgendiagnostick. Medisch Contract, 1969/24/685.
Medicamundi 14, 3, 137-149 (1969).
108. Radiation bio-effects. Summary report Jan-Dec.
1969. United States Department of Health, Education and Welfare. PHS Publication No. BRR/
DBE 70-1 (1970).
109. Radiological hazards to patients. Lancet 2:1325-1326 (1964).
110. Reboul, J.. G. Delorme, Y. Meilhan et al. Doses
gonades resultant de l'utilisation des radiations
ionisantes en France. 3. Radiotherapie. Ann.
Radial. 3: 293-304 (1960).
111. Reboul, J., G. Delorme, J. Tavernier et al.
Doses gonades resultant de l'utilisation des radiations ionisantes en France. II. Radioscopie. Ann.
Radio!. 3: 89-99 (1960).
112. Reboul. J.. J. Tavernier. G. Delorme et al. Doses
gonades resultant de !'utilisation des radiations
ionisantes en France. I. Radiodiagnostic (suiteet fin). Ann. Radial. 2: 571-584 (1959).

113. Reboul, J., J. Tavernier, Y. Istin et al. Doses
gonadcs resultant de !'utilisation des radiations
ionisantes en France. I. Radiodiagnostic Ann.
Radio!. 2: 179-196 (1959).
114. Recommendations of the International Commission on Radiological Protection. Protection
against ionizing radiations from external sources.
ICRP. Publication 15, Pergamon Press (1970).
115. Reduction of radiation exposure in nuclear medicine. United States Department of Health. Education and Welfare. PHS Environmental Health
Series. Radiological Health. Publication No. 99RH-30, 1967.
116. Reekie, D., M. Davison and J. K. Davidson.
The radiation hazard in radiography of the female abdomen. Brit. J. Radio!. 40: 849-854(1967).
117. Report of the Working Party on the Organization of Radioactive Isotope Services, London,
H.M.S.O., 1970.
118. Report on radiation control and population dosein New Zealand. National Radiation Laboratory,
Christchurch, NRL UN/2 (1970).
119. Report on some aspects of radiation protection
and population exposure in Thailand. Ministry of
Public Health, Thailand, Radiation Protection
Service, Department of Medical Sciences, 1970.
120. Report to the Surgeon General. U.S. PHS. Protecting and improving health through the radiological sciences. National Advisory Committeeon Radiation. United States Department of
Health, Education and Welfare. Public HealthService. Washington D.C., 1966.
121. Research Group on the Genetically Significant
Dose by the Medical Use of X-ray in Japan. The
genetically significant dose by the x-ray diagnostic examination in Japan (March 1961).
122. Resolution of the 24th World Health Assembly
WHA 24.31 sixteenth plenary meeting A24/
VR/16, 18 May 1971.
123. Rogers, R. T. Radiation dose to the skin in
diagnostic radiography. Brit J. Radio!. 42: 511518 (1969).
124. Russell, W. J.. H. Yoshinaga et al. Active bonemarrow distribution in the adult. Brit. J. Radio!.
39: 735-739 (1966).
125. Sagerman, R.H., J. R. Cassady, P. Tretter et al.
Radiation induced neoplasia following externalbeam therapy for children with retinoblastoma.
Am. J. Roentgenol. 105: 529-535 (1969).
126. Sanders, A. P., K. Sharpe, K. Cahoon et al. Radiation dose to the skin in diagnostic procedures.
Arn. J. Roentgenol. 84: 359-368 (1960).
127. Sawada, S., T. Wakabayashi and W. J. Russell,
Photofluorography techniques in hospitals andclinics. Atomic Bomb Casualty Commission,
Technical Report 3/68 (1968).
128. Schoen, D. On the dependence of radiation exposure on the experience of the examiner andon the characteristics of the patient. Strahlenschutz Forsch. und Prax., 7: 31-48 ( 1967).
129. Scholte. P. J. L., A. van Vianen, J. W. E. Vos
et al. Genetically significant dose from radiotherapy in the Netherlands, 1942-1951. Brit. J.
Radio!. 36: 622-623 (1963).
171130. Seelentag, W. Die gegenwartige Exposition der
Bevolkerung <lurch die medizinische Strahlenanwendung und ihre Bedeutung. Strahlentherapie
52: 326-333 (1963).
131. Seelentag, W., D. V. Arnim, E. Klotz et al. Zur
Frage der genetischen Belastung der Bevolkerung <lurch die .-<\nwendung ionisierender Strahlen in der Medizin, II. Teil: Messungen Uber die
bei rontgendiagnostischen Untersuchungen an die
Gonaden gelangenden Dasen. Strahlentherapie
105: 169-195 (1958).
132. Seelentag, W., E. Seelentag-Lupp and E . Klotz.
Zur Frage der genetiscben Belastung der Bevolkerung durch die Anwendung ionisierender Strahlen in der Medizin, V. Tell: Werte und Schwan1...-ungsbreiten von Untersuchungsfrequenzen undgemessenen Dasen in 10 grossen und kleinen
Krankenhausern und in der freien rontgenologiscben Praxis. Strahlentherapie 111: 435-467(1960).
133. Seelentag, W. On the importance of the radiation burden of a population with special reference to the genetically significant dose from application of radiation in medicine. Progress in
Nucl. Energy. Series XII; Health Physics, Vol.
2, Part I : 125-155 (1969).
134. Seelentag, W., T. Nurnberger, D. Knorr et al.
Zur Frage der genetischen Belastung der Bevolkerung <lurch die Anwendung ionisierender
Strahlen in der Medizin, IV. Tei!: Die Strahlenbelastung durch die Rontgendiagnostik in Kinderkliniken. Strahlentherapie 107: 537-555(1958).
135. Seyss, R. Radiation exposure in radiography of
the gastrointestinal tract. Radial. Aust. 17: 135142 (1967).
136. Sobels, F. H. Estimation of the genetic risk resulting from the treatment of women with 131 Iodine. ~Strahlentherapie 138: 172-177 (1969) .
137. Stanford, R. W., K. Twinn and C. B. Allsopp.
Some problems encountered in the investigationof gonad doses received by patients undergoing
dental x-ray examinations. Brit. J. Radial. 35:
366-371 (1962).
138. Stevens, D. J. and D. W. Kearn. Unpublished.
139. Stewart, A., G. W. Kneale. Radiation dose effects
in relation to obstetric x-rays and childhood
cancers. Lancet 1: 1185-1188 (1970).
140. Stewart, A. M., G. W. Kneale. Age distributionof cancers caused by obstetric x-rays and theirrelevance to cancer latent periods. Lancet 2: 4-8(1970).
141. Stewart, A., R. Barber. Epidemiological importance of childhood cancers. British Medical Bulletin 27, 1: 64-70 (1971 ).
142. Survey of the uses of radio-nuclides in medicine.
Preliminary report. United States Department of
Health, Education and Welfare. PHS publication
MORP 68-10, 1968.

172

143. Survey of the uses of radio-nuclides in medicine.
United States Department of Health. Educationand Welfare. PHS publication BRH/DMRE,
70-1, 1970.
144. The use of vital and health statistics for genetic
and radiation studies. Seminar UN and WHO,
Geneva 1960. UN publication A/AC.82/Seminar (1962).
145. Thompson, P. L. and I. R. Mackay. Radiation
nephritis after gastric irradiation for peptic ulcer.
In press (1969).
146. Twelfth annual report 1967-1968, p. 83-85.
Atomic Energy Commission, Ja pan.
147. United Nations. General Assembly. Report of
the United Nations Scientific Committee on the
Effects of Atomic Radiation. 1958. (A/3838:
G.A. Official records, 13th sess. Suppl. No. 17.)148. United Nations. General Assembly. Report of
the United Nations Scientific Committee on the
Effects of Atomic Radiation. 1962. (A/5216:
G.A. Official records, 17th sess. Suppl. No. 16.)
149. United Nations. General Assembly. Report of
the United Nations Scientific Committee on the
Effects of Atomic Radiation. 1964. (A/5814:
G.A. Official records, 19th sess. Suppl. No. 14.)150. United Nations. General Assembly. Report of
the United Nations Scientific Committee on the
Effects of Atomic Radiation. 1966. (A/6314:
G.A. Official records, 21st session. Suppl.
No. 14.)151. United Nations. General Assembly. Report of
the United Nations Scientific Committee on the
Effects of Atomic Radiation. 1969. (A/7613:
G.A. Official records, 24th sess. Suppl. No. 13.)152. Verksamheten 1970. Statens Stralskyddsinstitut
Stockholm (1971).
153. Weber, J. Beenmergdosis tengevolge van derontgendiagnostiek. Thesis. Leiden ( 1964).
154. Weber, J. Unpublished.
155. Williamson, B. D. P. A simple patient dose calculator for radiographic exposures. National Radiation Laboratory, Christchurch, New Zealand,
Publication T /26-undated.
156. Williamson, B. D. P. and A. C. McEwan. The
genetically significant radiation dose to the population of New Zealand from diagnostic radiology.
NRL/PDS/1965.
157. World Health Organization. The medical uses ofionizing radiation and radio-isotopes. Report ofa joint IAEA/WHO Expert Committee ( Geneva,
26 October-1 November 1971). Technical Report Series No. 492 (1972).
158. Zuppinger, A., W. Minder, R. Sarasin et al. Die
Strahlenbelastung der schweizerischen Bevolkerung durch rontgendiagnostische Massnahmen.
Radial. Clinica 30: 1-27 (1961).

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