REPORT OF THE

UNITED-NAXI-ONS .

SCIENT1ft&~f'iMfttTTEE"'\."'\., /'l
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EFFECTS OF !iit}ifffHiADIATION.. : . . .

·'GENERAL ASSEMBLY
OFFICIAL RECORDS : SEVENTEENTH SESSIONSUPPLEMENT No. 16 {A/5216}

New York, 1962

NOTE
Throughout the present report and the annexes thereto, references to theannexes are indicated by a letter followed by a number: the letter denotes the relevant
annex and the number the paragraph therein. Within each annex, references to its
scientific bibliography are indicated by numbers.
Symbols of United Nations documents are composed of capital letters combined with figures. Mention of such a symbol indicates a reference to a United
Nations document.

h we ut··m,.

MEDICAL, OCCUPATIONAL AND OTIIER EXPOSURESCONTENTS
Paraoraplu

Paraorap/&s

I. INTRODUCTION • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •I!. MEDICAL USES OF IONIZING RADIATION • • • • • • • • • • • •The genetically significant dose . . • . . • • . • • • • • . • • . •Definitions and calculations • . • . . . . • • . . . . . . . . • .
Data .. . . .•. . . • . . . . . • . . . .. . . . . . . .. . . •. . • . • • . •X-ray diagnosis . . . . • . . . . . . . . • . . . • . . . . . . • . . .
(a) National surveys • . . . • . . • . . . . . . . . . .. •( b) Other investigations . . • • . . . . • . . . . . . . .
(c} Mass survey examinations of the chest(d} Comments • • • • • . • . . . • • . . . • . . • . . • . . . .
(e) Consideration of the dose-rate effect...
(/) Reduction of the genetically significant
dose . . .. . . . . ... .•. • . . . • . . •. .• . . . • •External radio-therapy by X-rays and sealed
radio-active sources . . . • . • . . • • . . .. .. • . . • .
(a) National surveys • .. .. .. • . • • • • . • • • • • .
(b) Other investigations . . .. ... . . . • . •. . • .
(c} Comments • . . . . . . . .. • . . . . . . . • . . • • . . .
(d) Consideration of the dose-rate effect..
(e) Reduction of the genetically significant
dose • . . . . . . . . • • • . . . . • . . . . . • . • . • . . .
Administration of radio-isotopes • . . . . • . . . . . .
(a) National surveys . . . .. • . . . . . .. . . . .. . •(b} Comments...........................
(c} Consideration of the dose-rate effect • •(d) Reduction of the genetically significant
dose •• ••• • • . • . • .. . . . . . •. . ••• • •• . . .
Summary....................................
Exposure of the bone-marrow • . • • . • • • . • . • • • . . . •Determination of the mean marrow dose . • . . . .
Distn1iution of active bone-marrow . . . • • . . . • . • •Dose data . . . . . • • . • . . . . . . . . . . . . . . . • . • . . • . . . • .
X-ray diagnosis . • . . . . . . . . . . . . . • • . • • • . • . . . . .
External radio-therapy by X-rays and sealed
radio-active sources . . . . • . • . . . . . • . . . . . . . . .
Administration of radio-isotopes . . . . . . . . . . . .
Comments . . . . . . . . • . . • . . . . . . . . . • • . . . . . . . . . . . .

Dose to other organs and tissues of special interest 91-98
General remarks . . . . . . . • • . . . • . . . . • . . . . . • • • • • .
91
Data . . . • •• . .. . • . .. .• . . • . • •. . . •• . • . . • . .. . . . . . 92-97
Foetal tissue . . . . . . • • . . . . . . . • • . . . . • . . • . . • . . .
93
Lens of the eye • . . • . • • • • . • . • . . • • • . . . • • • • . . . •94
Thyroid . . . •. . •..•..•.. ••. . . . . . . .• .• . .• • . . •95
Thymus •.... .... •. ••• •.. .• . ••.•... ••... .. .
96
Liver......................................
97
Reduction of doses to various organs and tissues
including the bone-marrow . • • • . . . . • . . . . . . . •98Fields of research . . • . • • . • • • . . . • . • . • • • . • • . • . . . . •
99

1-6

7-99
9-74
9-12
13
14-43
14-28
29-30
31
32-37
38-4-0Ill. OCCUPATIONAL EXPOSURE . . . . . . . . . . . . . . . . . . . . . . . 100-116
Number of installations and radiation workers •.. 101-103
Recommendations on the conditions of work •.•. 104
Dose information from individual monitoring .••. 105-110
Internal contamination • ; •.••.••.••.••.••••••• 108
Mining: industrial processing of uranium and109
thorium ••••.•••••••.••••••.••••.....••••.•
Luminizing industry .....•..••............••. 110
Estimates of occupational e.'tposure in high altitude
aircraft ..................................... 111-114
Genetically significant dose • • . . . . .. . .. • . • . • .. . .. 115~iean marrow dose . . . • . . • . . . . . . . . . . . . . . . • . • . . .
116

41-43
44-61
46-49
50-53
54-57
58-60
61
62-73
64-69
70
71-72

IV. OTHER EXPOSURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117-126
Radiological installations . . • . . . . . • . . • . • • . . • • • • . • 118
X-ray fluoroscopy for shoe fitting . . . . . . • • . . . • . . 119
Luminous markings in clocks and watches........ 120
Television sets ................................. 121-123
Passengers in aircraft • • . . . . . • . . . . . . . . . . . . . • • • • . 124
Use of nuclear power in ships . . . • . . . .. . . . • • • . • . 125
Genetically significant dose • . . . . . . . • . . • . . . . . • . . . . 126

73
74
75-90

76-77
78-79
80-89
81-85

APPENDIX

86-88
89
90

TABLESREFERENCES

I. Introduction

3. The term "occupational exposure" is, in the present
annex, taken to apply to all activities involving exposureof workers to ionizing radiation in the course of theirwork, regardless of whether the workers are directly engaged in radiation work or not.1 • 2

1. This anne.x deals mainly with information and dataon radiation doses to individuals and populations as aresult of exposure to ionizing radiation of:(a) Patients undergoing medical radiological procedures-medical e.xposure;(b) Workers as a consequence of their work-occupational exposure ;( c) Persons from miscellaneous man-made sources
and abnormal exposure to natural radiation, when thee.xposures do not belong to (a) or (b)-other exposures.
2. The term "medical exposure" is taken to apply to
all types of e.xposure (except occupational) resulting
from radiation administered by radiologists, generalpractitioners, dentists, obstetricians, osteopaths, chiropractors, etc.

4. Data concerning radiation doses to specific organs
and tissues, and to the whole body may be used for the
purpose of:(a) Risk estimates; this implies adequate knowledgeof the dose-effect relationship;( b) Education, which, by presenting comparative
data, might result in improved standards of operation
and a reduction of doses ;( c) Guiding epidemiological studies.
5. The concept of significant dose for the evaluationof a specific biological risk was considered by the Com-375

mittee in its 1958 report (chapter II, para. 26) 3 in thefollowing way:
"Any specific biological effect of irradiation mustbe evaluated from physical factors such as the distribution of tissue dose (expressed in rem) in space
and time and from biological factors such as radiosensitivity. latent period, recovery and repair. TJ1e
simplest situation is that in which a dose-effect relation for a biological effect is known, making it possible
for the probability or degree of this effect to be calculated. Whether the effect eventually may manifest
itself in the form of deleterious consequences, however, depends on individual circumstances such as expectation of life, or, in the case of genetic injury,
expectation of children. For this reason, the potential
effect indicated by a direct application of an assumed
dose-effect relation must be weighted according tothese individual circumstances."
As has been pointed out earlier in the present report,
quantitative risk estimates presuppose assumptions regarding the dose-effect relationship. As long as the truemode of dose-effect relationship is not known, any useof the presented dose data for risk estimates must be
made with the recognition of the necessary assumptions
and the awareness of the uncertainty of the result. In
any circumstances only comparative risk estimates may
be made on the basis of the presented data and theyshould be limited to considerations of exposures to thesame organs or tissues.
6. The present annex deals with the following typesof radiation dose:(a) Genetically significant dose;( b) Mean dose to the active bone-marrow;( c) Doses to organs and tissues of special interest.
Data on radiation exposure to the gonads are presented
using the accepted definition of the genetically significant
dose (para. 9) with the intention that they may be used
for comparative risk estimates of the radiation-induced
genetic effect. following the procedures outlined in the1958 report. However, in the cases of radiation e.-x:posures to the bone-marrow and to other organs and tissuesof special interest the data are not given with the intention that they be used for risk estimates but for educational purposes and as a guide for epidemiological studies
as mentioned in paragraph 4 above. Medical exposure
is dealt with in paragraphs 7-99, occupational exposurein paragraphs 100-116 and other exposures in paragraphs 117-126.
II. Medical uses of ionizing radiation

7. Medical exposure arises from the following typesof procedures:(a) X-ray diagnosis ;( b) Radio-therapy by X-rays and sealed radio-active
sources;(c) Administration of unsealed radio-isotopes fordiagnostic, therapeutic and research purposes; radiation
exposures also result from the use of contrast media
containing radio-active materials. e.g. thorium dioxide.

(a) Table I deals with X-ray diagnosis. Alt.hough thefrequencies are based on sample studies, nine of thetwelve countries which had carried out comprehensive
surveys had similar amounts of radiography and fluoroscopy (excluding mass surveys and dental exposures).
Their annual frequencies range between 260 and 410
examinations per 1,000 individuals. The frequency figures in the cities tend to be higher than those based on
the whole country, not only because cities usually havemore X-ray facilities, but also because many patientsare examined there without being residents of the city
itself or the surrounding suburban area.
( b) Table II, which sets out the frequencies of cases
treated with X-rays and sealed radio-active sources,
shows large differences between the various countries
and areas.
( c) Table III gives the frequency of the administration of radio-active isotopes to cases for either diagnostic
or therapeutic reasons. The number of patients undergoing diagnostic procedures is four to ten times higher
than the number undergoing therapeutic procedures. The
table also gives the annual consumption for medical useof !131 , P 32 and Au198 • The contribution to the amountsof radio-active isotopes from the diagnostic use may bedisregarded, as compared to the amounts used for therapeutic purposes. The information usually originatesfrom the distributors. The figures given for the amounts
should be regarded as maximum estimates in view ofthe disintegration of the radio-active isotopes in transit
and because the total amount of requested isotopes may
not have actually been used for medical purposes.
THE GENETICALLY SIGNIFICANT DOSE

Definitions and calculations

9. In the 1958 report the genetically significant dose
was defined (chapter II, para. 27) as" ... the dose which, if received by every member ofthe 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 definition was based upon the following assumptions and considerations :(a) The relevant tissue dose is the accumulated doseto the gonads ;( b) The dose-effect relation is linear, without athreshold;( c) Th~ individ~al gonad dose is weighted with afactor which takes mto account the future number of
cl:ildren expected of the irradiated individual comparedw1~ an average member of the population (in this connex10n the foetus is treated as such an irradiated individual and not as a child to be expected).
10. Evidence ha~ lately been obtained that although
the dose-ef!ect relat~on for the prod.uction of most genetic
damage rrught be linear at any given dose-rate, it has
a lower slope for low dose-rates than for hicrh ones.
(C, 84-87) There are also indications that th~ genetic
damage to future generations at any given dose or doserate may differ with sex and with the cell-stage of agamete, depending on a difference in the radio-sensitivityof the male and female gametes and on a difference in
the J?Ossibili~y of transferring the damage to future generat10ns. This means that the \Veighting of the individual
gonad dose should, in addition to the factor for future
number of children, include weighting factors for thedose-rates to the gonads and for the difference both be-

8. Data on the frequencies of radiological proceduresin various countries and areas are presented in tables I,
II and III. The frequency figures are obtained as theannual number of procedures per 1,000 individuals of
the population under study:
376

tween the se.xes and the cell-stages. Since these newweighting factors are not yet known, it is not possible
to incorporate them in the calculation of the geneticallysignificant dose.
11. It is still justifiable to use the formulas for the calculation of the genetically significant dose as they were
presented in the previous report. The derivations of theseformulas are therefore repeated in the appendix.. *12. Available information on genetically significant
dose and its parameters is given under the heading"Data", with the following subdivisions: X-ray diagnosis; radio-therapy by X-rays and sealed radio-active
sources; administration of radio-active isotopes.
Data
13. During the last few years many investigations
have been performed to determine the genetically significant dose arising from medical exposure. Thoughmost of these were performed along the lines presented
in the appendix. using either formula 8 or 11 for the
calculations. the sampling techniques and the modes ofmeasurement or estimation of the gonad doses vary.
Because of this, short explanatory statements of the investigations presented are given below in paragraphs
17 to 30.
X-ray diagnosis-(a) National surveys
14. Tables XVIII and XIX present the average gonaddose for each of the ten most significant examinations
for each of the countries submitting information, withthe reservations of paragraph 15. Table XVIII gives thevalues for examinations of male patients and table XIX
the information for female patients. Table XX presents
the values for the foetal gonad dose during examinationsof the obstetric abdomen and pelvimetry. Only the Federal Republic of Germany (Hamburg) and the United
Kingdom presented separate values of foetal gonad doses
for the other examinations. Some countries assumed
that the foetal gonad dose was the same as the female
gonad dose for these other examinations. The variationin the values shown in these tables demonstrate that for
any one e.xamination a wide range of gonad doses may
be obtained. This is due to varying techniques, for e.xample the amount of fiuoroscopy carried out as part ofan examination and the size of the incident skin fields.
Reductions in both of these will greatly reduce gonaddose in an examination. Table XXI presents the total
genetic dose contribution for each examination for eachof the countries submitting information. Similarly, table
XXII gives the same information but presented as thepercentage of the total genetic dose of each country,
whilst the totals are summarized in table XXIII.

15. Further details of the genetic dose computations
and data for each country may be obtained by reference
to the national tables presented as tables IV-XVI. In
these tables the ten types of examination which contribute most to the genetically significant dose originatingfrom X-ray diagnosis are set out in descending order of
their contribution. All other types of examination arepresented as a whole. As an exception to this principle,
the two types of obstetrical examination, e.g., pelvimetry
and obstetric abdomen, are always individually presented, although their contribution to the genetically sig-

* Although, for editorial reasons, the pertinent paragraphs
are not directly quoted, they are substantially a quotation fromthe Co=ittee's 1958 report, annex C, para. 6-17.

nificant dose does not always justify this. They are thenplaced at the bottom of the table, replacing the ninth andtenth types of examination. It should be mentioned that
although the genetically significant dose is referred toas the "annual" dose, the validity of the figures is limited
to the year or years to which the surveys relate.
16. The doses to the gonads and the annual geneticallysignificant doses are presented in mrem. The dose-rates
being the dose averaged over the exposure time are presented in mrem per sec and for the purposes of thisanne.x it is assumed that for X-, /3- and y-radiation 1 r
corresponds to 1 rad and to 1 rem.
17. Argentina (Buenos Aires). Table IV is based ona report by Placer. 4 His investigation is limited to radiography. Studies on the numbers of different types ofradiographs and their distribution by sex of the patients
radiographed were undertaken in a total of eighty-si.x
hospitals and medical centres. The dose measurements
were made with ionization chambers and film badges attached to the skin of the patients. Depth dose data wereused for computing the gonad doses. The geneticallysignificant dose was calculated from formula 11. The
mean age of child-bearing was set as thirty. It should beemphasized that Placer's report deals with numbers ofradiographs and not examinations. An estimate of thecontribution to the genetically significant dose caused byradiography in private clinics and practices has been
made, assuming the distribution of the radiographs invarious types of examination to be the same as in thehospitals.
18. Denmark. The figures presented in table V are
taken from the investigation published by HammerJacobsen. 5 The figures on the numbers of various typesof examination are based upon a sample inquiry. Information on sex and age distribution of the patients was
obtained from a special study on 139,000 e..xaminations.
Measurements on the doses to the gonads were madewith ionization chambers on 2,475 patients during theactual course of examination. Data on doses to the foetus
were obtained by measurements in a phantom. The genetically significant dose was calculated by means of formula 8 in the appendix. The fertility factors used were
calculated from the official vital statistics of the population.
19. Federal Republic of Gernumy (Hamburg). The
data in table VI are taken from the investigation published by Holthusen, Leetz and Leppin. 6 The geneticallysignificant dose was calculated by means of formula 8.
Information on the number of examinations of various
types, subdivided by sex and age of the patients, wascollected by means of questionnaires. compiling all examinations during the period from November 1957 toOctober 1958. Measurements were made on the gonad
doses to adults in the course of examinations belonging
to the types which were e..xpected to give the highest
contribution to the genetically significant dose. In addition, gonad doses to children and to adults were takenfrom an investigation made by Seelentag.7 The figuresford; in table VI are, according to the original paper,mean figures including all age groups. They were obtained by means of formula 8 after the detailed calculation of the annual genetically significant dose had beenmade. The fertility factors were computed from theofficial vital statistics of the population. For comparative
purposes figures are presented for the annual geneticallysignificant dose using formula 11 and a figure for theannual per capita dose for the whole population, disregarding fertility factors.

377

20. France. Table VII is based upon data publishedby Reboul et al.s-Hi The sample study of ~he nu~b:r. ofdifferent types of examinat10ns ar_id their subdjv1s1onwith regard to sex and age of the patter_its, was perrorme_d
in Bordeaux during 1957, and compnsed ~6,0~0. exa!111nations. By means of the records of the Secunte soc1ale
the results obtained from the sample study were extrapolated to cover the whole of France. Measurements ofthe gonad doses were made during the examinations.
For the female patients, the ionization chambers wereplaced on t_he skin at the level of.the ovaries. The fac_tors
for the ratio of ovary dose to skm dose were determinedby measurements in cadavers and phanto~s. The genetically significant dose was computed with the use offormula 11.
21. Italy (Ro-me). Table VIII is based on an investigation published by Biagini, Barilla and Montanara.11
The numbers of examinations of various types, subdivided by sex and age of the patients, are based upon ayear-long study of the number of examinations performed in certain selected hospitals and clinics. A special
correction was made, to exclude the e..'Caminations onpatients who were not residents of Rome. Using ionization chambers the authors arrived at gonad doses throughmeasurements in a phantom and in patients during theexaminations. In order to account for the variations in
the gonad doses as a consequence of differences in technique and physical parameter, figures on gonad doses
were obtained as mean figures from pertinent data
presented by ten authors. The genetically significant dose
was calculated from formula 8. The fertility factors werecomputed from official vital statistics of the population.
22. Japan. Table IX is based upon data from a Japanese report.12 This investigation is based upon two
sample studies, the first covered seven districts comprising around 80,000 examinations and the second was
representative of the whole of Japan, in which details of
66,000 examinations were obtained. The sample studies
for the collection of numbers of examinations lasted for
one week each. During this period, information was also
obtained on the sex and age distribution of the patients.
The gonad doses to adults and children were obtained bymeasurements with ionization chambers in body-shaped
phantoms. The influence on the gonad doses as a consequence of variations in physical parameters was investigated. No measurements were made of doses to the
foetal gonads. Fertility factors were determined fromofficial statistics. The genetically significant dose wascalculated according to the principles set out in formula 8.
The contribution to the genetically significant dose fromthe exposure of foetal gonads was computed only for
obstetrical examinations.
23. Netherlands (Leiden). Table X presents data obtained from Beekman and v\Teber. 13 The numbers ofroentgen examinations of various types are based upona study of the records from 30,000 examinations. Information on sex and age distribution in different typesof examination was also collected. The gonad doses wereobtained from measurements with ionization chambers
in a body-shaped phantom. The influence on the gonad
doses was studied in relation to variations in e..'\:amination
techniques and physical dose parameters. The figures
presented for gonad doses are averaged with regard to
the existing ranges of techniques and parameters. The
annual genetically significant dose was calculated bymeans of formula 8. For comparative purposes, formula
11 was used, under the assumption that the mean age ofchild-bearing was thirty years. In addition, a per capita
378

annual gonad dose was calculated without reg~d to thefertility factors. The fertility factors were obtamed fromthe official vital statistics of Leiden.
24. N oriJJay. The data set out in table XI are extracted
from an investigation performed by Flatby.u Information on the numbers of examinations of various types
was obtained during 1957 and 1958 from all the establishments in Norway where X-ray diagnosis was performed. The subdivision of the number of examinations
by sex and age of the patients was based on a study c?mprising four diagnostic departments ( 40,~0 examu~a­tions). The gonad doses were measured directly withionization chambers during the e.~amination. In addition,
doses to the ovaries were also assessed by measurements
in a body-shaped phantom. The dose measurements comprised around 1,300 patient and 100 phantom measurements. The fertility factors were determined from theofficial vital statistics of the population. The geneticallysignificant dose was calculated by means of formula 8.
25. Sweden. Table XII summarizes the data on genetically significant dose presented in the _Comn:iitt~e's
previous report. The data are based on the mvest1gation
published by Larsson. 15 Information on the numbers of
examinations of various types, subdivided by sex andage of 'the patients, was collected from a sample of hospital records ( 40,000 examinations) and corrected by an
estimate of the numbers of examinations performed byprivate practitioners. Only around 5 per cent of the total
number of examinations were carried out by these practitioners. These were mainly chest and small bone
examinations. Around 1.900 measurements of the doses
to the male and female gonads were performed withionization chambers during the actual course of examination. Only the doses to foetal gonads were obtained bymeasurements in a phantom. The fertility factors werecomputed from the official vital statistics of the population. The genetically significant dose was calculated fromformula 8.
26. Switzerland. Table XIII is based on an investigation performed by Zuppinger, Minder, Sarasin and
Schaer.16 Through a sample study, lasting for three
weeks in 1957 and comprisin'g around 65,000 examinations, information was gained regarding the numbers of
examinations of various types, subdivided by sex andage of the patients. The doses to the gonads were obtained partly from the authors' own measurements withionization chambers in patients and a body-shaped
phantom, and partly, when appropriate, from dose data
published in other countries. Since the Swiss investigation started with the original intention of computing thegenetic dose to individuals below the age of forty butlater changed to a determination of the genetically significant dose according to formula 8, the calculations
were not made directly with the use of this formula,although the principles were the same. The fertility factors were determined from official statistics.
27. United Arab Repieblic.17• 18 Investigations carriedout in Ale.'\:andria and Cairo during the years 1955-1961
are presented in tables XIV and XV. They are representative of the whole of Alexandria and the area west
and south-west of Cairo. Phantom measurements werecarried out on a selection of units used in these cities.
The calculations were made on the basis of formulae 8
and 11 and the results presented as a weighted mean.
The survey showed that some 17 per cent of the annual
examinations were for investigations of the urinary
tract. This is due to the investigation of the endemic
disease, schistosomiasis.

28. United Kingdom. The material presented in table
XVI has been taken from the report of the Adrian Committee.19 The comprehensive survey covered all medical
radiology carried out in the United Kingdom, except
Northern Ireland. The numbers of e..xaminations ofvarious types and their distribution by se..x and age ofthe patients are based on t\vo nation-wide sample studies
in 1957, each one lasting for one week, and together
comprising around 310,000 examinations. The wholecountry was divided into nineteen regions and in eachmeasurements were carried out in a sample of six hospitals. The gonad doses were obtained for 5,400 examinations by measurements with ionization chambers. The
methods used for making these measurements were:( i) Male patients: by a direct dose measurement madewith the chamber in contact with the scrotum during theexamination ;(ii) Female patients : by an indirect method, using
the dose to the skin at the level of the iliac crest, measured
during the course of examination. and the ratio of thecorresponding skin dose and the ovary dose, as obtained
from dose measurements in body-shaped phantoms;(iii) Foetus: by calculations based upon dose data
derived from body-shaped phantoms.
The fertility factors were computed from official statistics. A separate statistical investigation was made to
determine the average number of future children to beborn to a pregnant woman. While the accuracy of thisestimation is low, the general indication is that the fertility factor for a pregnant woman is higher than thatfor a woman in the population at large. These higher
fertility factors, although admittedly approximate, havebeen used solely in computations on examinations madein conne..xion with a pregnancy, viz. pelvimetry andobstetric abdomen examinations. The genetically significant dose was calculated by the use of formula 8.

( b) 0 ther investigations
29. United States of America. Most of the national
surveys are performed in countries with small populations. In countries with large populations, a small-scale
study may not truly reflect the situation, especially when
there are great variations within the country in the parameters that determine the genetically significant dose.
For the United States, Laughlin and Pullman 20 made anestimate of the annual genetically significant dose, on thebasis of those data in the literature up to 1955. using
formula 11. They arrived at a figure of SO + 25 mrem
as a minimum estimate and a more probable estimate of
140-+- 100 mrem. With the same formula. Nonvood
et al. 21 calculated the annual genetically significant dose
caused by X-ray diagnosis for the inhabitants of a small
American town to be 45 mrem. Another United States
investigation 22 covers the employees of the Oak Ridge
National Laboratory who were regarded as patients. The
annual genetically significant dose from X-ray diagnosis
was found to be 50 mrem ( 13 mrem caused by e..xposureof male patients and 35 mrem by e..-..cposure of female
patients). The results of the two later investigations arewithin the range of the minimum estimate obtained by
Laughlin and Pullman.
30. USSR. In the USSR no calculations of the genetically significant dose arising from medical X-ray diagnosis have yet been published. However, Pobedinsky23 has
published data on the doses to the gonads during diagnostic X-ray examinations, e.g. chest, stomach (barium·meal), kidneys, gall bladder. pelvic region, lumbar spine
and lumbosacral region. The data, which are based

upon dose measurements in a body-shaped phantom, arewithin the ranges of the individual gonad doses presented in tables XVIII and XIX. Data have also been
published by Vikturina. ~~ Provided there are not significant differences in the age distribution of the patients and in the numbers of examinations of various
types, it is reasonable to believe that the annual genetically significant dose from X-ray diagnosis in the
USSR is of the same order of magnitude as the doses
presented in the summary table, XXIII.
( c) lvlass sitrvey examinations of the chest
31. Since mass survey examinations of the chest are
frequently performed in many countries, current interest
has been devoted to the doses associated with this typeof examination. In table XVI! data have been collectedfrom various countries and areas for gonad exposure inthis type of survey examination. In most countries these
examinations are performed as mass miniature radiography (photo-fluorography). The table shows that theseradiographic examinations, in spite of their high numbers, give a very low genetically significant dose. In somecountries, however, survey e..-..caminations are performedby means of fluoroscopy. These e..xaminations give individual gonad doses which are up to 100 times higher
than those given by mass miniature radiography. Even
if the doses to the gonads are much lower than in manyother types of examination, the high number of these
fluoroscopic examinations among individuals in the prefertile and fertile ages may cause a considerable contribution to the genetically significant dose. Therefore, inorder to reduce the dose, mass miniature radiography
should be used when practicable rather than mass survey
fluoroscopy.
( d) Comments
32. Certain types of examination, mainly those of thepelvic region, together contribute 85-95 per cent of thegenetically significant dose. This is shown in table XXII.
However, in terms of numbers of examinations, these
examinations represent only about 15 per cent of thetotal in those countries where the contributions fromchest and mass survey examinations are small.
33. The following points from the national tables require further explanation:(i) In table VI, relating to Hamburg, the colon examinations are responsible for a third of the total genetically significant dose. Holthus en et al. 6 have e.-..cplained
this as being the result of a special technique used in
Hamburg for colon examinations, involving extensive
fluoroscopy.
(ii) In Japan12 stomach and colon e..xaminations cause
50 per cent of the genetically significant dose. Table IX
shows high gonad doses for the fluoroscopy in these two
types of examination, which form 23 per cent of thetotal number of Japanese examinations.
(iii) In the Netherlands (Leiden) (table X),13 pelvimetric examinations are never performed and the number of obstetrical abdomen examinations is very low.
Although the investigation reflects only Leiden, thisstatement is valid for the whole of the Nether lands.
(iv) Table XII, relating to Sweden, 15 shows a highcontribution to the genetically significant dose caused by
foetal exposure during pelvimetry. Since the investigation was made, the examination technique for pelvimetry
has been changed in Sweden with the result that thedose to the foetal gonads has been decreased to a small
fraction of the previous dose. 25379

(v) Table XVI (United Kingdom) shows that obstetrical abdomen examinations form nearly 70 per centof the genetically significant dose caused by foetal
exposure. 19
34. In table XXIII, the annual genetically significant
doses arising from X-ray diagnostic procedures invarious countries and areas are brought together. The
contributions to the genetically significant dose causedby diagnostic exposures of males, females and foetuses
are given separately. For some countries and areas, estimates are also given of the uncertainty in the determination of the genetically significant dose.

35. Table XXIII gives information covering populations that together comprise over 200,000,000 individuals (6-7 per cent of the total population of theworld).
36. Some estimates of the genetically significant dose
arising from X-ray diagnosis do not include the contribution from dental radiography. However, available
data show that this contribution is very small with values
ranging from 0.01 to 0.15 mrem/y.
37. In the investigations from the Federal Republicof Germany (Hamburg) 6 and from the Netherlands(Leiden) 13 comparisons were made between the genetically significant dose computed according to formulas
8 and 11 in the appendix. The figures are set out in
table XXIII. There is good agreement between the figures derived by the use of fonnula 8, which accounts forthe relative child expectancy of the average individualfor each type of examination, and by the simplified formula 11, which considers only the examinations performed on patients below the mean age of childbearing(usually thirty years). The per capital dose was also computed for Leiden and Hamburg. In these two cities fae
per capita dose is much higher than the genetically significant dose, which means that the relative child expectancy factor ( w i/w) is considerably less than unity
for most of those types of examination that contributemost to the genetically significant dose. In other countries
the per capita gonad dose may be of the same magnitude
as the genetically significant dose as indicated in the lastreport. This depends upon the age distribution of thepatients within the various types of examination and thefuture number of children expected to be conceived after
the exposure.
( e) Consideration of the dose-rate effect
38. As was pointed out in paragraph 10, there is now
experimental evidence with mice and insects that thegenetic effect caused by irradiation is governed not onlyby the magnitude of the dose but also by the rate at
which the dose is delivered. Table XXIV presents probable dose-rates to the gonads during some types of examination and during fluoroscopy and radiography. Because of the difference in the sites of the testes and theovaries. the dose-rate to the ovaries is lower than to thetestes when the gonads are in the primary beam. Since
examinations usually consist of several radiographs ofvarious sites and in different projections, and sometimesof both radiography and fluoroscopy, the dose-rate mayvary considerably during an examination, by a factor of
1,000 and even more. Although table XXIV presents
only probable dose-rates, these range from 0.005 mrem/
sec to 2,000 mrem/sec, which is a difference of a factor
106 • The lowest dose-rate presented in the table is still
1,000 times higher than the dose-rate by which the natural radiation is delivered. The range of dose-rates used
380

by Russell in his experiments are quoted in table XXIV.
These dose-rates, which were used in obtaining experimental evidence for dose-rate dependence, are within
the range of dose-rates which occur in X-ray diagnosis.
39. Except for e..xaminations consisting of only one
radiograph, or continuous fluoroscopy, the dose to thepatient strictly must be regarded as fractionated, eventhough for most examinations the duration is short compared with the time cycle of cells. An exception is thegeneral film series taken over the alimentary tract. This
type of examination may be conducted over a period oftwenty-four hours, during which radiographs are taken
at intervals of minutes or hours. The rate of deliveryof the dose may either be represented by the actual doserate for each exposure, which usually does not last morethan ten seconds, or by the average dose-rate over the
total time for the examinations, e.g. twenty-four hours.
The computed rate will thus differ by a factor of 104,
depending upon the criterion used.
40. Since Russell's experiments were carried out on
mice with continuous irradiation, with a constant rateof dose delivery at doses of 100-1,000 rem, it is not possible to use his results for a quantitative determinationof weighting factors for the dose-rate dependence in thecalculation of the genetically significant dose arisingfrom X-ray diagnosis.Neither is there information sufficient to take into account the variation in the sensitivity
with the cell stage of the gamete.
(£) Reduction of the genetically significant dose
41. It is obvious that efforts to reduce the geneticallysignificant dose should be devoted to the types of examination which give the highest dose contribution.
Since the genetically significant dose (formula 8) caused
by a type j examination (Di) is the product of the frequency of conducting the examination (Ni/N), therelative child expectancy of the individuals e..xamined(wi/w) and the gonad dose (dJ), a decrease in thegenetically significant dose may be achieved by a reduction in NJ, WJ or di:-(i) Ni may be decreased by lowering the number oftype-j examinations, which means more rigorous indications for the examinations ;(ii) WJ may be lowered by a reduction of the numberof examinations of young patients;(iii) In general, however, the greatest effect in the
reduction of the genetically significant dose can be obtained by lowering the dose to the gonads, di.
42. The ways of reducing the gonad dose are wellknown and are recommended in most of the papers on
which the tables are based and they are summarized asfollows :26(i) To reduce the number of radiographs per patient;(ii) To reduce the length of time and the intensity of
exposure;(iii) To avoid, as much as possible, pre-set schemesof radiological e..xaminations;(iv) 'When fluoroscopr is not essential, to take radiographs only;(v) To use the appropriate physical parameters, withspecial emphasis to the use of the smallest field size ;(vi) To avoid the inclusion of gonads within the
primary beam ;(vii) To protect the testicles by adequate shieldingof scrotum during male pelvic radiologic examinations ;and(viii) To train properly the staff engaged in X-ray
diagnostic examinations.
43. The Adrian Committee19 states that the result ofbringing the techniques in the 10 per cent of hospitals

showing the highest doses up to the standard of theaverage technique of all the other hospitals would in
total reduce the genetically significant dose to 70 per
cent of the present one. If the techniques used by the 25
per cent of the hospitals in the survey showing the lowest
doses were used by all hospitals it would mean a reduction of the genetically significant dose to less than 20 per
cent of the present value. For Sweden, Larsson15 estimates that an increased use of already existing examination techniques, which give low gonad doses, would
mean a reduction of the genetically significant dose to
40 per cent of its existing value. Such reduction may
be achieved without detriment to the diagnostic information to be obtained from the e..""{aminations.
External radio-therapy by X-rays and sealed radio-active
sources
44. As compared to those for X-ray diagnosis, there
are few data for gonad doses and genetically significant
dose caused by exposure of patients undergoing external
radio-therapy. One of the reasons for this is that thefirst investigations showed that the contribution fromexternal radio-therapy to the genetically significant dose
was less than the contribution from X-ray diagnosis.
However, detailed data on gonad doses and geneticallysignificant dose arising from external radio-therapy haverecently been obtained from the Federal Republic of
Germany (Hamburg), France and the United Kingdom.
To make estimates of the average gonad dose received
during the treatment of any one disease is more difficult
than for one diagnostic examination since a disease suchas eczema may affect any area of the body and the detailsof the actual treatment are not always available. Therefore details of the treatment of a large number ofpatients are required to get a representative distributionof the sites affected by a particular disease.

45. Radio-therapy is used in the treatment of nonmalignant and malignant conditions. It is necessary toconsider in any calculation of genetically significant dosefrom radio-therapy the effect of the disease itself andthe irradiation on the relative child expectancy. It may
be assumed that neither the non-malignant conditions
nor the radiation doses, with the possible e..""<:ception of
those in the regions of the gonads, affect the fertility ofthe patients. However, for patients suffering frommalignant conditions the life expectancy is usuallyshorter than in the general population and in each age
group of such patients a lesser number of children will
be conceived as compared to the statistics for the whole
population. The irradiation itself may cause decreased
fertility, which would also reflect upon the number ofchildren to be e..""<pected.
(a) National SJ.trveys
46. Federal Republic of Germany (Hamburg): The
investigation performed by Holthusen, Leetz andLeppin6 also covers radio-therapy. The number of patients treated for various conditions, subdivided by sex
and age, and the individual gonad doses were arrived
at by the same methods as were used for X-ray examinations (para. 19). In their calculations Holthusen et al.
have taken the fertility factors to be zero for patients
who have been irradiated for malignant diseases, andpresume that the genetically significant dose caused by
381

external radio-therapy arises only from irradiation for
non-malignant conditions. The annual genetically significant dose is presented in tables XXV and XXIX in
which the genetically significant dose is subdivided byvarious locations of treatment. The individual gonad
doses and the numbers of patients treated are also set out.
The genetically significant dose was calculated fromformula 8. For comparative purposes, Holthusen et al.
also calculated the genetically significant dose, using
formula 11, and the per capita dose for the whole population (para. 19).
47. France. The figures for France in tables XXVI
and XXIX are based upon an investigation by Reboul
et al. 21 who determined the number of patients who undenvent external radio-therapy for various conditions ina large hospital. By means of information from the
Securite sociale, these numbers, subdivided by sex andage, were extrapolated to cover the whole of France. The
doses to the gonads in various types of treatment were
measured with ionization chambers in the same way as
has been described in paragraph 20. The genetically significant dose was calculated according to formula 11. In
the cases of non-malignant conditions, only around 7 percent of the dose, expressed by 1:.N i · dl> was estimated tohave been given to patients below the age of thirty. Whenthe contribution to the genetically significant dose fromthe treatment of malignant conditions was calculated,the cases with the most severe prognoses were disregarded. Also, the cases where the irradiation was expected to have caused sterility were disregarded. From
the remaining cases, the numbers of patients below thirty
years of age were estimated by means of their hospitalrecords. These patients together form around 6 per centof all those treated for malignant conditions.
48. Netherlands. The data presented in tables XXVII
and XXIX are from an investigation by Scholte et al. 28
for the period 1942-1951 based on radio-therapy treatments in three large hospitals in The Hague, Leiden andRotterdam. The survey does not include any contribution
from dermatology. The calculations were made according
to formula 8 and it was possible to use the actual numberof children born to the patients up to 1960. The numberof children conceived by the patients who received highgonad doses from pelvic region irradiation were only
53 per cent of those which would be expected from thenumber of legitimate live births in the period 1955-1959
in the Nether lands. Even though these statistics are notstrictly comparable they emphasize the effect of the diseases and the irradiation itself on the relative child
expectancy compared with that based on average valuesof the population.
49. United Kingdom. The data presented in tables
XXVIII and XXIX have been taken from the report of
the Adrian Committee19 which covers the United Kingdom except Northern Ireland. The numbers of patientstreated for various conditions, subdivided by sex andage, were calculated from a sample study during threemonths in 1957 of all treatments carried out in United
Kingdom hospitals and comprising around 30,000 patients. The doses to the gonads were calculated from information on the dose parameters used in various
hospitals and private clinics and the results of dose
measurements in a phantom under various conditions.
The genetically significant dose was calculated according
to the principles set out in formula 8. In the calculationsof the contribution from radio-therapy of non-malignant
conditions, it was assumed that the child e.,"{pectancy was
zero for all patients in whom an artificial menopause wasOark's figures for the United States of America, 2 P 12
mrem, should be compared with the figures in the lastcolumn of table XXX, which are 6.5, 21 and 9 mrem in
the Federal Republic of Germany (Hamburg), France
and the United Kingdom respectively. The explanation
for the difference between the figures for per capita doseand genetically significant dose is the same as was given
in paragraph 37.

induced. For all other non-malignant conditions the fertility factors obtained from population statistics wereused. In the calculation of the genetically significant dose
caused by external radio-therapy of malignant conditions,due attention was paid to the changes in the fertility factors, as determined from official statistics, that are causedby the shortening of the patients' life expectancy and by
the reduction in fertility, due to the radiation received
by the gonads.

57. Both in the FederalRepublic of Germany (Hamburg) (table XXV) and the United Kingdom (table
XXVIII) the major part of the genetically significant
dose caused by ~ternal radio-therapy for non-malignant
conditions originates from treatments of the skin(around 55 and 75 per cent respectively). In France(table XXVI) the bulk of the corresponding geneticallysignificant dose arises from treatment to the lumbar
spine and the hips.

(b) 0 ther investigations
50. In the United States, Oarki 9 estimated the annual
per capita dose of the total population due to external
radio-therapy to be 12 mrem. He assumed that the gonad
doses arising from irradiation for malignant conditions
were of no genetic significance. A survey of the individual gonad doses received has also been carried out
by Bailey.30( d) Consideratioii of the dose-rate effect
58. For the reasons indicated in paragraphs 10 and
38 the probable dose~rates to the gonads during external
radio-therapy of certain treatment areas, are given intable XXXI. The dose-rates have been calculated assuming a maximum dose-rate at the treatment site of 50
rem per minute. Since high doses to the gonads may
cause sterility or reduced fertility, treatment sites havenot been included in this table when the dose to the
gonads during a complete treatment is estimated to exceed 200 rem. The dose-rates range between 0.002 mrem/
sec and 50 mrem/sec, which means that the highest doserate is around 10' times greater than the lowest one. This
range of dose-rates covers the lower portion of the range
used by Russell in his e.xperiments.

51. A survey by Purser and Qvist31 yields an estimateof the annual genetically significant dose in Denmark(Copenhagen) of 1 mrem. In the Danish estimate, reduced fertility as a consequence of the severity of the
prognosis of the disease and of the actual irradiation
was allowed for by subdividing the patients into threegroups, with the fertility factor being zero, one-fifth ofnormal, and normal, respectively. Twenty-two per centof the genetically significant dose was assumed to arise
from treatments of malignant disease.
52. For Australia, Martin82 • 33 estimated the annual
genetically significant dose from external radio-therapy
to be 28 mrem. The estimate was made using the appropriate survival rates from the Central Cancer Registry.
It \vas assumed that the prospects of parenthood were
not impaired by the treatment, except for those patients
receiving doses which would cause sterilization.

59. In most instances external radio-therapy is administered in fractionated doses. In external therapy fornon-malignant conditions a total dose seldom exceeds
3,000 rem given over a period of two to three weeks,
while for malignant conditions doses to the treated volume of up to 7,000 rem may be given. The period oftreatment is varied, dependent on the total dose, up to
about seven weeks. If the gonad dose-rates are calculated as mean dose-rates over these periods, the figuresin table XXXI should be divided by a factor of around103 • The lowest dose-rates would then be of the same
magnitude as the delivery rate of natural radiation(3.1()-6 rem/sec).

53. In the United Arab Republic (Cairo) a survey
has been carried out in 1959-1960 of the frequency oftreatments by X-rays. 3 '· 3~(c) Comments
54. Compared to the genetically significant dose.originating from X-ray diagnosis (table XXIII) the genetically significant dose from external radio-therapy (tableXXIX) is small. However, the individual gonad doses
received from external radio-therapy are larger thanfrom an X-ray diagnosis examination.

60. In radio-therapy, as in X-ray diagnosis (para. 40),it does not seem possible to use Russell's results for aquantitative determination of weighting factors for thedose-rate dependence in the calculation of the geneticallysignificant dose. Neither is there information sufficient
to take into account the variation in the sensitivity withthe cell-stage of the gamete.

55. It is the practice in some countries to use radiation
for so termed ovarian stimulation in cases of subfertility. Little data are available regarding the numbersof such treatments but a report36 shows that, in 33 institutions surveyed in Buenos Aires, 222 cases were treatedin 1960 representing some 2 per cent of the total numberof patients treated by radio-therapy for non-malignant
and malignant conditions. The radiation used was generated at 200-250 kV and the average dose to the ovary
was 60 rem with a range of doses from 35-110 rem.

( e) Reduction of the genetically significant dose
61. In contra-distinction to X-ray diagnosis, where
the radiation is a means for producing an image on ascreen or a film, the dose in radio-therapy to be delivered
to an actual part of the body is determined with regard
to the effect that is sought by the treatment. With reference to paragraph 41, Ni, Wi and di govern the genetically significant dose. Regarding malignant conditions,where there are strong indications for treatment, NJ andwi cannot be expected to undergo changes in favour of
reduced genetically significant dose. For non-malignant
conditions, it might be possible to reduce Ns and WJ byusing stricter criteria for the treatment of non-malignant

56. In the German investigation6 the annual genetically significant dose was calculated according to bothformula 8 and formula 11. The per capita dose for thewhole population was also calculated. On the basis of
the data from investigations in France27 and the United
Kingdom111 the per capita dose to the population arisingfrom the treatment of non-malignant conditions in eachof the two countries has been estimated. The figures
are set out in table XXX. As expected, the per capita
doses are higher than the genetically significant doses.
382

conditions, especially among young patients. Reductionsin the individual gonad doses, di, when the gonads are
not the sites of the irradiation, may be obtained asfollows:(i) By the use of strictly appropriate physical conditions of exposure, placing emphasis on the smallest possible radiation field and, for instance, the use of low
energy radiation and beta-emitting sources in skintherapy;(ii) By satisfactory shielding against leakage radiation;(iii) By the use of scrotum protection;(iv) By adequate positioning of the patients during
treatment so that the gonads are.as far away as possible
from the primary beam.

are presented in table XXXII. The dose was calculated
according to the principles of formula 11 and the genetical significance of treatment for conditions with severe
prognoses was considered. It >vas estimated that only
the use of P 31 gave a dose of genetical significance.
69. In the national surveys presented above (paras.
65-68), calculation of the gonad doses was basedon existing information regarding deposition in variousorgans and tissues and the effective half-lives of theradio-isotopes in question. In table XXXIV, some results
are presented for gonad doses arising from the administration of 1 me P 31 or paz. 31 • 3 - 1 Weijer et al. 39 obtained their results from measurements on patients withdifferent diseases, thus allowing for disturbances in thenormal distribution of P 31 in the body. Regarding I1 3 1,
Johns and Taylor37 found that the beta and gamma components formed 50 per cent each of the gonad dose. The
figures in table XXXIV, or results from other investigations, can be used for estimating the genetically significant dose arising from the medical use of unsealed
radio-isotopes in various countries.

Administration of radio-isotopes
62. Only a few national surveys exist on the contribution from the medical use of unsealed radio-isotopes to
the genetically significant dose. It is assumed that thiscontribution is even less than the contribution from external radio-therapy. The number of cases to whom theisotopes were administered and the total quantities ofisotopes are given in table III.

(b) Comments
70. The contribution from the administration ofradio-isotopes to the genetically significant dose is small(table XXXII) as compared to X-ray diagnosis (table
XXIII) and .external radio-therapy (table XXIX).
Between S and 15 per cent of the genetically significant
dose caused by the administration of radio-isotopes
originates from their use for diagnostic purposes. The
individual gonad doses are estimated to range between
25 mrem and 200 rem.

63. Since unsealed radio-isotopes are used for bothmalignant and ·non-malignant conditions, the same
allowance described in paragraph 45 has to be made forpossible changes in the fertility factors among patients.
This means, for instance, that Aum, although used inconsiderable quantities for treatment {table III) has
been considered to be of no genetical significance. ·(a) National surveys'
64. In the present anne..x, national surveys and estimates of genetically significant dose are presented from
Canada, the Federal Republic of Germany (Hamburg),
the United Kingdom and the United States of America(table XXXII).
.

· 65. Canada.. The figures in table XXXII are takenfrom an investigation published by Johns and Taylor. 37
They considered patients below thirty years of age(formula 11) but did not make any correction with' regard to severe prognoses for malignant· conditions.
P 31 formed 75 per cent and P 32 25 per cent of the genetically significant dose from the administration of radioi active isotopes.

( c) Consideration of the dose-rate effect
71. The dose to the gonads from a deposited radioisotope is received through continuous irradiation, witha decreasing rate of delivery as a consequence of theexcretion and the decay of the radio-isotope. The initial
dose-rate to the gonads per millicurie administered P 31
or P 32 is of the order of 1()-3 mrem/sec. This estimate
does not allow for differences in dose-rates as a consequence of .various distances from the gonads to thedeposits of activity in the body. Since the administered. amounts of radio-isotopes usually range between around
5 µc in diagnosis and 200 me in therapy, dose-rates may
range between s.10-s mrem/sec to 0.2 mrem/sec.

66. Federal Republic of Germany (Hambiwg). Holthusen et al. 6 have studied t.he genetically significant dosefrom P 31 (table XXXII). The dose was ·calculated: according to fohriula 8 but the malignant conditions weredisregarded ( cf. para. 46).

72. Although these dose-rates should be regarded as
rough estimates, they are lower than the ones used byRussell in his e.xperiments. It is not possible at thepresent time to take into account variations of dose-rateor of the cell-stage of the gamete.
( d) Reduction of the genetically significant dose
73. Since the administration of radio-isotopes contributes only 1 or 2 per cent to the genetically significant
dose caused by medical exposure, there is no urgent needfor improvements aimed at lowering this contribution.
The amounts of radio-isotopes used can be decreased indiagnostic investigation by further improvement of thesensitivity of the measuring instruments and by the useof in vitro rather than in vivo tests. Particular care isnecessary when labelled substances are used \vhich areincorporated into the chromosomes, such as thymidine,
for these may result in high radiation doses to the genetic
material. In therapy, deposits of radio-isotopes in organs
and tissues which are not objects of treatment, can sometimes be reduced by special measures. For instance, highfluid intake following P 31 administration induces fre-

67. United Kingdom. The Adrian Committee's results 10 are presented in .table X.XXIII. The geneticallysignificant dose was calculated from formula 8 and thenormal fertility factors were modified for some of themalignant conditions. In table XXXIII the annual genetically .significant. dose is. subdivided into the diagnostic
use of radio~isotopes and their use for the treatment ofmalignant and non-malignant conditions. P 31 delivers
60 per cent and P 32 40 per cent of the genetically significant dose from the administration of radio-active
isotopes.
68. United States of America. Chamberlain 38 has
estimated the annual genetically significant dose fromthe medical use of unsealed radio-isotopes. His results383

quent micturition, thus reducing the residual time in the
bladder of the excreted radio-isotope. 89 This causes a
decrease in the dose to the gonads.

photon energy 50 keV, there is a 13 per cent increase in
the dose received by soft tissue remote from bone.
Distribution of active bone-marrow
78. The calculation of the mean marrow dose presupposes knowledge of the distribution in the body of
the active bone-marrow. A comprehensive study was
carried out by Mechanik 43 of the quantitative distribution of the total bone-marrow in adults. A summary of
his data has been published by Woodard and Holodny."
These studies do not, however, give any information on
the distribution of the active marrow. Studies on the
distribution of the active marrow have shown that before
birth the liver and spleen are the major erythropoietic
organs, the activity of the liver being equal to that of thebone-marrow at 7~ months. At birth all bones whichcontain marrow have active red marrow: however withincreasing age this is gradually replaced in some bones
by inactive yellow marrow. By the age of eighteen to
twenty years little red bone-marrow exists in the limb
bones, except for the proximal epiphysis of femur andhumerus.' 5 A gradual replacement also takes place in all
adult bones with increasing age and measurements ofthis effect have been given by Custer" 6 for the ribs,
sternum and vertebrae. Ellis 47 has calculated from thedata of Mechanik and Custer the distribution of total
and active marrow in the adult (table XXXV). This
table also gives the set of distribution figures that waspresented in the Committee's 1958 report.
79. Further research on the distribution of the bonemarrow is needed, for it is well known that the distribution of active marrow varies very much between adultindividuals. Also diseases or other conditions which impose a stress on the haematopoietic system cause the redmarrow to reappear in the limb bones. Large radiation
doses to local volumes of active marrow may also cause
variations in the active bone-marrow distribution. 0

Summary
74. The annual genetically significant dose frommedical exposure has been shown to be in the range 6-.58
mrem from diagnostic radiology .for. those countr~es
given in table XXIII. The contnbutton from radiotherapy and the use of radio-active isotopes has beenshown in tables XXIX and XXXII to be in the ranges
2-13 mrem and 0.18-0.42 mrem respectively. Due to themany national and international reports on the sub~ect
which have been issued in the last seven years there 1s agreater awareness of the desirability of reducing thegenetically significant dose. This has resulted i~ many
countries in a downward trend in the levels estimated.
For the purposes of making comparisons of risk inanne......: H it has been accepted according to table XXIII
that a representative value of the genetically significant
dose would be 30 mrem/y from diagnostic exposure and5 mrem/y from radio-therapy.
EXPOSURE OF THE BONE-YARROW

75. This section of the annex summarizes the data
regarding the doses received by the active bone-marrowof patients undergoing radiological examinations ortreatments. This tissue is regarded as the significant one
in respect to the induction of leukaemia by radiation(D, 254-271, 485-489). It has been suggested (H. 8) thatthe mean dose to a tissue should be used, in the light ofpresent kno\\•ledge, for the assessment of the effects ofradiation at these dose levels. The term "mean marrowdose" is defined as the dose received by any portion of theactive marrow averaged over the whole mass of active
marrow. The mean marrow dose can either be given for
an irradiated individual or as a per capita dose for a
population. ·Dose data
80. There are few available data on mean marrowdoses from medical exposure.

Determination of the mean marrcr& dose

X-ray diagnosis
81. In its 1958 report the Committee presented mean
marrow doses calculated on the basis of assumed averagepractice and available information for various types of
examination-number of radiographs, skin doses anddepth dose data. Several of these dose figures are set
out in table xxxvr, together with the results from a
Danish investigation performed by Buhl," 9 and frommeasurements by Epp et al. 50• 51 A national survey has
been conducted in the United Kingdom {para. 28) andextensive phantom measurements at eleven marrow sites
are being used to derive a per capita mean marrow dose.
82. Even though the investigations presented in table
xxxvr show differences between the dose figures ineach of several types of examination, the order of thetypes of e......:amination with regard to the size of the doseis nearly the same in the investigations. These types are
examinations of the upper and lower gastro-intestinal
tract (barium meal and barium enema), the gall bladder,dorsal and lumbar spine, and the lumbosacral region.
Pelvimetry also belongs to those types of examination
giving among the highest mean marrow doses. The differences in the dose figures reported for any one examination are due to the variations in the assumed e.xtent andtechniques of the particular examination and the valuesof percentage depth doses used.

76. The marrow doses presented below are given as
individual mean marrow doses for various types ofradiological procedure. Mean marrow doses are usuallyobtained from dose measurements with small ionizationchambers placed either on the skin in the radiation field
or at the actual site of the primary irradiated bonemarrow. In the latter case, the measurements are madein phantoms which undergo the irradiation procedures.
The phantoms should represent as closely as possible,
in size, shape and material, the radiation conditions
in viva. Since measurements with ionization chambers
express exposure doses in roentgens under given conditions, the absorbed doses have to be calculated with theapplication of appropriate conversion factors. Whencalculations are based on exposure doses to the skin, thedose figures have to be multiplied by the percentage depth
dose at the location of the bone-marrow in question,corrected for the shielding effect of the bone surrounding
the bone-marrow.
77. In soft tissues adjacent to bone, the absorbed doseis increased by secondary electrons, which are generated
in the bone. This should be allowed for in the calculationof the absorbed dose to the bone-marrow. A discussionof this effect is included in the report of the ICRU. 42 A
typical example from this report shows that within amarrow cavity of size 400 µ., irradiated by radiation of384

83. It is obvious that the mean marrow dose will depend upon the field size and the incident skin dose.
Another parameter that influences the magnitude of themean marrow dose is the quality of the radiation used.
For radiography of the chest, Epp, Weiss and Laughlin50
showed that a low kilovoltage technique ( 60 keV, 1-2 mm
Al filter) gives 50 per cent greater mean marrow dosethan kilovoltages between 80 and 120 (2-3 mm Al filter),for which the mean marrow dose is nearly constant.
Weber 52 has reported similar results for radiography ofthe stomach (barium meal) and abdomen. He found
50 per cent higher mean marrow doses at 70 ke V ( 2 mm
Al filter) than at 90 ke V ( 3 mm Al filter).

of the bone-marrow. They calculated the mean marrowdoses by means of Ellis's distribution figures for active
marrow.
88. Mean marrow doses to children below two yearsof age who were treated with radium skin applicators forhaemangioma have been reported by Nordberg. 57 Dosemeas~rements were made in a phantom which, in shapeand size, corresponded to a child below the age of two.
It was assumed that the active bone-marrow is distributed throughout the skeleton. The mean marrowdoses were calculated by means of the data on the distribution of marrow space given by 'Woodard andHolodny« assuming that the distribution of marrow
space in children is the same as in adults. The results
are given in table XXXVIII and the distribution figures
used are presented in a footnote to the table.

84. In paragraph 31 it was pointed out that in somecountries mass survey examinations of the chest are
performed by means of either fluoroscopy or radiography (table XVII). Skin doses to patients from f!uoroscopy may amount to more than 100 times the skin dosewhen radiography is used. 53 While reported mean marrow doses for mass survey examinations of the chest
using radiography range between 50 and 100 mrem,
it has been calculated that mass survey f!uoroscopy inAustria, France and Spain gives mean marrow doses
averaging 1,900, 1,200 and 1,300 mrem respectively. 53
For Belgium and Switzerland, the corresponding doses
were reported to be 380 and 230 mrem respectively. The
doses are set out in table XXX:VII. Owing to differences
between apparatuses and the duration of the fluoroscopy,
the individual mean marrow doses range from around
200 mrem up to around 4,000 mrem. Since many of theexaminations in France10 are made on young people( 40 per cent on individuals below the age of twenty)
the figures for the mean marrow doses, calculated bymeans of distribution figures for the active marrow in
adults, may be rather uncertain (para. 78). It is obvious
from this table that in order to reduce the dose, massminiature radiography should be used rather than mass
survey fluoroscopy (d. para. 31).
85. In the 1958 report of the Committee (annex C,
para. 50) an estimate of the population per capita bonemarrow dose was made and it was suggested that it
might be of the order of 50-100 mrem/y. The Committee
has no reason to alter this estimate, as little information
has been obtained since the last report.

Administration of radio-isotopes
89. The data at present available to the Committee on
relevant parameters for !131 , P 3 ~ and Au198 do not sufficefor estimating the individual mean marrow doses withany certainty. The estimates of the total dose to theblood following administration of these isotopes give afirst approximation of the mean marrow dose. 37• 39
Comments
90. The mean marrow doses caused by external radiotherapy are, of course, much higher than the ones caused
through X-ray diagnosis. A diagnostic examination of
the lumbar spine results in a mean marrow dose of 100400 mrem . but the treatment of this site for non-malignant conditions may give a mean marrow dose that is
100 times greater. In certain types of radio-therapy formalignant conditions, the mean marrow doses may beeven higher.
DOSE TO OTHER ORGANS AND TISSUES OF
SPECIAL INTEREST

General rem.arks
91. The organs and tissues which, in addition to the
gonads and the bone-marrow, are usually considered of
special interest with regard to radiation doses are thefoetal tissue, the lenses of the eyes, the thyroid, skin,and the liver. Information regarding the effects causedby the irradiation of these organs are given in anne..x D
together with analyses of the radiation doses which havecaused them. Other information is given in the reportof the meeting, held at the Committee's invitation, of the
ICRPJICRU Study Group in 1960.58

External radio-therapy by X-rays and sealed radioactive sources
86. Few data on bone-marrow doses are available atpresent for patients who have undergone radio-therapy.
Comprehensive measurements of the radiation doses tothe spinal marrow in a phantom were carried out by
Jones and Ellis 5' as part of the survey by Court Brown
and Doll54 on patients irradiated for ankylosing spondylitis. Maudal 55 has also made measurements of doses toorgans and tissues for several sites of treatment. The
latter investigation also gives data regarding the dose
received by sites outside the primary beam. Further
measurements have also been conducted in the United
Kingdom as part of the national survey. All these measurements give the dose at the particular site in terms of
100 rem incident at the skin. Table XXXVIII gives representative values of the mean marrow dose received
during such treatment.
87. Holodny, Lechtman and Laughlin56 have reported
mean marrow doses arising from the treatment of cervix
carcinoma ·with radium applicators. Their results, presented in table X..XXVIIL are based on measurementsof the doses in a body-shaped phantom at different sites

Data
92. Table XXXIX gives a few e..xamples of the radiation doses which may be received by these selected tissues
as a consequence of various radiological procedures. The
doses must not be considered as being the results ofextreme circumstances but as figures obtained fromradiological procedures at present or recently used invarious countries. Particular points regarding each tissue
are given in the following paragraphs.
Foetal tissue
93. During the first two months after conception, it
may happen. because of unawareness of pregnancy, thatwomen undergo various kinds of radiological procedures
which would not have been performed if the pregnancy
had been known. Because of the small dimensions of the385foetus at this stage, the foetal dose can be regarded as
the same as the dose to the maternal gonads. Data regarding the incidence of malignancies following irradiationin utero are given in annex D, paragraphs 277-285, andtable VII.

Lens of the eye
94. Full mouth examination and encephalography are
two X-ray diagnostic procedures which may give substantial doses to the lens of the eye. Similarly, treatmentof lesions of the eye, or in the region of the eye, mayalso contribute high doses. Data regarding the formationof cataract or lens opacity is given in annex D, paragraphs 91-93, 289-307 and 443-445.
Thyroid
95. Tests of thyroid functions are frequently performed in most countries. The dose to the normal adultthyroid is about 1.5 rem per µ.c administered !1 31 • Barium
swallow and examination of the cervical spine are assumed to be the two types of commonly performed
X-ray diagnostic procedure which give the highest doseto the thyroid. The treatment of hyperthyroid conditions
and heart conditions with !1 31 gives doses of the orderof 10,000 rem to the thyroid (see para. 96 below)(D, 286, 402-404).
Thymi's%. In some countries enlarged thymus glands havebeen treated by radiation with doses of the order of 200
rem. In annex D, paragraphs 263-272, 485 and table VI,
data are given regarding surveys carried out on theincidence of leukaemia and thyroid cancer in thesepatients.
Liver
97. The use of thorotrast as a contrast medium indiagnostic radiology has been curtailed since its possible
deleterious effects have been recognized. The effects
observed are sequelae at the site of injection and theinduction of liver malignancies. Reports of surveys ofpatients injected with thorotrast have been given by
Hursh et al., 59 Baserga,60 Looney 61 and Blomberg et aZ. 62
Studies of the radiation doses received have been carriedout by Rotblat and 'lv ard63 and Rundo. 64 • 85 A comparisonof the doses to various body tissues over twenty years
from an injection of 20 ml thorotrast is given in table XLfrom Marine!li. 66
Reduction of doses to various organs and tissites
including the bone-marrow
98. Earlier in this annex (paragraphs 41, 42, 61) the
Committee has considered ways of reducing the doses to
the gonads. Most of these measures are also applicablefor the reduction of doses to other organs and tissues
and can be summarized as follows :(a) Improved methods of radiological procedure ;( b) The use of strictly appropriate physical conditions of exposure, including the smallest possible radiation field and good collimation of the beam ;( c) The reduction of the incident skin dose, e.g. by
reducing fiuoroscopy time ;( d) Satisfactory shielding against leakage radiation;( e) The use of radio-active isotopes in diagnostic investigations utilizing in vitro rather than in viva tests andthe use of the nuclide with the shortest half life consistent with the requirements of the investigation; forexample, 1132 may be used rather than !1 31 for some thyroid investigations.
(f) Well-trained staff of all categories for the performance of the procedures.
FIELDS OF RESEARCH

99. The present state of knowledge requires that consideration should be given to the following items andthat research in these fields should be encouraged:(a) The promotion of statistical studies concerning
the number of people medically exposed;( b) Follow-up studies on the offspring of pregnant
patients having radiological examinations or treatmentsof the pelvic region;( c) Follow-up studies of patients having had ( i)radio-therapy for non-malignant conditions such asankylosing spondylitis and enlarged thymus ; (ii) pu
treatment, or (iii) diagnostic e..xaminations using thorotrast as a contrast medium ;( d) Investigations aimed at defining good practices
in diagnostic radiology so that minimum gonad doses arereceived;( e) Investigations of the effect of dose-rate on the
production of mutation;(f) More quantitative information on the distribution of active marrow and how it varies with age;(g) Investigations of the dose received by the bonemarrow during radiological procedures.

ID. Occupational exposure100. In the introduction to the present annex (para.
3) the Committee considered the term "occupational exposure" as being applicable to all activities involving
exposure of individuals to ionizing radiation in thecourse of their work, regardless of whether they are
directly engaged in radiation work or not.
NUMBER OF INSTALLATIONS AND RADIATION WORKERS

101. Work with ionizing radiation is usually subdivided with regard to the purpose of the work as follows :!Dedi~ (diagnosis and therapy), dental, veterinary,industnal, research and educational, and atomic energy.
!able ~LI gives the range of the number of X-ray
installat10ns* per thousand of total population for these
purposes in th~ Netherlands, 67 New Zealand, 68 Norway, 6 P
Sweden, 70 Sw1tzerland,16 and two areas of the UnitedStates of America, New York City71 and Califomia. 72
Most of the installations for medical and dental purposes
have ~-ray apparatus o~ly. Th~ number of X-ray installat10ns used for veterinary, mdustrial, and researchand educational purposes, is at present very small compared \vith those used for medical purposes.
102. Only a few data exist on the number of installations where radio-isotopes are used. In Californi;hwith radio-isotopes is performed in, 6. :Per,';~ent ·of ·tjle
total number of installations and most of this .work.is
done w?ere X-ray work al~o.i~ p~~for,in~d~72 :~ven~1f
work w!th radio-iso_topes i~ ·cafrie:~ PBt.fn ·}h~jfuijorityof hospitals and of md~stnal and research installations
the large number of' pri~ate m~qical ~4 ·derib! practi~

work* "~nstallation''. cove·r~ ~ny d~pi;~eni:~~ ~rl~~~·e p~ctid~,If ·~~os~1tal h~~ ..a. cent~al .x-.r:ai. depanr.iert:.as \a,·e!La~ X~!;ay fadli-

t1es m vanous ·other sections of the hospital each· one· is counted
as an installation: :; . .'.· ·:·r! i >. :;c:• · , , ~:· ", '., . , _tioners using X-ray apparatuses: e.."<clusively, keeps thefigure low as :compared to X-ray installations. It does.
not· seein likely that in any c9untiy the number! of in-_stallations where radio•isotopes are used . would , sur-·mount 10-20 per cent of-the total number ofinstall~ticins.103. Table XLI also·giv'es the r~nges cif the numbersof individuals per 1,0QO of the p9pulation directly occupied in radiation work· in the· countries listed in paragraph lOl. . - ' '.
.
··: · ; 1 ntenu1l.c011tcimination:

RECOMMENDATIONS.ON
THE CONDITIONS
OF ·woRK.
'.

104. '~ecom~endations regar.ding .the ~~p~sure . ofworkers. to iqnizing ra\iiation have been 01ac).e by the,
ICRP. 1 The doses to whi.ch th~i~.siiggesfed.ligi'its apply
do not include the contributions from natural sources ofradiation, or. f1:qm th,e exposure, of, tl-w. workers for medical reasons. The' ma."<imum permissibfe.levefa of exposure
are . ~ept under .constant ·~urveillance and. the· present
recommendations state that for the dose "accumulated:
in· the gonads; the bl09di forming organs and· the lenses·of the, eyes;· at: any age over 18; shall be g6verned· by the:relatiomn;:::: 5 .(NL..,...18) 'rem;,vhere'D:is1ti~sue dose in·rem.'and N: is age in years'~. TheICRPgoes on::'.'.To_ thee."ttent·the forroUla.1peimits, an ·occupationally e."<posed:
person :mai accumulate, the mafilmum. permissible dose•
a:t.a:rate nbt in· excess :of:3 rem,during~any per~odc:of·
13 consecutive weeks"·~ Exposure·Iimited to• certain parts,of therbody,: stich as. the •extreniities,r orto single·.di-gans;:
as<in:the cas!! 6f internal e.."<posure, .is· subject.to· speciali
recommend~tions '.allowing:,' ~somewhat ·higher' 'doses.:B.ased on these·recommeridations, many national ,arid fo";ternational organizations have produced thei.r own: rules:
and recommendations.

. P9?P i,l:t'.FOR,MA;TIQNFl}IJ¥ J;!-<:D~V!DUAL¥<?1:1'.l'.f,ORJ;N.q'• •• ,' ' . ' , '
I

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107. For: atomic energy work; detailed _results hav~
been ,published:·on the .extensive,.mo11itqririg- of i11;d_i"';vic;luals for· occupational ·exposure. Table -xin_r gives;
data on occupational. exposure from penetr~ting radia-:tion at Oak Ridge National Labotatory:,,l]nited Stat~s, 78
the establishments of ,the iUnited Kingdom Atomic:
Energy Authority/ 5 I Argentinaj 36 . Canad~ 79 a,nd , the;United Arab Republic. 80·• ~'' 10s: Table XLII·seis out averagediguresAor the arr•(
nuaVoccupationaf..exposure to' individuals from. external:?<"'and- y-~~,Y sources ;in: various :~inds" of radiation 1w~rk:
in Argentmar Canada/·~ the Netherlands;~ 1 1 Norway/:':and the United:Kingdom. 1S:In Norway:and the=United;
Kingdom; for.which doses'a:re given 'separately for diag-:
riosis ·and .therapy; 'the; anriual dbs'es-in •therapeutic work:
are :higher: than,· in diagnosis~·This •may be •ex:plained"by'
the fact that therapeutic work involves the handling:Of ~radium applicators . .It.~.~ nc:!.Cc:!Ssary that there be a continuous improvement ofpfot~ctlciri devices, especially forworkwithradiumapplicators ... ,, •:·; .. :-T;I :·i·1· \':ia

; J 06: .::Even' :=tho'tigh! •tb'e' . verake" va'.Iti~s' ( received. 'by:.i-f

. 1os: As. fat a'.s .occupatiqna! .e.,.;{posur:e, ca~s·e~ )y in- I
teriial 'cpritarhihation qf. lhe body .by radio-isotopes· is'C<?~C~t;ri~d, ,.s~fX'~Y.S are :fr~q~etjtly fl?-lade. On. t,he .'ni~io:_:activity m the .an~ ~d.\vat~ :;nq by',yhole body C()untmg\
arid unn.e survey~ thb' inhal~~ or~ '.ot.her:-vi~e' ab~orbed I
radjo;-isot6p ~s"t,nay b~ dfilliatec;t P,uring usualW6rkirlg 1
conqitiorts. tl+{ s'urV;eys' 'J:iav~ ;gjven:'. co~~en't_ra.ti?ns far'.
beIO\v the .highest pei:missible' concenfrations,"·cortected'
1

to allo\v Joi-'o.c~hP.at!oriaI, ~#b~ui:f .6§ e.xt'e~ri;i.Iiradfatloll'..}At".'Oak'.· 1s; the letel -'of''afr'·. • .Rid··. 'g·e',National''Laborafo. " ., I '.,.' ' ' ·· .... ry
I · - · ,.. f" .. ' "c6ntaminatiori. itj the Iao1:>~iitories :d·ur~ng~ 1959. 1\'>'.!l~ only{
0.4 per' cent o'f the:a.§sVmed 'ma:X:ihiuiri pbmissible cbii'centration (10-~: JkC)cm 8 .i of, air): ,Regarding. suzyeys: ofbody.burdens of radio~isotopes,,practicallyncu:,ontentra-1
tions ,beyond the maxi~um 'perrr,i~ssible: qnes ha:v;e ...been r
detected for radio-'isotcipes·bther than uranitun-15!: 8~: ,~<;

Mitling: i1i,d~~t'rwl1.p~bcissi~g oj 1!truiiiun '.dnd'tlioriilJi .
' " ' ~ -, •' \. :; ; : '/ \. . ~ .. / ~ ..,.. ' { ' ! , , 1 <I: i : i.
~ ~ J; \1: • ; • ),J.Q9,:, High .~i:incentr;,i.~jon.s, qf1 ~aqo.~ ,~nd:if~qr;on ;~c;l:daughters e."<ist in mines. In areas_. 9f. !P<?OI ~ei;i.ti~t!8~ !
J-

I • :

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; . •

: ,

i

i I

where high-grade uranium ores or radium ennchecf residues are stor~q,.ll)e. radoµ c9~centrates 1 m~y! be as highas 1()-i to Hr5 /tc/cm 3"of air.sz':Experieiice has shown,however, tna.t the concentrations of radonrdatigh.ter products", can ;·b'e, ·great}y .-•reduc~d:• by.. Jcircea;, ventilatiOn:s,~ i
DuFing'' thel industrial iprocessing· p£; uranium: and thcH
riumrfine :dusts are often.produced and precautions;must tl:ietaken to prevent inHalatiori-of.them.~h 8 ~,Consideratiop.;o'fi these· hazards is .giveri .in the, reporl i ofth~ rUnited~
States National .Academy::ofa, Science: qµ (the,1eff.ests, of)inhaled,,radio,acti:ve. particles, 83 which also gives data
regarding: the radon": concentration. in_ se:v.et;J.trfiv;e; uranium mines surveyed.ih .Utah. Information• is' als'o ·available for''the Argentillian,~ 6•• Canadian;sa Frerichj8 TJiaiid
S_o11th Af~ic<J,n 88 urapiµi;n_µiin~.~, and!tl~e p~qspl).at~ m~i;ie~ .
in: ilie Un'ited'Ai-!ab' Rg ublic 59· Since' uffi.niuiTi i~-'excf~teHlv~·· ''ia' '1dl":"£~dm:.t11~ 6od? :coti2Jntrlitiat!s."M'
tiled tsb:.
t/~=c:a~"e!sn· . I>h'~det'e'cte<f'!t1i'1ni~ti:· :tn· 1the '\voikeH fo'.(A~ en'tiniaiia<i:~ries·
ffi'e'~!tie~eis' of 'urli.Hh1ni fl1 tlie ufihe::1Il·a.·g:;·frohl
2~29
ritlcrc/r ' 's id:d~te<l. 'e}'24hbtirs'. '. 1 ' " try.Ji•:«:; <c';~:~;;r,·;1( '.'I» ,P n:'·1 ·.y1·;1··l•i': •:•>

wbrkers'at~ oflntei~t, 'the' distiib'utfon 'of dbs'es; and.the~1riiliiiber; M .persolln'etexC:ee'ding i:he r~b:>mmended liiiiioaI 1

Vof· the 1doses reteived··by -the· lZ,QOO workers ·m the'Fed'etaJ '.Republic'df Gerfnatiyha's 1 b~i!ngi~en·W Wkchs:.;
mru;lli16 'ana sho\Vs £6'r the Jears:1952'to, 1959'the·gtadu~lr'~dhctibtl: iri' 'the' riumbet of ;plfr~6ns exceeding the 1 rec~f
drhinended' 'level.' Ji:i 1952;.23 per. ceiit ·e'..xceeded '.0:4/
1
r~m/nib ·while' i;{ i958 bnly '4 pei'615sei.-%Ci/
Tl:ie .divisio'n. ·of ,these irifo riiedicine,' indi.istij :a:nd 're~·s~arcldh6Wea that} I peiceht, ~2 pb: cetit, 'and'J4 pe~'cenh'eipectlvdy 'dfthf.personhel ,vorkµig ur.these fieidre){ceeded' 5'rem/y! It 15 kllowii that' there ha~ !Heen: ·o~er'.
the last decade a great improvement in the doseirniceived·by workers so that r"eportS 6•7! rs ..7 1·show that :only' 0;1'20.5
per .cent of1the.dose· mea:5tirements· 'show. doses :of such ai,
magnitude thatithe individual,: if ~these 4oses continued!
to be· recorded;wotild exceed .the ma.~umi pemiissible:
annual m:"quarterly levels,! ' :.- · :: i, : ;... , , . . , :- , f lthe· tluminizing• in'dustiy hav<i :been .meastired<in:· tthe
United Kingdom.1 ~::Ten of·these were;found•tothave1
body' burdens:in e.{ccess:of• 0,1 ..µ.c.rradii.:ifu;·:the highes~;
being 0.61 ji.c.- Twehty.-"nine persons had, burden's betweeri:
0.05 µ.c and 0.1 µ.c and 234 had burdens lesl:i than '(W5t µ.'c~:
All those persons having burdens above 0.05 µ.c were
employed before the introduction, in 1942, of the first
regulations. An irn;ideqt µivolying t}l~- O!=cupational contamination from Sr110 used in the luminizing industry hasb.~~1?-1~~?i;~~d.rff?1¥.·Sz~irboslqy*,ip.;s~ ,,,,: ,~: :, : ,Jl . <i (Lmninizing
industry_-·:er:.,,., __ ,.{'"!·.:· :1·,:
110. Total body 'burdens' o'f 273 persons employed in

1ev~i. f's ·,of 1HdrT:}~poi;~~~~ • A: '.fompre~e~si~~ '~p41y§i~~
1c'efit were(

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i

·~. ·. '· Jf~. ·•1~.,.:.,.I.~ I.;., ,;·, .,l-:; lj':).J;STIMATE;S,QF.~<;:CpfATIO~Aj:.. ,EXPOSURE,J;~ fiIG;Ei1:'. J..
'·' ..... , . (ALTJ'fpDf.:A~C(JµE,T,.,! ; .,:, "";;.;;;, ",(;·11 L Costrik'' 'radiation· increases ~rith aititi.lde.-' Corti)'

merc~ial jet.a~rcraft.fly.at,~ ;;1ltitude qf&-12,~m,.(25,000-

387:

40,000 feet), while military jet aircraf! may re~ch analtitude of 16 km (50,000 feet). According to estimatesin the United Kingdom 75 and in the United States, 91
the annual radiation dose to a crew at 16 km amounts to
400-500 mrem. At an altitude of 12 km, the corresponding dose is around 300-350 mrem. Dose figures relate
to a northern latitude of around 40°, assuming 80 hours'
flying time per month.

shoe fitting, luminous markings in clocks and watches
and other luminous devices, and television sets. The
public living in the vicinity of radiological installations
and passengers in aircraft may also receive additionalradiation. Some of the more important sources are considered in the following paragraphs.

112. It is anticipated that supersonic transport aircraft, if and when they become commercially available,
may fly at altitudes of up to 26 km (85,000 ft). Aircraftcrews might be e.xpected to fly a maximum of 40 hours
per month at these altitudes. It has recently been calculated by Foelsche92 that at a latitude of N 50° a crew,
under these assumptions, would be exposed to an annual
dose of approximately 1,500 mrem. However, during
intense solar flares a few hours' supersonic flight at analtitude of 24 km may cause· a dose of 8,000 mrem.
If these solar flares can be predicted in advance, aircraft
flying at very high altitude~ would be able to descend tolower altitudes before the peak activity is reached.

118. Members of the general public living near or
having access to these installations may receive small
doses mainly from scattered radiation. The Committee
notes that the ICRP1 has made recommendations thatsuch people should not receive from such exposure morethan 500 mrem per year in the gonads, the blood forming
organs and the lenses of the eyes.

113. The contribution to the dose from contaminationof an aircraft by surrounding radio-active particles canbe disregarded, although the exposure of maintenancestaff has received some consideration.91 • 93
114. Consideration~ has been given to the computation of the radiation likely to be received by space crews
and also to the problem of determining the dose due toprotons in solar flares. 95 • 96
GENETICALLY SIGNIFICANT DOSE

115. By the use of dose information obtained fromindividual monitoring, the genetically significant dosefrom occupational exposure has been reported from anumber of countries. Allowance has been made for theage distribution of the workers. The estimated annual
genetically significant doses calculated from formula 11(see appendix) give the following results :Doumrem Year of Estimatwn

Austrial.19 . . . . . • • . • • • . . . • . • • • . . • . 0.2
N etherlandsB7 . . . . .. • . . . . • . • . . . . • 0.3
Unitea Kingdom75 ..•••..•.....•. 0.4

1955
1960
1959

In the United Kingdom, the contribution to the genetically significant dose from atomic energy establishments
has been calculated to be 0.15 mrem. There is no reason
at present to assume that the genetically significant dosefrom occupational exposure in other countries would
considerably exceed the figures listed above.

RADIOLOGICAL INSTALLATIONS

X-RAY FLUOROSCOPY FOR SHOE FITTING

119. A survey by Seelentag and Peck97 has comprehensively reviewed the literature regarding the doses
received from these machines. They also report measurements on ten different units. The average annual genetic
dose to the population of the Federal Republic of Germany was estimated as 4-7 microrem per year. The
Medical Research Council of the United Kingdom75
estimated in 1956 that the annual genetic dose in thatcountry from this source was not more than 0.1 per centof that received from natural background and that after
the full implementation of present legislation (by 1963)
the dose would be reduced to some 0.01 per cent. In
several countries fluoroscopy for shoe fitting has beenprohibited since it is regarded as causing unnecessary
radiation exposure.
LUMINOUS MARKINGS IN CLOCKS AND WATCHES

120. Reports of the activities of watches and clocks
have been made in Germany, 98 Nonvay,99 Sweden,100
Switzerland101 and the United Kingdom. 75 These showthat there is a wide variation in activities of watches
and clocks up to about 0.5 microgram of radium with amean value of about 0.1 microgram. Estimates of theannual genetically significant dose from this source are
2.6mrem, 98 l-3 mrem,1° 0 8 + 3 mrem, 101 and0.5 mrem. 75
The annual dose to the sales staff has been estimated as
90 mrem. 98
TELEVISION SETS

121. The ICRP 1 has recommended that the dose-rate
at any accessible point 5 cm from the surface of any set
used in the home or place. where the public is likely to
be shall not exceed 0.5 mremjhr under normal operating
conditions. Braestrup and Wycoff102 have shown thatat 15 kV, the normal operating voltage of home televisionsets, the dose-rate at the surface of the screen is about
1 mrjhr. However, most sets are provided with a further
plastic or glass sheet which reduces the dose-rate, but'vhen these sets are operated above normal voltages, for
testing purposes for example, then the dose-rate may
be increased greatly. Operation at 24 kV increased thedose-rate by a factor of 1,000. It has been pointed outthat colour television tubes operate at about this voltage
so that further shielding is required to conform to the
ICRP recommendation.
122. The dose-rates received by the operators of projection TV units working at 80 kV may be of the orderof 10 mremfhr, but high dose-rates of the order of
1 rjhr have been measured close to the tubes. However,these are not in the direction of the audience. 102

MEAN MARROW DOSE

116. No data are available on the actual mean marrowdose from occupational exposure. However, the values
given in table XLII may be regarded as the dose at theskin and therefore the bone marrow doses will be considerably smaller.
IV. Other exposures

117. In addition to the doses received by individuals,
either as patients undergoing medical radiological procedures or by radiation workers during working hours,
irradiation may come from other man-made sources."
These comprise such sources as X-ray fluoroscopy for*Environmental contamination is dealt with in Annex F.

388

123. Braestrup103 has estimated that the average
gonad dose from home television is much less than
1 mrem/yr.
p ASSEKGERS IN AIRCRAFT
124. The enhanced cosmic radiation experienced inaircraft makes a negligible contribution to the total dose
received by the population at the present time.
USE OF KUCLEAR POWER IN SHIPS

125. Information has been given of the predictedradiation levels to the workers and public from the useof nuclear propulsion in ships.104 • 105 The doses received
by occupationally exposed workers were on the average

about 0.5 rem/y and were up to a ma.'(imum of 1-2
rem/y. 130 The activities discharged as waste from thesevessels are unlikely at the present time to make any contribution to the dose received by the general public.
GENETICALLY SIGNIFICAXT DOSE

126. The use of these miscellaneous sources is likely
to contribute about 2 mrem/y, mainly from the use ofluminizing of clocks and watches. However, with theincreasing uses of miscellaneous sources of radiation,none of which individually contribute an appreciabledose, the total genetically significant dose may be expected to increase slightly.

Appendix
1. A general definition of genetically significant
dose has been given in paragraph 9 above. Approximations must be made to calculate this dose, the mostobvious being consideration of groups rather than
individuals. It is convenient to start with the approximate definition*+ N'Ml w<M> d1<M>)+ NiM> wiMl)

w<F>
d<F>
D - 1:I 1:le (.NCF>
Jlc
Jk
lk
-

l: (NiFl wiF>
k

Ji:

Jk

lk

(1)

where
D
(annual) genetically significant dose,
N 1k = (annual) number of individuals of age-class k,
subjected to class j exposure,
Nt = total number of individuals of age-class k,
Wit = future number of children expected by an exposed individual of age-class k subsequent toa class j exposure,
wk = future number of children expected by an average individual of age-class k,
d1k = gonad dose per class j exposure of an individualof 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 thedenominator by w•N, where
N<Fl
N<M>
w = • w<F>
w~1 >
(2)
N
N
and
1
(3)
w • = N. ~~ Wk• Nt•+-- ·future number of children (w;) of an individual in any
specified age-group.
4. The assumption could be that the average individual will have a future annual child-expectancy
expressed by the present specific annual birth rate.
This makes it possible to calculate, by summation, thetotal future expected number of children of an individual of any age, and hence a~so the mean for any
age-group. If significantly less than unity, the probability of an individual of age a to reach age t should
also be considered. This givesc:ow; = t-a~ c; • At • P: (t)

(4)

where
w:
= expected future number of children of anindividual of age a. With knowledge of thefunction w; of age, the average w~ for any
age-group k can be calculated,c;= age-specific annual birth rate, i.e., annual
expected number of children of an individual of age-group t,
At= number of years included in age-group t,(t) = probability of an individual of age a to reachage (group) t.
5. It must be noted that c; may have a tendency tochange 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 assumed not to vary with time.
6.
= w:-+o is the number of children expectedby the average individual during his whole life. The
range of w· is normally 0.8-2, and the range of w· is
2-4 for most developed countries. The ratio W /w
ranges from 1.5 to 3.
7. The female and male contribution to the genetically significant dose can both be written
1• d.llt
D • = -N ~ ~ N•lli: W1k
(5)

P:

w·

In the last expression, •denotes the sex. N is the total
number of individuals of the population. It should benoticed that w•N is about twice the future number ofchildren expected by the present population eventhough the value of w may be as low as 0.8.
3. As formula 1 has w' in both the numerator anddenominator, the numerical value of w has no direct
relevance, and all terms can be expressed by help of
the ratio wr~/w. For understanding of the demographic
background, however, it is valuable to realize that w
must be calculated from the sum of the age-groupproducts w;·N~ for a population, which means thatan assumption has to be made regarding the expected

v,r

J

k

8. If the gonad dose due to an examination of type jis nearly uriiform for all age-classes k, thend;k = d;(6)
approximately for all k, and formula 5 reduces to1•
D • = -N 1: d.l l: N*Jk WJk(7)
W*The degree of approximation involved in the use of formula
1 depends on the definition of classes j. In theory, there need
be no approximation since the classes may be made so restrictive
as to include only one individual per class.

JorD •l = d.I ' -

k

1

~
\VN k

389

N•Jl< WJt•

:which the'patient is examined: wj can theri be ea!: culated ;from· the: age~d1stribution 'of the patients :andthe normal child-expectancy for each age-gr~up, ... r(c) wj/w\Theoi formula .iis 1iapplitable1:alsbrf ta: .foetal: rexposui;e(w 1 = \V) which must not be overlooked.::': j,,,;,i:,~.-;<:
•

I

•

LI

I

..

.

•

I 1Q·.r:·Qft'eri':d,1 :vanes '.'Considerab)y! ~ftj)t;n:: hospi,t~J. ,to·~hbspi~a1.:·:Mbsf 1 of':t1J~··uncehainfy!'in:'estini!ltesiof;D 1·~iS'prot;iably due'.tq the pi~ci.Jity'of.~sti'ma.Ptig.. a rel~a,~!e''a'\•erage''ofid~;for ·a-'.popiilati'c:>ri·. ~.'· •1c' ", :;: ;.: .. ~·:'.,, w' !

• !i

-1;i 11:;

L1 J1';-,:,nr: .. , ·H, ·~~1.l!!!H/1 :.-:;1~1~;_,·,_:·· ~.;·!nin~~ !·:·it~:irtheye ;tl'e;:~q 9a;ta. ;on: ,th!!,:~hil9~~n,cy; !Qf. :the-.~t11ei:i~1'i 1an iapprQXIJ'.l'l~tene~ttm~t<? :Af .Dj.J~!l-Y.}~e\'. H '1 h'1 I.~! ~e, :uni:leri :th~, ~Sisurript•oi:i .tha,t1tfl~1cl.;i:ilp-e?-peq¥.J;ncy
is not influenced by tlle·;I\~torjei' qf. t)le,:conqitjpn.,for,~ •. -~;~i ·i!i!."1;!ij1 '.::· ·.~:;1:·.1;.;~; Ii<-'. ~:t.;~Hi1•:)(i) ; ~ ~ . 5 / \

(! )

J

~<

:1

I'

,v.'

.... ! .. :.;:f·1 ~;~:'· ·h, ~.'r.fd1!-,>j;1:d ·/(, ·,: l tiJIH (! ;1;;11,1;)
1J,::,;1 .. · ;;k.!'·jo f;: .. ·.~LJ!d·· 'ic1 ·,~.'.:r1~tr!1 ~/:!r:"dJI j.~:.J·,::;.~ ..--~;:!d;J ·~o ~;·:-·!i·./v;n;i/ sl1j\.\ 1 .r ~;.~·'· ·~~; l··~d)ivil1!1i.
0',!JU: ·i:t"J ;.-,', ~.;'' ·,~.\'L !•·~! ,:,;·~; 'ic·; ,•: u:-1il:>f1l! ]

,".'/

f1!·

1 :

_,:

Jl:l J; "ft ::JJ' I';:\;If i •JI/I

j ·'.;i:,,:·., ::r:~.

.:~'~II:•·!:'. ~l.'''· ·1u fr;1dd ~ih,:; rt?r::., ... ~; '.L r1i L:.~;:if~,t:i r:1'"';,• ·:l~, ·• 1.Jr11;i:1 =•t·.:·•icin;:, : '.

'

1 , ·,.',

:

· .

J

J . .,.

•. ·.. PQJ.ulfJtwn alfl'< "' Oov.n"'1..cwut11 •.ii 1;:1;ruu.qfistudJ1 ·: •!llimeofs1"1Y-' .• ·:·, J ' ' ' . I ' ''1•>

J'"'.':·llJ:·t'.'.': •• • •I•• ~i.I
}(\

,

: .•

,;! L-~i;J:> ! 1:!.', .J<.1 :l1:1JIJ!•1i~\H; 'j·, "1-:._;!i1!U1 1· h•.•·:..-.~; H~: \:d );:.J:>'.•:.::::; 1:··,-1h~i1l·.1 ,,1 ';i. ::,;!111 ~;-JLJ.rJl.j
pj ·:11~ .. !tp:·,~:_:!!" ) i.--•J:> ~;;:'.~ ·:<• f 1.fl!,j-.:;;1::; L:• ·:1 !

! :'.-, 1 . I',._,' J ••. :·. ; : 1 , • ! \ ·; 1. 1-\ • •. ! 1 ·~,1; r · ·I-, r;. .~.·.1•:1. . t.11H1'. . ' ' • 111,r1r.TABLE
I. ANNUAL FREQUENCIES
OF. y -RA~" EXAMINATIONS
I. I ·,
I.
.
·1:11·i;; _~. !;·:<;:.<l• L·:j,'(I!, y.\·' 11 •• 1. ... • : .. ·, ~t·.;.;!l.il i _., !_. 11d.Ii1 ~dIJ11JJ
1

I r;11nr1r;

i ; :.;-J, 01•••'.:'I"'

;"N

,I!

Ann~al. !'um~tr of.:c-raJ!.,exomi~ions pd-.1;0(}(} If! 10iai'p0pui"1icfi" '&aminaJioJs:~~pl'~~}s' .: .. ,.i ..... "·!'··· l' · ._,. ·: ·' . d : ' . .:'"'.:::ifuneys and den,alJ.fass surveys , . ' ·!·, :-=:~~(Rizd;DiraphJI. '.'.FJuo;./,si:0PJ1''. lRaaibvapJ.;,; 111 ·: • Fliwouopy' ;; :· , .. · .: ;D.enJal ;· · 1&ier~q
j

•

·;

.t ' : } ~' " ,1,
"
•
I
I .
. '
t
•
' .
•
:litable' ·, N~ri:lata' ~ .; . 4
c~ep~~.{~~en~~,.A!r~~)F l!?~q.:.195!? '"r !! ,6,000'.QOQa: i .(. 270b ·'"Ng'ciahi' ! ,.,1 80b::i:'J\'Not"a1,~~tfill!a·:. ''.' ;.·;·'.· .. •,:;·, .~-95?:;-1.9~7.. ;, : 9,,5q<) 10<J9, . , }~O: :.: • :.~. ' " ' 190~ · '!'Not'a~~li&ib1e 1 '.···~fo.da'.hi: ·· a2•:$3
310•
25·.:·. '25 · ': · :: '.•No data;""' 53ii19
Austna.... ... . . . . . . . . . . 195571958
6,974,000 ; .
67·BeigiwiL!,:".!.'.'.,':J.. ::.:: '.: '195& ·". ·.: · '8i924,00p'·. 'No.data No data ,, " 130 •.•: . .
(., 21 · · :<No data53:eaiiaaa:.·,.-.:-:.'..::.:-.::.." · '1958' .. , • .11,04s,ooo. :'.220° i'30•.: 90 · , . Not applicable
Nii data 106, 107.neiiffiark.··::L•: .......i.;·.ri :.1956.,, . 4,466;090 .· ·:260-d
140
Not applicable40!u ,, 5Jf~~ ;Republic of. ·: ... '., . 1, • :, • i , . · _. : ,;,-d130/ · .. Not applicable
80
6. !per:n;ia,ny,(l:Iam~\lrg) ..... 1?5~-:-~95~,;•. • 1,75.~.ooo.,
560
.I
. SiO
"
'F
· ... " · ;·.:·.·~••r··~·.
··' · 1'957'1958
OOO OOO··· 1-0-d
40
No data
8-10:.· ran_ce·,·:,·_·, . :-, ,, '~'.. · 42
I j _,I- • ~~1,.110.:.
170
NQt applicable. 151<}~1 : .. ... ; .....·.. .. .. . .. 195,9' . ; 2,06-,000
. 300
. 20
:. ' !~08··1ta'.1y (Rome).'.;·" ..... :-,, · ' q9s1· · ,.
1,875,ooo
500
11N.ot applieable · Nfrdata ,·,•.;:-;f ,, .',.BO·
.
"
'
10~
'
..
'53
' Not appli{;able
Japan................. 1958-1960.· '. 90,000,000'HO-:-:-:", . ;, ;~20
2001 . . '130
4<Jb' ' . . . 13
Not a·pplicable:-~~Fhed~nd,s,(J,eip~~;.··;. 1 ,.,1~~9 ., · !, :.~ 1;0,000. i "350-d .
: ' ' ' 90•"240• ,.
""68· Not applieable
New Zealand.!;:;'.>; ... ::: ", 1951. , , , : , -·.~-~.OOO : ., : i 340°
_d . . ·,210 .
,,:,14
Norway...............
1958 ,
3,~2~,000· 390
Not applicable · d 100:,15
Npt applicable , No data
(Sw7den .......,'.; ..,·:·:~-.:,:·' . .1958,'f\300,000
290
I' . . J30d".~·jg.
.60 ,, I. ..
'. 140'.
·'· ,16·Switzerland ....... :....
1957.
5,160,000
310:c:> .,.,' . '; '. United Arab Republic:· .
. . ... , . . 1 ..
·~d··'·: 17
( :, Alex~ndi'ia'..,.:. 1 .::'.: ,,19S9:1.i?6o'· 1·361700c' · · ,?6
0.3
4
Not applicable;· 5·.: >isCairo ... !'.:!·'.::::.'... 1955-1·901 ,: 1 1 ' 2~640:-00'0~ '"' .. '40·2"
Not ':!Pplicable(~United Kingdom (except ; : . ' ,., , ·' . !''.95.
' .. , :,,19:Not applicable
4.0:
Nsirt'1e,i;111rrl;i.nd~~'l'~' ·.1957-:-1,95&1, . 50,QQQ,ppo:.
280
UnitedStatesofAmenca. 1955-195.6 · ·162;doo,ooo· '"':'z'50° :, ' ,'I :80• •. :400~ .;;• ,. ·; ..20
;135•
.Not applicable0'·I : • : , I

11

ii:

0

l

c.:~

,, . . ,..

•!I'•Including commutorsib Figures relate to films and not to examinations.
·"': D~ta are tak~n frc;>Jll ~he li958 report Q~. f~e Uni~ed. Nations
3
Sc1ent1fic Comm1ttee!on the .Effetts'Of' Atomic Radiaaon.
. d Fluoroscopy is generally' performed only in connexion with.radio~raphy.

'

' J

'

•

~ '

'

l :

, .,
.. .
,
:'':"•Figures· relate tc>'hospitals·only. " ·· · : ··.:., .. . t Fluorosco,py of the cbest rtot connected with radiography out·:not rriass'rurveys.: '"'·· •':• :· ·, .. .: · ' :,:. . ;.. , , :. :• Population sel'Ved ·by" bo~piials 'surveyed.!.. · 1 • • . . . . ..

i.'39oT ..uiu: II. ANNUAL FREQUENCIES OF CASES TREATED BY X-RAYS AND SEALED RADIO-ACTIVE SOURCES

Year of study

Co-"lllry or area

Austria •.. , ......• 1955-1957
Canada •• , •• ,,, .• ,1958
Czechoslovakia(Prague) ...•....
1958
Federal Republic of
Germany(Hamburg) •••.•• 1957-1958
France •••••......
1957
Israel. ............
1959
Italy (Rome) ...•. ,1957
Lebanon ...•..•... 1956-1960
United Arab Republie:
Alexandria.,, •• , 1956-1961
Cairo ........... 1959-1960
United Kingdom(except Northern
Ireland) •••••••.•
1957

Annual 11umber of <asu per J ,OOO of
total popu14Jion

Popvlalion al
lime of study

Maiivsan:6,974,000
17,048,000

410No data

No data

990,000

No data

7.7

1,755,000
42,000,000
2,062,000
1,875,000
1,500,000

4.0
3.7
0.6•.b

12.3
5.9
4.1•,b

0.2

8.3
2.2
3.5•.b
1.3
0.1

0.3

6
27
108
110
111

1,361,700
2,640,000

0.25
0.6

0.21
0.7

0.46
1.3

18
34, 3550,000,000

1.2

1.2

2.4

19

N on-malignanl

No dataTolal&/ertnu

14
1.9•

119
106
109

•Figures relate to hospitals only.
non-malignant conditions around 70 per cent of all cases. For malignant conditions
around 80-85 per cent of all cases.
b For

T.'J!LE III. ANNUAL FREQUE."CIES OF ADMINISTRATIONS OF RADIO-ACTIVE ISOTOPES FOR MEDICAL RE:.ASONSAND THE AN1'"UAL AMOUNT OF pa1, ps2 AND Aul98 FOR MEDICAL USE

Country OT area

Year of study

Population ol
lime of study

Argentina •.•••••.•.....•.•..
Australia ....................
Canada ••••••...•.•....••.•••
Federal Republic of Germany(Hamburg) ••••••••..•.....
Israel .••• , ••••••••.•••......
Lebanon •••••••••••••••••.•.•
Norway .• , .••.••.• , ••.•• , •••United Arab Republic:
Cairo ••••.••••••••.•••.•.•
United Kingdom(except Northern Ireland) ..•United States of America .••••.

1960
1959-1960
1958-1960

20,956,000
9,800,000
17,048,000

1957-19581959
1956-1960
1960

1,755,000
2,062,000
1,500,000
3,500,000

1961
1957
1959

Annual number of tases per
J ,OOO of total populalio11

Annual amounls :{ rodio-aaire isotoPcs
for medic use (turks)•

Diagnosis

TherapyJUl

pn

Aull 1

Re/eren<1

0.30
0.65b

6.0•
8.2
55.0

0.8•
2.1
5.1

No data

No data

0.03
0.09b
0.04•

36
112
106, 113

1,l'd
1.7
0.1

0.2Qd
0.16
0.01

No data

No data

No data

No data

2,640,000
50,000,000
180,000,000

3.4

6
108

No data
5.7

69

1.1

18

4.2•

88•

No data

No data

20
114

No data

2.5
0.3
2.1

0.3
<0.1
0.5

0.33

0.42

1.3

0.07

0.5
1.2

0.08
0.3

SO•
No data• See paragraph 8 (c) above.
b Minimum estimate.

4.4
23.8

d Figures refer to the use of Iut only.

•Figures refer to the quantities actually administered.

•Figures refer to hospitals only.

391

•

11

TABLE IV.

DATA ON THE ANNUAL GENETICALLY SIGNIYICANTDOSE FROM DIAGNOSTIC X-RAY EXPOSURE

Argentina (Buenos Aires)•

Suroey, 1950-1959v•I~ (mrem)MakadultsFemak
adultsFo•lusMok

Femok

Footus

mum

2.2
3.0
2.7
3.7
18•
1.6
1.0•
2.3
0.6•

700
600
300
200
10
600

900
600
450
400
15
700
800
600
900

No data
No data
No data
No data
No data
No data
No data
No data
No data

1.9
1.7
0.8
0.5
1.3
0.7

2.0
1.8
1.2
1.5
0.6
1.1
1.8
1.4
1.2

No data
No data
No data
No data
No data
No data
No data
No data
No data

3.9
3.5
2.0
2.0
1.9
1.8
1.8
1.7
1.2

16
14
8

1.0

0.6

600

800

No data

0.6

0.5

No data

1.1

4

Sun-TOTAL

72

36

7.8

13.1

20.9

83

Other types of examinationb .••

67

56

1.7

2.7

4.4

17

SUB-TOTAL

139

92

9.5

15.8

25.3

100

4.5d

7.5d

12d

14

23

37

Mak

T:YP• of ozaminalionA.

PerUfll..

ate

HOSPITALS AND CITY CENTRES (RADIOGRAPHY)

Urography (descending pyelography) ••••••••••••....•.••
Hip, upper femur •.•.••.••••••
Colon (barium enema) lower GI
Lumbar spine ••.•••••••••••••
Mass miniature radiography •••Pelvis .......................
Obstetrical abdomen ••••••.••.
Lumbosacral region ••.•••..•••
Pelvimetry •••••..•••.•...•.•
Retrograde (ascending)pyelography •••••••••.•••••

B.

F•mal•

2.7
2.8
2.7
2.4
58
1.1
1.2

230

0.3

PRIVATE CLINICS AND PRACTICES (RADIOGRAPHY)dTOTAL• Figures are related to radi~apbs and not to examinations.
b Does not include dental radiography.
• Does not include contribution from foetal exposure.

TABLE

8

7
7
7
7
5

100

d Estimated figures (see para. 1 7).
• Below mean reproductive age, i.e., (nj/n).

v. DATA ON THE ANNUAL GENETICALLY SIGNIFICANTDOSE FROM DIAGNOSTIC X-RAY EXPOSURE

Survey, 1956-1958

Dentnarks
N*
1
N XI,()()()

Typo af e:raminoJio1<

Mak

F•mal1

Intravenous pyelography ••••••
Retrograde pyelography ••.••••
Cystography •••••••.•..•••.••
Hip and femur ••••.......•.•.
Pelvimetry .••••.••.•.••..•..
Urethrography ••.•••••..••...
Pelvis ....•........••••.•....
Spine lumbar ....•...•....•...
Abdomen obstetric .••.........
Abdomen A.P..••..••.•.•...•

4.3
0.9
0.4
2.2

4.3
0.4
0.4
2.5
2.2

0.4

0.7
3.4
2.0
0.4

SUB-TOTAL

15.4

16.3

0.4
2.5
4.3

~ (mrem)MakadultsFemok
adults

1,019
2,580
5,078
980

565
1,136
437
58
822

3,709
567
104
610

210
222
190
85

D~ (mrem)

Foolus

Mak

Femok

4.3
2.3
2.3
2.2

2.4
0.5
0.2
0.1
1.8

Foolusmrem

PerurU-

Ot•J

0.3

0.1
0.7
0.4
0.1

6.7
2.8
2.5
2.3
1.8
1.7
1.5
1.1
0.4.
0.4

24
10
9
8
7
6
5
4
2
2

14.9

6.3

21.2

77

5.0

5.0
1.3

18
5

5.0

27.5

100

1.7
1.4
0.4

Foetal contribution• Other types of examination ..

244

0.7

0.6

TOTAL

260

15.6

6.9

392

D1

TABLE VI.

DATA ON THE ANNU.U. GENETICALLY SIGNIFICANTDOSE FROM DIAGNOSTIC X-RAY EXPOSURE

Survey, 1957-1958

Federal Repiiblic of Germa11y (Hamb11rg)6l~
i x l,ooo~ (mrem)~ (mr<m)Di

adullsFettUJka
adulls

F~!us

Male

FemaleFoetusmrem

P<r«nlate

4.0
3.2

890
1,520

2,530
214

2,740
255

1.87
3.15

4.03
0.17

0.19
0.01

6.09
3.33

34
19

3.6
10.2
3.7
0.32
16.9

241
63
275

439
183
94
680
67

476
178
166
677
63

0.70
0.52
0.90

0.71
0.72
0.24
0.22
0.47

0.04
0.04
. 0.01
0.54
0.02

1.45
1.28
1.15
0.76
0.60

8
7
7
4
3

1.2
4.6

1.1
2.9
0.05

311
88

657
128
600

720
167
2,900

0.21
0.27

0.27
0.20
0.03

0.02
0.01
0.37

0.50
0.48
0.40

3
3
2

SUB-TOTAL

56

46

7.73

7.06

1.25

16.04

90

Other types of examination ..•.

369

299

1.07

0.61

0.02

1.70

10

TOTAL

425

345

8.80

7.67

1.27

17.74

100

T'YP< of aaminaJion

Male

FemaleColon (barium enema) lower GI
Hip, upper femur ......•.....•
Urography (descending
pyelography) ...............
Lumbar spine ................
Pelvis •....••................
Obstetrical abdomen .....•....
Stomach (barium meal) upper GI
Retrograde (ascending
pyelography) ..............
Abdomen .•........•.••..••••
Pelvimetry ..•••••............

3.7
2.6

5.1
11.2
3.8
23.9

Mai<"

65

0.11

•Denotes mean figures of gonad dose. After detailed calculation of D; formula 8 was used for obtaining d;.

TABLE VII.

DATA ON THE ANNUAL GENETICALLY SIGNIFICANTDOSE FROM DIAGNOSTIC X-RAY EXPOSURE

Frances-10

Survey, 1957-1958~ x l,oooN'Tn• of aaminalion

Male

Chest (heart, lung) •....•.•••.
Abdomen •..•...•.•.....••...
Hip, upper femur ...•...•.....
Urography ..•........•....•..
Lumbar spine •.......•..•...•
Obstetrical abdomen ..........
Urethrocystography ....•.••.••
Stomach (barium meal) upper GI
Colon (barium enema) lower GI
Pelvimetry ...................

340
3.7
2.1
2.1
3.0
0.7
5.9
2.0

SUB-TOTAL 360~ (m1em)Maleadults

230
4.4

1.7
1.8
2.4
0.2
0.5
3.8
2.5
0.02

Foetiu

1,300
180
4,500
700
1,600
1,800
300
264
1,200

No data
No data
No data
No data
No data
No data
No data
No data
No data
No data

30b
1,500
1,200
390
250
1,900
90
134

247

v'J

~ (mrtm)

Femak
adultsMale

FemaleFoetusmrnn

P<runJage

4.62
0.23
2.30
0.80
0.80
0.23
0.29
0.23
0.02

No data
No data
No data
No data
No data
No data
No data
No data
No data
No data

38
10.20
2.84
2.62
1.28
0.80
0.47
0.43
0.37
0.02

65
18
5
4
2
1
1
1
1
0

9.52

57.03

98

0.96

1.18

2

10.48

58.21

100

38•
5.58
2.61
0.32
0.48
0.24
0.14
0.14
9.51
38•

84

65

0.22

TOTAL 444

312

9.73

Other types of examinationd •..

38°
figure cannot be split into male and female dose.
d Does not include dental radiography.

• Does not include contribution from foetal exposure.
b !\lean value for the dose to testes and ovaries.

• Since di is given only as mean figure for the gonads the dose393

TABLE VIII. DATA ON THE ANNUAL GENETICALLY SIGNIFICANTDOSE FROM DIAGNOSTIC X-RAY EXPOSURE

Italy (Rome)ll

Survey, 1957

Nj
N

•

X 1,000

D * (rnrern)d (mrern)
1Di

1Type of eumin<Uion

Mak

Femak

adulU

FemaleadullsDigestive tract ...............
Hip, femur .•..••............
Urography (descending
pyelography) .......•.•...•.
Pelvis ...••............•.....
Lumbar spine ................
Barium enema ......••.......
Cholecystography .•.•.•••••.•.
Abdomen ............•.......
Obstetrical abdomen ..•.•.....
Pelvimetry •.•........ ; .•.....

27.8
6.1

14.2
7.0

123
586

411
223

No data
No data

3.08
3.93

5.25
1.09

8.33
5.02

5.2
5.0
7.9
4.7
9.1
5.2

3.4
4.7
4.8
2.4
11.6
3.4
0.8
0.1

940
1,130
234
239
12
141

1,060
330
570.
1,050
156
210.
399
1,250

No data
No data
No data
No data
No data
No data
No data
No data

2.44
3.38
2.03
1.01
0.12
0.66

2.52
1.40
2.19
2.27
1.27
0.64
0.59
0.23

4.96
4.78
4.22
3.28
1.39
1.30
0.59
0.23

Sun-TOTAL

71

.52

16.65

17.45

34.10

79

Foetal contribmion• .•..•• ;, •••.•
Other types of examination• ••

2.59
276

174

4.15

2.57

2.59
6.72

6
15

TOTAL 347

226

20.80

20.02

2.59

43.41

100

Mak

Fodus

Mak

Female• No figures subdivided into various types of examination areavailable.
bThe figures for D; are the sum of the male and female

TABLE IX.

Foe!us•mrtmb

Pauftl-

ate

19
12

u
11
10

8
3
3
1
1

contributions.
• Does not include dental radiography.

DATA ON THE AN~UAL GEN'ETICALLY SIGNIFICANTDOSE FROM DIAGNOSTIC X-RAY EXPOSURE

Japan 12

Sur-.;ey, 1958-1960

N*cl'; (rnrem)

Nl X 1,000
Type of examination

Male

FemaleStomach (barium meal) ui;i!ler GI

53

33

Colon (barium enema) lower GI

5.0

4.5

Lumbar spine ................
Lumbosacral region ....... ; ...
Hip, upper femur .............
Pelvis .......................
Chest (heart, lung) ...........

7.6
3.7
4.7
1.6
103

3.6
1.6
6.0
1.5
65

3.6

2.6
1.1
0.15

Urography (descending
pyelography) ...............
Obstetrical abdomen ..........
Pelvimetry ...................

SCB-TOTAL 182

Mak
adulU

Femaleadults

4.3•
74~ '(28) (2,660)
81 •220(2,390) (4,320)
121
767
1,700
116
30.5
691
1,490
80
8:0•
1.0(78)
(0.6)
631

92
162
322

~ (mrern)

D1
PtrU'ltl-

FoetusMak

Female

Fodus

mrem

age

No data

0.69

10.92

No data

11.61

30

No data

4.01

4.28

No data

8.29

21

No data
No data
No data
No data
No data

4.36
4.44
1.93
1.58
0.41

0.19
0.06
0.46
0.08
1.07

No data
No data
No data
No data
No data

4.55
4.50
2.39
1.66
1.48

12
12
6

No data
162b
322b

1.27

0.13
0.12
0.03

No data
0.30
0.09

1.40
0.42
0.12

4

4
4

1
0.3

119

18.69

17.34

0.39d

36.42d96

Other types of examination' ....

74

37

1.82

0.79

No data

2.61

4

TOTAL

256

156

20.51

18.1

0.39d

39.Qd

100

graphy and fluoroscopy.
b The dose is assumed to be the same as to the maternal ovaries.
0
Does not include mass miniature and dental radiography.
d The figure implies contribution from foetal e.xposure only
from obstetrical examination.

• Dose figures relate only to the radiographical part of theexamination. In around 8 per cent of chest, 38 per cent of stomach
and SO per cent of colon examinations, fluoroscopy is performed.
The figure ,,;thin brackets denote the gonad doses arising fromfluoroscopy. The values of Dj refer to the total irom both radio-394

TADLEX.

DAT... ON THE ANNUAL GENETICALLY SIGNIFICANTDOSE FROM DL..G:SOSTIC X-RAY EXPOSURE

Netherlands (Leiden)13

Sur"Jey, 1959-1960~ x 1,000
z;rType o/ e::aminalion

Urography (descending
pyelography) •.•.•••...•.•.
Hip, upper femur ....•....•...
Colon (barium enema) lov.·er GI
Lumbosacral region .......•...
Pelvis .•..••.•••••..•...•.•.•Urethrocystography .••...•..••
Abdomen •••...•.•.••.....•..
Lumbar spine .•.••.•••..••.••
Obstetrical abdomenb •••.•••••
Pelvimetry .••......••..••••.•d'; (mr'111)

Mak

Fnnak

5.6
1.6
3.7
1.9
3.4
1.1
3.7
4.5

3.0
2.1
2.6
1.5
3.4
0.3
2.6
3.3
0.1
0

~ (mrem)Di

MakadultsFtmak
adults

Fot-

Mak

Fcmak

Fotlus

mrcm

Ol<

512
3,323
25
60
157
423
92
16

604
140
613
790
142
1,608

604
140
613
790
142
1,608

1.16
1.48
0.03
0.07
0.35
0.11

132

132

0.18

47
100

47

0.03

0.62
0.04
0.50
0.46
0.19
0.30
0.16
0.06
0.01
0

0.08
n
0.08
0.07
0.01
0.03
0.01
0.01
0.02
0

1.86
1.52
0.61
0.60
0.55
0.44
0.35
0.10
0.03
0

27
22
9
9
8
6
5
2
<1
0

100

Pt7U111-

St:B-TOTAL

26

19

3.41

2.34

0.31

6.06

89

Other types of examination' •••.

282

222

0.32

0.36

0.05

0.73

l1

TOTAL

308

241

3.73

2.70

0.36

6.79

100

• Doses are the same as for female.
b The position is not justified by the magnitude of the dose.
• Does not include mass miniature radiography and dental

TABLE XI.

radiography.
n = negligible.

DATA ON THE ANNUAL GENETICALLY SIGNIFICANTDOSE FR.OM DL-\GNOSTIC X-KAY E..XPOSUR.E

Nor..vayH

Survey, 1958

~ x 1.000z;r

dj (mrem)~ (mrcm)

D;

Mak

Ftmak

:Mak
adultsFemck
adulisFo.Jus•Mak

FemaleFoetusmrem

PercenJate

11.9

9.2

130

592

592

0.78

1.81

0.12

2.71

27

3.0
5.7

3.4
5.9

185
376

2,050
135

2,050
135

0.16
0.92

1.19
0.29

0.09
0.01

1.44
1.22

15
12

3.8
3.4

217
384

159

0.37
0.61

3.3
14.4

3.5
6.0
0.3
1.4
0.3
3.0
11.2

0.12
0.05

0.51
0.20
0.19
0.01
0.10
0.27
0.07

0.03
n
0.50
n
0.34
0.01
n

0.91
0.81
0.69
0.59
0.44
0..10
0.12

9
8
7
6
4
4
1

SUB-TOTAL

47

44

3.59

4.64

1.10

9.33

93

Other types of examination ....

320

294

0.30

0.32

0.02

0.64

7

TOTAL

367

338

3.89

4.96

1.12

9.97

JOO

Type of czamination

Lumbosacral region .••........ }Lumbar spine ••.••..........•
Colon (barium enema) lower GI
Pelvis .••••......•...........
Urography (descending
pyelography) .••..•......•.•
Hip .•.....••••.•.......•...•
Pelvimetry .....•..•.........
Femur •....•....••••........
Obstetrical abdomen ••........
Abdomen ...•.....•.....•....
Stomach (barium meal) upper GI

1.4

407
65
2.8

403
800b
10
400b
178
17.5

403
159
900b
10
600b
178
17.S

0.58

b Estimate and calculation based on e..xposure data.
n = negligible.

• Except for obstetrical examinations, the doses are the same
as for female.

395

TABu;XII. DATA ON THE AN!l.'UAL GE1'"ETICALLY SIGNIFICANTDOSE FROM DIAGNOSTIC X-RAY EXPOSURE

Survey, 1955-1957

Swede1115N*I
N X 1,000

T:H>1 of enmination

Femak

9.1

7.0

940

5.3
4.1
2.5
4.1
2.6
1.0
1.8

0.6
3.8
4.2
2.4
5.0
4.4
0.2
0.9
0.6

Male

Lumbosacral region .••.••••••. }Lumbar spine •.•••••• , •••••••
Pelvimetry •••.•••••••••••••••
Urography ....•..•...•••.••..
Pelvis •.•..••.•..••.•••••....
Abdomen ••••••••••••••••••••
Colon •••••••••••••...•••••••
Hip •••....••.•••.•••.•.•....
Urethrocystography ...........
Femur ••••.•..••••.•••••.•.•
Obstetrical abdomen ••••••.•.•~ (mrem)Maleadulls

1,240
870
1,360
310
1,090
3,700
830

Femak
aduUs

~ (mrem)

D1

Pauni-

mrem

Foe/SU"

Mak

490

490

6.30

1.36

0.14

7.80

21

1,080
925
200
1,150
1,520
260
1,940

4,500
925
200
1,150
1,520
260
1,940
35
910

3.48
2.70
1.78
0.56
2.19
1.57
1.40

0.28
1.77
0.40
0.93
2.03
0.25
0.14
0.02
0.06

6.40
0.16
0.03
0.11
0.21
0.01
0.02
0.01
1.20

6.68
5.41
3.13
2.82
2.80
2.45
1.73
1.43
1.26

18
15
8
7
7
6

35
265

Femak

Foetusare

5
4
3

SUB-TOTAL

31

29

20.0

7.2

8.3

35.5

94

Other types of examinationb •••

186

188

0.3

1.8

0.2

2.3

6

TOTAL 217

217

20.3

9.0

8.5

37.8

100

• Except for obstetrical examinations the doses are the same
as for female.

b Does not include dental radiography.

TABLE XIII. DATA ON THE ANNUAL GENETICALLY SIGNIFIC..\NT
DOSE FROM DIAGNOSTIC X-RAY EXPOSURE

s.L'itzerland16

Survey, 1957
N*1
N

Type of t%amina!ion

Urography (descending
pyelography) ...............
Obstetrical abdomen .•........
Pelvis ...............••......
Lumbar spine ................
Colon (barium enema), lower GI
Retrograde (ascending
pyelography) ..............
Chest .......................
Hip, upper femur .............
Stomach (barium meal), upperGI
Pelvimetry •..•..............

Mak
adults

Femak

4.0
1.1
2.4
7.4
6.9

1,000

1,000
700
300
500
200

1.2
188.0
3.5
26.5
0.24

1,000
2
100
20

Male

Female

3.7
2.8
7.4
6.9
0.8
190.0
4.1
31.1

Sun-TOTAL 247

dj (mrem)

XI,000

1,200
150
150

adults

1,000
1
300
50
700

D* (mre'")FoetusMale

Female

1.93

2.14
1.73
0.55
1.62
1.20

800
2.55
0.48
0.90
0.42
0.69
0.27
0.31
800

1.96

mretn

Pcruntage

4.07
3.69
3.10
2.10
2.10

18
17
14
9
9
5
5
4
4
3

0.38.

1.04
1.04
0.97
0.96
0.72

2.34

19.8

88

2.5

12

22.3

100

7.55

9.90

290

194

I.78

0.73

TOTAL 537

435

9.33

10.63

396

Foetus

0.62
0.35
0.70
0.65
0.34

241

Other types of examination .•..

Di

2.34

TABLE XIV. DATA ON THE ANNUAL GE:SETICALLY SIGNIFICANTDOSE FROM DIAGNOSTIC X-R..\Y E..XPOSURE

Survey, 1956-1960

United Arab Rep:iblic ( Alexandria)11..

N*
Ni X 1,000•d (mrem)D (mrm:)1

T:ype of e.ramir.olion

Mole

FemaleUrinary tract. ................
Lumbosacral spine ............
Lower GI tract ...............
Upper GI tract ...............
Mass radiography ............
Chest .......................
Cervical spine ................

3.7
3.2
2.3
0.7
7.2
3.6
2.4

Skull ••.•••••.•••••.•••..••••

1.1

4.6
3.1
2.2
0.8
10.7
7.4
2.4
1.2

24

32

.\fak
adulls

Fema~

SOO

320
270
600
470
5
5
1
1

255
100
70
5
5

adult;

D;

1

Foel:ts•mrem

Per<enla11

1.47
0.84
1.3
0.36
0.05
0.04
0.002
0.001

3.32
1.66
1.5
0.41
0.09
0.06
0.002
0.001

47
24
21
6
1
1
<1
<1

4.06

7.04

100

--"

--"

__.

_.

2.98

4.06

7.04

100

Mok

Femok

1.85
0.82
0.2
0.05
0.04
0.02

2.98

Foetus•Obstetrical abdomen• ...••....
Pelvimetry• .................•SUB-TOTALOther types of examination ....
36

TOTAL

•No data.

TABLE XV.

DATA ON THE AN?.-UAL GENETICALLY SIGNIFICANT
DO:SE FROM DIAGNOSTIC X-RAY EXPOSURE

United Arab Republic (west and so1ith-west of Cairo)lB

Survey, 1955-1961
N~NI

x 1,()()0

Mak

Femak

Mak

Type of examinaJion

adullsFemaleadultsUrinary tract. ...............
Lower GI tract ...............
Upper GI tract ...............
Lumbosacral spine ............
Mass radiography ............
Chest. ......................
Cervical spine ................

4.1
1.5
1.0
0.9
5.7
5.0
0.9
2.6

5.1
1.8
1.1
0.9
8.4
10.0
0.9
2.9

500
100
70
255
5
5

320
600
470
270
5
5
1
1

SUB-TOTAL

22

31

Other types of examination .•..

22

4

TOTAL

44

35

Skull •••..•••••••••••••••••••~(mrem)~(r:rem)

FoelurDi
mrem

PerU?UOle

1.9
1.10
1.13
0.23
0.04
0.05
0.001
0.003

3.98
1.23
1.18
0.46
0.06
0.07
0.001
0.003

57
17
17
7
1
1
<1
<1

4.45

6.98

100

Mok

Femak

2.08
0.13
0.05
0.23
0.02
0.02

2.53

Foetus•Obstetrical abdomen• .........
Pelvimetry* .•................

--A

2.53

•No data.

397

4.45

6.98

100

TABLE XVJ. DATA ON THE ANNUAL GENETIC.<\LLY SIGNIFICANT.
DOSE FROM DIAGNO,STIC X-RAY !"XPOSURE
Surve)', 1957 ~ ~958

United Kingdom (except Northern lreland)to~ x 1,000
N
Maia

Tl'P• of ezaminalion .

Female•d (mum)1

MakadultsD

Fnn4k
od,,U,

Foetus

367

723
536

Male

• (:r.rem)

D1

1

Percnoi-

Femck

Foe/Ju

mrem

1.12

2.27

3.39

24

1.72

1.17

0.22

3.11

22

0.96

0.69

0.09

1.74

12

1.33

0.01
0.60
0.06
0.04

1.48

ci,22
0.11

0.14
0.55
0.32
0.36

0.60
0.51

11
8
4
4

0.14

0.29

0.05

0.48

3

83

4.48

4.64

3.34

12.46

88

52

40

0.35

0.39

0.04

0.78

6

TOTAL 136

123

4.83

5.03

3.38

13.24

94

0.83
0.01
0.01

6

14.1

100

Gl<

A.· NATION.AL HEALTH SERVICE·, HOSPITALS

Obstetrli:a:I abdomen ••..••....

1.5

Pelvis .•••,;;.'. ..•..•....••.••.
1.8
Lumbosa~I ~gion ••••..•.••• : 2.2
Lumbar sp1ne •.••..•••......• , 3.5' I~
Urography '(descending. •.. 1
2.3
~ pyelogi'aphy) ••••••.•••.•. ·1 ::1,liRetrograde (ascending
pyelography) ...............
0.3
Hip, upper femur .... ·....•.•..
2.0
Pe.lvimetry, •••.••.....•••.••.
Abdomen;;'.~ ••••.•..••••.•.. ' : ·3.0
S.tomach (barium meal), upperGI
6.0
Chest (heart, lung) (excluding, ~ass mi~iature radiography). q3.•:,.. ! •

,,_,
.._.-

370

392

2.0

765

585

740

102
745
183
333

0.4
2.9
0.4
3.0
4.3

ql

105
44
2.75

I

5.4

'"!
154
885
281
448

5.5

1.15

··~

SUB-TOTAL 84
Other types of examination ..••

2.0}
2.3
3.1

B. DIAGNOSTIC X-RAY EXPOSURE OUTSIDE NATIONAL HEALTH SERVICE HOSPITALSGeneral diagnostic examinations
Mass miniature radiography •••Dental radiography ..•••••••••

22
95
40

0.09
0.3

0.09
0.3

TOTAL genetically significant dose

398

0.09
0.3

No data
No data
No dataTAnLE XVII.

DATA FROi.r VARIOUS COUN'J'IUES AND AREAS ON GONAD EXPOSURE FROM MASS SURVEY EXAMINATIONS 01' THE CHEST

Populatiot1 at time of studyt'..>l\0'°Country or area

Total

Below age JO

Argentina (Buenos Aires) ...........
Australia .........................
Austria ...........................

6,000,000
9,500,000
6,984,000

2,770,000

Belgium ......................••.•

Number of examinations
Per 1,000 of
total population

Number of examinations
per 1,<JOO of population
below age JO

Radiography Fluoroscopy

Radiography

Fluoroscopy

-"

_..

2,990,000

76
190
25

25

166
No data
37

8,924,000

3,797,000

128

26

226

48

Canada ............•...•..........
Denmark ........•................
Federal Republic of Germany(Hamburg) .....•...•............
France ...••.................•..•.
Italy (Rome) .••.......•...••......
Japan ...........•..•.•...........
Netherlands (Leiden) ............•..
Norway ...........................
Spain .............. , ..............

17,048,000
4,466,000

9,300,000
2,080,000

90
140

_.

86
120

_..
__.

Sweden ...........................
Switzerland .......................
United Arab Republic:
Alexandria .••..•.............•..
Cairo .....................•.....
United Kingdom (except Northern
Ireland) ..••.•..................
U nitcd States of America ......•....
R = Radiography.
F = Fluoroscopy.

1,755,000
43,600,000
1,875,000
90,000,000
110,000
3,525,000
29,000,000

16,000,000

130
40
77
322
80
211
2

7,300,000
5,160,000

2,300,000

140
130

1,361,700
2,640,000

787,000
1,527,000

4
5

82,000,000

95
135

50,000,000
162,000,000

20,000,000
58,400

_.

_.
_.
_.
5
-"

60

-·

-"

No data71
No dataNu <lata
53
No data4

28-"

Gonad dare adults (mrem)
FemaleMale

Femalt:

Total

Reference10
No data
R 0.3
F 7
R 0.2
F 5
0.7
0.25

15
No data
0.8
18
0.6
13
12
0.15

1.3
No data
No data

0.6
No data
No data

1.9b
0.2"

4
3,33

No data

0.36L
002"l
0.09h

53

No data
0.03
0.03

0.5
0.02

0.45b
0.53"
0.05

0.16

0.32
0.6
11
0.4
0.4
1.0
0.8
31
1.6
0.5
1.5

0.02
No data
0.33
No data
0.01
0.02
No data

0.0:!
No data
0.60
No data
0.01
0.06
No data

0.1
No data

0.3
No data

5

7
7

0.04
0.03

0.05
0.04

0.09
0.07

17
18

0.09
1

0.09
3

No data
0.05

No data
0.13

0.01
0.18"

19
20

R 0.25-"

6

No data
155

70

7
6

-·

No data

_.

-"

90

Ge11etica//y significant dose (111re111)

Male

5.5
0.05
0.4
0.13
R 0.3
F 12
0.8
R 0.2
F 0.6
5

0.05
0.02h
0.93
0.08b
0.02
0.08
0.002''}
0.13"
0.4
0.05}
0.07"

53
107, 115
5
6
3, 10
11
53
13
14
53
15
16, 53• Not applicable.
significant dose calculated according to formula 11, e.g. assuming themean age of child-bearing to be 30.
h Genetically

TABLE XVJll,

GONAD DOSES AS SUDMITIED DY COUNTRIES AND EXAMINATIONS (MALES)(mrem)

Argentina (Buenos Aires)'.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Denmark .................•.......... , . . . . . . . . . . . . . . . . . . .
Federal Republic of Germany (Hamburg)... . . . . . • • . . . . . . . . .
France. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Italy...................................................
Japan ...................•........... , . . . . . . . . . . . . . . • . . .
Netherlands (Leiden).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Norway.................................................
Sweden•. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Switzerland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
lluited Arab Republic ......... , ........ , ... , , ....... , ... ,United Kingdom.........................................

Mass
suri•ey,chest

Chest,
htart.
luni

10
0.3
0.2

5
0.4
0.5

2

60
2
4
45
12
2
3
3
6

I0
5
3

8

3()d
6

0.5

0.1
0.4
0.1
0.8
0.4

1
2

5

0.1

Cho/eels·
lo1rap y

1

Stomach,bari1tm
meal

Abdomen

150
610
88
250
141
220
92
65
1,360
105

Col011,bari1t111
enema

300
40
890
134
239
1,310
25
185
310
150
100
146

Pel•is

600
567
275
1,500
1,130
1,490
157
376
870
1,200

Lumbarsf>ineLumbasacral

230
200
104
63
555
250
234
767
1,700
60
16
-130h-940h150
255
370

Ilip,

upper
f•mur

Ftmur

600
980
1,520
1,200
-586691
3,233
407
384
1,090
830
100
740

d Estimate fromcontribution due to fluoroscopic examinations in private practit'e.
• Including urethrocystography.

b

TABLEXIX.

Retroerade
pytlotrophy•

600
700
2,580
1,019
311
241
1,900
390
940
631
512
423
15
217
1,240
3,700
1,000
1,000
500
-765-

60
20
65
90
123
13
4
3
14
20
70
44

• Radiographs, 11ot examinations.
In these countries the two types of examinations are combined.
•Hip only; femur 011ly.

Uro1rap/1ydesc.ndint

GONAD DOSES AS SUBMITIED BY COUNTRIES AND EXAMINATIONS (FEMALES)( 111re111)

Argentina (Buenos Aires)• ................
Denmark .. , ....... , .. , ................
Federal Republic of Germany (Hamburg)
France .................................
Italy .............................. · ...
Japan .................................
Netherlands (Leiden) ....................
Norway ..................... ··········
Sweden• ...............................
Switzerland ............................
United Arab Republic ...................
United Kingdom ........................

Masss-uney.
chest

Chest,

15
0.2
0.3

10
0.1
0.7
30d
1.0
13
2

11
0.4
0.4
1
1.6
1.0
5
0.1

heart,

lune

2

4
5
5
5

Choltc:ystovaphy

90
16
35
105
156
80
4
8
17
299

• Ra<lioi;raphs, not examinations.
In these countries the two types of examinations are combined.
•Hip only; femur only.

i.

Sloma.eh,barium
meal

90
9
67
300
411
1,108
6
18
29
50
470
333

Uro1raphy
desetndint

Retroirade
pyelocraphy•

800
900
565
1,136
439
657
4,500
1,800
1,060
92
604
1,608
125
403
925
1,940
1,000
1,000
320
-585-

Abdomen

200
85
128
375
210
49
132
178
1,150
183

Obsl<lrieal
abdomen Ptl•imetr:y

900
822
600
1,200
1,250
322

800
190
680
1,600
399
162
100
400
265
1,500

800
1,080
1,500

367

745

Colon,
bari1on
enema

450
20
2,530
264
1,050
2,200
613
2,050
1,520
200
600
464

Pel•is

700
210
94
1,300
330
80
142
135
200
300

I.um bar
spin1

Lumbasacral

600
400
222
183
402
700
570
121
116
790
47
-592"--490h-

500

Hip,
upper
femur

Femur

600
58
214
180
-22331
140
10
159
35
260
300

270
392

102

d Estimate from contribution due to fluoroscopic examinations in private practice.

• Including urcthrocystography.

T AJJLE XX.

FOETAL GONOD DOSES AS SUBMITIE.D BY COUNTRIES FOR OllSTh'TIUCAL EXAMINATIONS(mrem)
Obsttlri,alabdomenFederal Republic of Germany (Hamburg) •.........•.......•
Netherlands (Leiden) •........•..•..•...••......••........
Norway •.....•...•..................•...........•.•.....

Obstetricalabdomen

677
100

2,900

JiOO

900

Sweden •.••••..••..•••.•..••......•.....•................
Switzerland .........•••....••...•..•.....................
United Kingdom ..••••...•..•••••.•......................

Ptloitntlry

910
800
723

4,500
835

.j>..

0

.......

TABLE XXI.

TOTAL ANNUAL GENETICALl.Y SIGNIFICANT DOSE FROM X-RAY DIAGNOSIS SUBMITTED DY COUNTRIES AND EXAMINATIONS( 111re111)
Alau

Argentinad(Buenos Aires) .......
Denmark ..•..........
Federal Republic of
Germany (Hamburg)
France ...•...........
Italy .................
Japan ................
Netherlands (Leiden) ...
Norway ...............
Sweden ...............
Switzerland ...........
United Arab Republic:
Alexandria ..........
Cairo .•.............
United Kingdom .......

Chl1t,

Stomatli,

Marl.

Clwletys·
lotrapliybariurn

lune

2.8

0.3

0.3

1.2

5.7
6.7

1.6
7.0

1.3
0.4

2.6
0.4

1.8
1.8

0.60
0.43
8.33
11.61

1.45
2.62
4.96

0.50
0.47

0.48
10.2
1.30

0.76
0.80
0.59
0.42
0.03
0.44
1.26
3.69

0.40
0.02
0.23
0.12

38•
1.39
1.48

meal

1.04

0.96

1.86
0.91
5.41
4.07

0.06
0.07
0.48

0.41
1.18
0.51

3.32
3.98
1.53

0.12

0.09
0.06

Urogr°J::h"dtscu1 int• Rounded-off total from national fi~ures.
In these countries the two types o examinations are combined.

hRttrograde
J>ytlouaJ>hy• Abdomensun•ey.
chest

1.40
0.44
1.73
1.04

0.35
0.40
2.82

Obstetricalabdomen Pelvimetry

0.69
6.68
0.72

Colon,
bariumenema

Lumbarsp;,,,

2.9

2.6
1.5

2.9
1.1

2.5

6.09
0.37
3.28
8.29
0.61
1.44
2.80
2.1

1.15

1.28
1.28
4.22
4.55
4.5
0.10
0.60
-2.71b-7.8 "2.1

4.78
1.66
0.55
1.22
3.13
3.1

1.5
l.23
0.21

0.60

1.15

3.39

Lumb~

Pelvissuer al

/UJ>,
"ppa
femur

Femur

Ot/1ers

1'oltll•

5.1
2.3

3.4
6.3

37
27.5

3.33
2.84
5.02
2.39
1.52
0.81
2.45
0.97

1.70
1.18
6.72
2.61
0.73
0.64
2.3
2.5

17.7
58.2
43.4
39.0
6.8
10.0
37.8
22.3

1.63

7.0
7.0
14.1

0.59
1.43

1.66
0.46
-3.11-

1.48

Includes contribution from fluoroscopic examinations in private practice.
These values include the contribution from private clinics and practices.
• Includes urethrocystography.
0dTAnI.E XXII.

Mass

Ciresi,suri•ey,htarl.

chtsl

Argc11lina (!3uenos Aires)
Denmark ...........•..
Federal Republic of
Germany (Hamburg)
France •........•.• , •.••~
0
Iv Italy •.•.•..•.•••••...•
Japa11 ...........•......
Netherlands (Leiden) •••.
Norway •.........•.....
Sweden ••.......•......
Switzerland •...•.•.•.••.
United Arab Republic:
Alexandria .•.........
Cairo ..............•.
United Kingdom ••••.•.•

lun1

Cho/ecystopaphy

8

65•
3

Stomach,bariummeal

COMPARISON OF PERCENTAGE TOTAi. GENETIC IJOSE FROM IJIAGNOSTIC
RAIJIOLOGY BY COUNTRIES AND EXAMINATIONSRetrograde
UroColon,
pytlobarium
1rapl1yObstetrical
descendint iraphy b .A.bdomm abdamtn Ptltim<lry enema

3

15
24

4
25

3

8

1
19
30

4

5

4

1
1
3

17
4

6

Lumbarspine

Lumbasacral

7

Hip,
upper
femur

Subtotal

Others

Total

14
8

92
77

8
23

100
100

89
98
79
96
89
93
94
88

11

7
6
12

100
100
100
100
100
100
100
100

13

100
100
100

Femur

4
2

7
2

5
7

8

7
5

8
4

3

3

34

6

18
3
4
5
4
7

4
1

2

1

1
1
1
4
3
17

1
0.3

7
2
10
12
12
2
9
-2721

19
5
-126
22

9

4

11

4
27
9
15
18

Pcltis

6
5
5

47
57
12

•Includes.contribution from fluoroscopic examination in private practice.

7
18
3

1
8
21
9
15
7
9

11

4
8
12
8
14

21
17
4

24

8

8
6

6

4

2
21
4
11

24
7
22

II Includes urethrocystography.

1087TABLE XX!II.

COMPARISON OF THE AN:SU.... L GENEI'ICALLY SIGNIFICANT DOSE ARISI:sG FROM X-RAY
DIAGNOSTIC EXPOSURE Di VAlUOUS COUNTRIES AND AREAS

Genetically sitnificanl dose (mwn)
JlakCountry or area

Femok

B

A

Argentina (Buenos Aires) ... : ...•.
14•l',io data
Austria ...•....••.•....... ·.,,···
Denmark ••••............•......
Federal Republic of .Germany. ·(Hamburg) .....•.....•.......
8.8
1Qb
France .••......•.......... :.. ' ..
Italy (Rome). . . .. .. .. .. .. .... . • .
21
Japan; ..•..... :;_.,, ......•. ·,·...;..
21:.
Netherlands (Leiden). . . . • . . . . . . .
3. 7
Norway ...•.............. "'.·":.: . ,,-?,?,
Sweden .••.••................ :..
20
Switzerland.....................
lOd
United Arab Republic:
Al.undria ...••...............
3
Cairo .•••.................•..
2.5
United Kingdom (except
Northern Ireland) .•....•......
S.1 •

Total

Foetus

B

A

A

23•
No data.

No data
No data

1Qb

;,1

20
18
2.7

s.o

IV
·16-25

1.J

18

No data
2.6
0.4
0.4

43 ± 35

9
12d

4
4.5
3.6•

v

29

VI
VII

VIII
IX

,\;,')'

6.8•
10 ±.338 ± 1022d

8:s· ;,No data

5.3•

17'
S8

39·~ d

1.1

I·

.. I

lobZ.

37•
28•

7.7

&ft:rtt'M

c

B

x

18.7•

S.7•

XI
. XII
XIII

:.;•J

7
7

XIV

14 ±1

XVI

xv

:;. A)s.coiµput~<\ 1~c;c:ording·P?.t?e,f9£'1lliµ~.O. ;== 1 2:. ~1: .,- 1: ; ·.di':1-;1.:,J11;;(1·.·,.:_ 1 _,;;~:.::.)'~-;•;.

!'1.,';"·~,_!:.j,··~J/!.ilj

B is computed according to the formula D = 2: n · d;..

. ' .: ~ -. ':,_,.'C is computed according to the formula~·":'., ~-~1 .-.p ..,·.. -, ..

I

(!..

l·•·'

1

l·:,,\,')--: ":.·,"

1•Arising from radio'graphy only.
.
.. d lnc!udes 'a' ·cpnt15hution from foetal exposure ansmg from"·Except for.1cbest examinations in private pra~tice· .. which "''obstetr1cal·eµ17Jmations . .,:·
. ,:...... -.
give a contribution of 38 mrem to the genetically significant
c 0.85 mrem, arising from examinations outside the Nationaldose and which cannot be split into male and female .figures. .• ,Health Service hospitals, are distributed among m,ale,. fem;ile•Does not include mass miniature radioizraphy.
' ."";.. ·and foetus.
'.-•·~ ·' · ·.r :r:"(l.1

t.:J:• I (t!'If,! ;:· ! "\ ~~-;~;I;;(..!,)

1( ,(i· l; f ' -!'U,ilo::: .i\i~l~ 1

~ ': .,\I(· 1.::

,

T,

,,:/J

.' 'J.11(ll.f}J ., , : Il}'/i!(;,()

JO.ll

c\'~

0 I

•I

1 .. ,•{;; ~ :···: ~r JI ; ~· •·~' ~~' f;. t ~.' 11; 1 I

c:1t .. ~·(J!!;,,ti_1\:;,(I{.)

f.-i J.t{ ~ .I.I

n.1

I ; 1.t I

IJ;J

"'

i (l

( .. (Io:J:-.,t'•t{~ ~ i ~ "! J i 1.I -'. ~ , i i~I:;'. ~);q''I/.•/ : I ::J';; I•e-;,·:,;.

~:I;;: f ·, I(';:,(l,,;, J;

: .!

l. i

; fl

.. '

..

·"

,.• J

LI.
:~ ;

U!l~

,,

J

j

10.11 1, •• ;,

: 1

· .•

.h

.

TestesChest ................................... .
Stomach (barium meal) ................... .
Colon (barium enema) .........••....•....•

0.00.H>.02
0.05 --0.2
1-lOQo•~I; . I:- • ,\

I '. '•. ,,'0.01--0.04
0.1 --0.3
3- 20!, ·.•

Radiography

1oct-:1 ,.~oey..

Naea'ral radiatiori .' .!'. ........ ·.~.:j ......... '..

. !! . ''.

}AP ......... ;·;; ... .-, ..,: ..

r,.,:,ii'1.:30- so10- so40-20020- 8010-30
4-8 . '.
30-2 00~·
40-siJoaJ.. ·, ·Chest .................................•..
Stomach ..•...................••........•,,. Colon ..... ~ .•.. ;, ............ , ..... ·"" .• ; ..... •.·Lumbar spine.Lumposacral joint :'"·' .. ·. '· ·:,~elvic region .
La~eral ... -, ........... , .
.l:f.D·~~ry blad~.l~r.;~; .::) ..;., ...... ~')), ....... ~'-"

0 ·. •

5~100

r , t 1. ~ 1

0•The testes in the primary beam.
b See:imnex:•C1 ;table·X.:1>.• • ,,~, ;w:-,c With scrotum protection ,.._, 10 mrem/sec. Ii:·:·d With scrotum protection 2-3 mrem/sec.

·'.C403

• '.

1. .

'. ~ ;( I( I ::'; .lt1:

_l
I

'
1'

30-100100-400

b:oi 4-14.00 'irirem/sec,hNole: Russell's experiments cover the following dosb-rate range,{I;: I J: ;.) • ';

'

,

~!·

~

I

L

'

'I

'

I

.,,

'.·

'
. .,1

.1,, ·.!.•,

: \.

l.

_; _;

"' "•'f.l ' ~ l

I •\

l

.'
I

d

Fluoroscopy

. I

i l

~

Dose rau (mum/sec)

Type of":111)

J,TYP~s19~X-R.w'~ici~i~j\TIONs' .·'.,,.. ··;";;,,,;;, :·::;: ...

ezaminalion•.. ~: ''·:.\\ I ;'"'"'' '''"''"' "i.Jii.i XXiV. 'pi«)~Al3il~sE-RA-r'is'~o!.Ali ~~ns~\mu;.d:v.Jubus' ~ . ;.... " .:·"
.:.

;~·

('

:,,1,, •.. ;TABLE XXV.

DATA ON THE ANNUAL GENETIC...\LL Y SIGNIFICANT DOSE FROM EXTEIL'>AL
RADIO-THERAPY FOR NON· MALIGNANT CONDITIONS

Sttrve)•, 1957-1958

Federal Repttblic of Germany (Hambttrg)S
Number of patients
lreoled per J ,OOO
of total
populatio11

Gonad dose (mrem)
Average figures

Annual teuticaUy significant dose
(mrem)

Loeolion

Mak

Femak

Mak

Femak and foetus

Mak

Femak

Fodus

Tol4l

Skin (various conditions) ...•

1.52

1.63

1.40

0.01

1.46

0.46

0.72

0.05

0.25

0.02

0.32

Other sites •••.••••••.•...•.

1.48

2.43

J-a
6,900
6,000
70-10,000

0.05

Spine ..••..•••.••••••.••••

0.1-"
390
800
40-3,000

0.18

0.22

n

0.40

TOTAL

3.5

4.8

0.28

1.87

0.03

2.2

•The dose ranges are due to various conditions and different
sites treated.

n denotes less than 0.005 mrem.

TABLE XXVl. DATA ON THE ANNUAL GENETICALLY SIGh'IFICAh"'T DOSE FROM EXTERNALRADIO-THERAPY FOR NON-MALIGNANT CONDITIONSSurve)', 1957

Fra11ce:1

L<>catwnN•mber of patimls
treald per 1,000of J.olal populaliorr

Gonad dose (mrem)..berage figures

Mak

Femak

Male

Femak

Male

FemaleFoetusTotal

5....h100

20....h200nn

No Data

n

900
2,800
14,2001,500
4,500
49,600

0.02
0.01
0.5

0.04
0.04
1.0

No Data
No Data
No Data

0.06
0.05
1.5

91,500100....h17,00099,500
20....h
8,000

0.5

0.5

No Data

1.0

0.2

0.3

No Data

0.5

1.2

1.9

Skin (various
conditions) .••••••.••••••.
Spine:
Cervical ..••.......•..•.•
Dorsal •.•••••••••••••••.•
Lumbar ..••••••••••••••••

0.31

0.38

0.16
0.04
0.25

0.22

Hip ••••..•••..••...•..•..•

0.04

0.04

Other sites •••••.•.....•.•..

0.26

0.29

TOTAL

1.1

1.2

O.o7
0.16

3.1

b The dose ranges are due to various conditions and different
sites treated.
n denotes less than 0.01 mrem.

• Reboul has calculated that 6.8 per cent of :!:N;d; oriiPnatesfrom patients below age 30. The subdivision into locations ismade under the assumption that this percentage is valid for all
locations.

TABLE XXVII.

Annual geu#cally si1rriji&anl dose
(mrem)•DATA ON THE ANNUAL GENETICALLY SIGNIFICANT DOSE FROM EXTE!L'>AL RADIO-THERAPY:FOR NON· MALIGNA..>\T CONDITIONS

Sm-,;ey, 1942-1951

N etherlands~s~umber of patierrts

treated PCT 1,000
of total
Population

Condi1io11
treatedGorrad dose (n:rem)
A rerate figures

Annual te11eticaUy sitnificant dose
(mrcm)

Mak

FemaleMale

FemaleJ,faleFemaleTotal

High gonad doses •.•.•..•.....

0.65

0.33

70

110

Low gonad doses ............ .

1.4(1.4)o1.16-5.Q3•(2.57-8.02)b
0.17

1.63
(3.i6)b(0.17)

2.79-6.66"(6.33-11. 78)b
0.34

TOTAL

2.1

1.7

(1)•

3.1-12.1• Based on actual number of children born to patients.
on total expected number of children averaged
throughout population.

•Female assumed equal to male.

b Based404

TABLE XX\rnr.

DATA ON THE ANNUAL GENETICALLY SIGNIFICANT DOSE FROM EXTERNALRADIO-THERAPY FOR NON·'..\IALIGNANT CONDITIONS

S11rvey, 195i-1958

U11ited Ki11gdom (except Northern Ireland)l9
Number of patientstreated Per 1,000
of total
pop:1la:io11

Coi:dition

Gonad dost (mrem).4 =erage figures

Annual geneJiccl!y significant dcse
(mrem)

treatedMale

FemaleMalt

Fem ale and foetus

Male

FemaleFoetusTotal

Skin conditions .••......

0.46

0.57

0.93

0.03

2.52

0.03

0.01

300-4
6,000
20,000

1.55

Ankylosing spondylitis ..
Arthritic and rheumatic~.:conditions ..••.......
Other non-malignant
conditions •.....•....

150-4
32,00050,000

1.07

0.08

n

1.15

0.02

0.02

0.18

0.05

0.27

0.07

160,000
20-a
50,0000.04

0.02

23,000
40-a
6,000

0.04

0.49

n

0.53

TOTAL

0.5

0.7

2.70

1.69

0.08

4.47

• The~dose ranges are due to various conditions and different
sites treated.

TABLE XX!X.

n denotes less than 0.005 mrem.

COMPARISON OF THE ANNUAL GENETIC,\LLY SIGNIFICANT DOSE ARISING FROM EXTERNALRADIO-THERAPY IN VARIOUS COUNTRIES AND AREAS
Annual genetically signiji<ant dose (mrem)
Non-malignant conditions

Country or area

Federal Republic of
0.28
Germany (Hamburg).
1.2
Franceb ••.••.•.•......
Netherlands ..•..•..... 1.33-8.19
United Kingdom except
2.70
Northern Ireland ..••

Malignant conditions
FemaleFoetus ·Sub-total

Total

Reference

2.2
3.1
3.1-12.1

O•-2.5"(0.5)d0.5O•No data
No data

0
2.5
1.0

2.2
5.6
4.1-13.1

6
27
28

4.47

0.41

0

0.52

5.0

19

FemaleFoetusSub-total

Malt

1.87
1.9
1.8-3.93

0.03
No data
No data

O•

1.69

0.08

Male

•Not subdivided into sexes.
d Female assumed equal to male.

•Fertility factors regarded as zero.
b Genetically significant dose calculated according

0.11

to formula

11.

TAllLE JL"{X. Cm.IPARISON OF GEJ.'TETICALLY SIGNIFICANT DOSE AND PER CAPITA DOSE CAUSED BY
EXTERNAL RADIO-THERAPY FOR NON-MALIGNANT CONDmONS
Mode of calculalion(doses in mrem)

N1!: ff •Country or area

Federal Republic of Germany (Hamburg). . • . • .
France •.......................•............
United Kingdom (except Northern Ireland)... .

TABLE XXXI."

Wi

w·di

!:

-ff ·d;

6.5
21
9

2.0
3.1

2.0

N

4.5

EsT:U.IATED DOSE-RATES TO THE GONADS FRO:.\! EXTER..'TAL RADIO-THERAPYFOR NON-MALIGNANT AND MALIGNANT CONDITIONSb
Dose role (mrem/ sec)
Orories

TestesLocation

0.01-0.05
2-5
20-50
0.008-1

Head .•••••••...................•.•... ·•···•··· 0.01-0.05
0.5-3
Thorax .•.•........•....•...................... ,5-15
Abdomen and pelvic region .................•.....
Skin (various sites) ...•....•....•.••.......•.•... 0.002-0.5
Natural radiation ..•............• , ............. .

3.10-G•Russell's experiments cover the following dose-rate range-0.014-1400 mrem/sec.
b Estimated on the assumption of 50 rad/min at the treatment site.

405

TABLE XXXI!. CoMPARISON OF THE ANNUAL'GENETICALLY SIGNIFICANT DOSE FROM THE
ADMINISTRATION OF R..o\DIO-ACTIV& ISOTOPES IN VARIOUS COUNTRIES AND AREAS
Gt1tdical1y si111ifi&ant

dose (mrem)Year of study. DiatP<osis

Therapy

1956

0.02•

0.4Qa

1111 , P=

37

195.h'':
1958 .

0.01

0.18

11 11

6

0.15

1111 , pa '

19 .

Jmc

38

Canada ••.. ; ..•.......•••••..
Federal Republic:of Germany._'J.
(Hamburg) .••...••••...•...
United Kingd6~, (except Nortiiern.
Ireland) •.......•..••..••••
U~ited States .
,, 1of America .••.•.•......•...

''<.

1957 ''-

l '.t

0.03. ,, .

'

0.24b

.!

•l

',I

•Computed accordintt to formula 11. No allowance made for the influence on fertility
Crom the severity of the, disease. , .
b Computed according td forffiula fa.':"".' "::
I .
' .
. "
0
Other radio-isotopes considered to be of no significance.

". '.''' . . . i ··.,

'!

.. ,

:1:.

t :·

. i

'

t':

'.

1·•••

..

:- -·.

TABLE.X:XXI!J;ANNUAL GENETICALLY SIGNIFICANT DOSE· FROM THE ADMINISTRATIONOF RADIO-ISOTOPES...... d;·it · •. ' ' I

Use 1 ,'

!

I

·i

' ~ [

:

',(I

tt ! I ' ~

: ·

'

,

I

'

Malignant diseases ......................... .
_· '.

,,,1 ·; . • r •·.

{ 1111pu; ;!·:.i ,,,'"I

Non·malignant conditions ••..••••••.••..•.••~.

Genetically si:nificant dost

Radio-isatopi>. DiagnO~·.·.'
Test doses •..•.•••••. , .•••.•....•.•. , •••••••
Therapy": l.United Kiiigdom (except Northeryi lreland)U;Survey, 1.957

.....

0.016
0.012

.. !

~

.;

:

''··

9

(;i
\,:··i

I

0.049
0.059
0.045

{Im
p=
Jiil

...

'
27
33

25

. o..~8±0.18,

TOTAL
i.,

..'>I•

Note. The contribution fr~m a"ther radio-isotopes is negligible.
·I

!''I

T ADLE XXXIV.

GoNAD DOSES IN MREM PER .WMINISTERED MILLICURIE OF
JlSl OR p32

Radio-isotope

Gonad dose (mrem)

450
450 (130-1,170)
1111 •••••••••••••••••••••••••••

600±300

pa ...........................

l&marksNormal physiologicalconditions
20 patients:
10 thyroid cancer
7 hyperthyroidism
3 others.
Normal physiologicalconditions.

&faen~e

37
39

40

2,600

Normal physiologicalconditions

37

7,000

Normal physiological· condition!

41

406

.'

':.ii.''It•·[

T AllU: XXXV.

MARROW DISTRIBUTION IN THE ADULT
Total

SiJe

Head.;;• •••• .-. •••.•... Cranium, mandible
Upper limb girdle., .... Scapulae, clavicles, head and neck of humeri
Thorax ••.•••..••..... Sternum
Ribs 1 to 12
Spine ................ Cervical vertebrae
Dorsal vertebrae
Lumbar vertebrae
SacrumLower limb girdle ..•... Pelvic bones, coccyx, head and neck of femora.:Mechanik0 , and Woodard and Holodny.~for ribs, sternum and vertebra at age 40. Other
values assumed in study.
• Ellis}7
d Half the contribution of 10 per cent from "other" (e.g. in

actiPeinga

actiPema"ow•

ma."owin g•Ellis"

tu commitkr

182
116
39
20i
47
197
152
194
364

0.75
0.75
0.6
0.4
0.75
0.75
0.75
0.75
0.75

140
85

13
8

10
5m

i.sl

25

25

85
35
150
115
150
270

3.5
14
11

26

Epp ~t al. U .S.A.• 11

Mean marrow doie (mrem)1958 &port oflheCommillee"'

Buhl"
DenmarJ:b

AP

Lal.

200
100

10
30
50

3
90
180

70
35

180

PA 1.3

4.5

50

Head •••...••...•....................
Spine •..•...•.•....•.•.........•.•.. ·Cervical ••.•.............••...•..•..
Dorsal •.......••........••.....••..
Lumbar ..........................•.
Lumbosacral region .. , ......•..•••.....
Pelvis .••..••.....•..•................
Hip, incl. upper femur .............•...
Arm and hand ........•....... , , , .....
Thorax (ribs and sternum) ...•....••..•
Chest (regular) •.....••....•...••......
Gall bladder. •........•........•.•. , ..
Stomach (barium meal), upper GI. •.....
Colon (barium enema), lower GI .•...•..
Abdomen ••••......••...••............
Urography .....••.•..........•.......
Retrograde pyelography ........•.......
Urethrocystography .......•.•....•....
Pelvimetry ...............•........•..
Obstetrical abdomen .........•......•..
Hysterosalpingography ..........•......
Dental. ....•...............•.•...••..

50
400
400
300
20
30
2
200
40
400
500
700
50
200
100
300
800
100
100
20

30
20
0.2
150
20
150
200
200
30
80
30

25

•Radiography only.
.,,J. , ;,•;_l :.,, r·,;1.·.,,.:·1 '.•, '''b In Buhl's investigation the dose calculations are b~~d.. up~h the figures 'for the distribution',. ·of active marrow presented by the Committee 3•
The technical factors used are those of the Memorial Hospital, New York. The doses arethose that arise from well collimated and aligned fields. The dose due to the scatter outside thedirect beam has been included but not the effect due to the photo-electrons from the bone.
0'·,r; ',:,·:/,"-,i_;._ ,;J;·: h::. ,:·:·: 'lq '1'r~_c;1',j,J1,;_ '·:'.
1

'. ~;

, . ;,;::•;:·.:~ :J.):·.'TABLE XXXVI!. INDIVIDUAL AND PEi.CAPlTA iIEAN.:i.JARROW DOSES IN SO~!E COUNTRIES ARISING
FRmI, MASS SU~VEY. ,i.uoROSCOPY .OF :rHE CHEST. AND COMPARlSON WITH C.~CULATED PER
c....Prtli."rxMis'FRoiii:'ilADi:CiGR.~PHY''';'::• \•'\i:.,,.:: ·'·,,;;.;;::· :: i:.! '.··;:··::,,.,; ..«:
1

-'

,, .

· .. ..

, ': '~

Mean marro1D ®se (mrem)<.::)

Per eapila
dose if

Number ofe~arr.inations! fier:1;000
\'

;

.. :

Per eapila

oj lotaf,

1 p·opula/~on•

Au'si:ria ..... .':::~.:: ..•.... 5·.';: .< ..••.•.. ;:;\':·:<. ;,25
I\elgium ..... ~.•..•.•... , . ~ ..• ~ ..•.•.••••.• ._40

14

MEAN MARROW DOSES FROM DL~GNOSTIC X-RAY EXPOSURE(EXCLUDING MASS SURVEYS OF THE CHEST)&:amination

1958 r1por1 of20•

extremities, etc.) in the 1958 report of the Committee (annex C,
para. 44).
•The contribution from pelvis and half the contribution of 10
per cent from ''other" (e.g. in e."<tremities, etc.) in the 1958
report of the Committee (annex C, para. 44).

b Custer's

TAllU: XXXVI.

.A.eti:e manes Per ctnJ

Total

Fra&lion

man-ow'". 26' ;France ..... .':';". ....... :.-:.:·,·; ........ ".';. '''·'570
sP4iln ...... :;;;:'1 . <.......... \'. ............. I. : 5·
Switzerland. ;· ~ ; ~< ! •••••••• L . . . . . . . . . . . . .

60

IIndividual .

2,000
'380
1,200
1,300 '
230••Figures taken from table XVII. . .' · . . ·,'··b Mean marrow dose per examination assumed tci be 100 mrem•;407

radicgraf>h:t· · in total· ·, is used•: ··imlead of

50.10 ....
680. .2~6 ; j. populaJwn · . ftuor,os"'P:I>

... 8
. ,14

2.5

57

.Q,5-".6

I

TABLE XXXVIII.

EXAMPLES OF MEAN MARROW DOSES IN EXTER.."'AL
RADIO-THERAPY"

A!ean marr1r.t1 close (rem)Site or e<>ndition

Cervical spine, 10 X 15

Type of radialion

Per 100 r skin dose

cm................... X-rays (170 keV,

2.6

filter 0.5 mm Cu)
Lumbar spine, 10 X 15 cm .•..••••..••.••.••• X-rays (170 keV,
filter 0.5 mm Cu)
X-rays (170 keV,
Hip, one side, 10 X 15
filter 0.5 mm Cu)
Carcinoma of cervix.. . • . . • • . . • • . • . • • • . . . . • • . • Radium (applicators
containing 50, 75 or
87.5 mg Ra)
Haemangioma•. • • . . • . • . • • . • . • • . . . • • . • . • • . • • • Radium (applicators
containing Ra ranging
between 8(H30 mg)

TABLE XXXIX.

54, 55

5.5

cm ....................

•With the exception of those for haemangioma Ellis's fiiures
for the distribution of active bone-marrow have been used (table
XXXV).
b The values of total skin doses used in references 54 and 55
range from 300 rem to several thousand rem delivered overmore than one course of treatment.
• Children below two years age. According to paragraph 78,
it is assumed that only red bone-marrow exists. The distributionof the active marrow is taken from Woodard and Holodny0

Total treatment

2.5
60-10056

0.5-25d57

under the assumption that the distribution of marrow space inchildren and adults is the same. The following distribution figures
were used: upper limbs 123, lower limbs 393, ribs 7%, head 7o/£!
spine 153, scapulae 23, clavicles 1 %. sternum 1 %. pelvis 16'10
of total marrow space.
d The range covers various sites of the haemangioma. The
highest fi~ures are received when the haemangioma are situatedon the skin of the abodomen and the thigh.

E.Ju.MPLES OF RADIATION DOSES IN VARIOUS KINDS OF RADIOLOGICAL PROCEDURE TO
ORGANS AND TISSUES OF SPECIAL INTEREST

Diagnosis
Examination

TissueFoetal tissue(a) age < 2 months ...•(b} age > 7 months •.•.
Lens of the eye .••..•••

Thyroid ..••••••••.•.•

Thymus •••••••..•...•
Liver •.••.•••••.•••..•

Dose remN on-maliinanl condition

Maliinant condition

Dose rem

See tables in this anne.-..-assume foetal dose is same as maternal gonad dose
1-3
Pelvimetry
Obstetric Abdomen"'°·5
Dental (full mouth)
5-25
Retinoblastoma(dose to unaffected eye)
5-20
Encephalography
Head lesions
Cervical spine
Uptake from40
400-1,200
25 µC 1131
2-10
Tonsillitis
150
Ba Swallow
Thyrotoxicosis JUI
10,000
Enlarged gland"'200
2,100-5,400
20 cc Thorotrast(over 20years)TABLE XL.

ESTIMATES OF RADIATION DOSES IN THOROTRAST PATIENTS(20 ml injection)

Estimates of Th 232 activity111: 0.02l7 µc/ml (German), 0.0244 µc/ml (U.S.A.)

TiSSIUl

Skeleton .......................
l\1arrow ..•....................
Bronchi .•......................
Lungs .........................
Liver ..........................
Spleen •••......................

RadioadiresourceAreragedose-rate
rad/yAca.mulatedrem•(ZO years)

Th=32 + d
Th:!32 + d
Thoron+daughter
Thoron+daughterTh 2!2 + d

1.4-3.0
1.2-2.9

600
580

116

12-19

3,800

117

0.8-1.9
27
71

380
5,400
14,000

117
118
118

Rcfcrt11ce

59•The RBE value used in this report for"' particles is 10, but l\farinelliH suggested that therange of RBE values in this case may be between 4-10.

408.......200
100-1,500

TABLE XLI.

RA:sGE OF NUMBERS OF INSTALI.ATIO:SS AND OCCUPATIONALLY EXPOSEDPERSONS PER 1,000 OF THE POPUL.-\TION
Numbtr of

Number of workers
directly engaged inradiation UJork

installatlon.s
Ptr 1,0CO
of kJtal(tier l ,000 of totaJ
population)

population

Medical:Diagnosis ......... , ......... ,, .... .
Therapy ..........•............. , .•Dental., ............................ .
Veterinary ..•........................
Industrial. ....•.•.............•......
Research and educational ......•....••.
Atomic energy .......••...............

TABLE XLII.

Co1rlribution
kJ Iii< annual
teneticallysigni}kan: dose

0.1-0.7}
0.02-0.1
0.1-0.80.004-0.03
0.003-0.02
0.01-0.03(mrem)

0.3-0.5""'0.90.1-0.3

0.05-0.06""'0.020.1-0.3

0.1-0.2

MEAN ANNUAL DOSES (IN MREM) OF EXTERNAL X- ANDY-RADIATION TO VARIOUS
GROUPS OF OCCUPATIONALLY EXPOSED PERSONS

Uniltd Ki111dom'I
Type of work

ArgenJina•

Canada a(1959-1960)(1959)

Medical:Diagnosis •...... }Therapy ........
Dental •.•••..•...
Veterinary ..••••..
Industrial. •.•.....
Research andeducational .••••
Atomic energy .••••

300-1,400b

70

430

(1960)

Male

Female{50-380
2,000
170
400
110
(1,900)d

440
1,900

500
1,600

1,100•

380

40

27

(1960)

150-225•640

400-1,000b

180}

100-SOOb(1959)NOTVJay"

N elherlandJD{

420•The lower figure concerns private practitioners: the higher, hospitals.
b The range of observed values is given.

• Both X-ray and gamma-radiography.
d The dose within brackets concerns gamma-radiography only.

TABLE XLIII. RESULTS FROM MONITORING RADIATION WORKERS AT THE OAK R.mGE N..\TIO:SAL LAlloRATORY, USA, THE
ESTAllUSHYE...,.TS OF THE UNITED KINGDOM ATOMIC ENERGY AUTHORITY, ARGENTINA, CANADA AND THE UAR(Penetrating radiation)
Oak Ridge NaJional
Lab01atorya(1959)

Artenlina"(1959-1960)

UAR"

CaP1ada"(191$1)(1959)(1959)

person.s

Peru111/J<TS011$

Per cent

No. ofpersoKS

Per "1ll

No. ofNo. of
Person.s Per ""' persoKS Per <enJ

4,695

100

16,374

100

579

100

423

100

600

100

1,492•

9.1

12.4

9

2

4

1

4.5

6°

No.of

Total wearing dose mders or films............

United Kintdom Atomic
Energy Authority"
No.of

Annual dose (rem)> ! ...................................
> 2 ••••••.••••....•.••...•....•.••••••

441

9.4

179

3.8

> 3 •••........•.............•..•....••>4 .•.•...........•............•.•..•.
>5 .................•...•......•...••.

74
35
10

1.6
0.75
0.21

> 6 ••.....................•....•....••

8
2

0.15
0.04

0

0.02
0

> 7 .•.....••...........•..............
>8 ...•..•..............•.............
>9 .••.....•..........................

•Annual dose > 1.5 rem.
l"'\,b Three individuals received annual doses of 17.2, 10.3 and10.7 rem.

2.6
0.81
0.26

417
133
43
22

0.13

6
3
3b

0.04
0.02
0.02

•In range 2.0-4.9 rem.

409

2.0
0.6

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