DTRA / NTPR - Standard Operating Procedures Manual 

RA05 – Expedited Processing of Radiation Dose Assessments for NTPR Hiroshima and Nagasaki Veterans 

Revision No.: 2.1 

Date: 4/18/2017 

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DEFENSE THREAT REDUCTION AGENCY 

NUCLEAR TEST PERSONNEL REVIEW PROGRAM 

RADIATION DOSE ASSESSMENT 

STANDARD OPERATING PROCEDURE 

RA05 – Expedited Processing of Radiation Dose Assessments 

for NTPR Hiroshima and Nagasaki Veterans 

Revision 2.1 

Key to SOP ID Codes 

RA (Radiation Assessment - SOP) 

ED (External Dose - Standard Methods) 

ID (Internal Dose - Standard Methods) 

UA (Uncertainty Analysis - Standard Methods) 
 

 

 

 

 

 

 

 

 

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RA05 – Expedited Processing of Radiation Dose Assessments for NTPR Hiroshima and Nagasaki Veterans 

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Date: 4/18/2017 

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Revision Control 

Revision Revision Description Revision Date Authorization 

Official 

1.0 Original Version 6/1/2015 Daniel N. Mannis 

1.1 Minor text edits, Section 5.8 removed the requirement to 

compare Full RDA doses to the EPG dose values, Section 

5.6 added the option for a consult or detailed Full RDA, 

removed reference to DTRA-TR-15-044 as it is not in 

publication yet – replaced with NTPR-TM-14-02, and 

removed references not used in this procedure. 

6/23/2015 Daniel N. Mannis 

2.0 Updated the doses in Table A1-1 to reflect weathering 

effects; clarified further evaluation actions, primarily in 

Sections 3.3 and 5.5, and Figure 1; deleted previous 

Section 5.5; replaced all references to NTPR-TM-14-02 

with DTRA-TR-15-044; other text edits to improve 

clarity, consistency, and to correct minor errors. 

2/8/2016 Daniel N. Mannis 

2.1 Minor changes to some rounded doses in Table A1-1; split 

Table A1-1 into three tables; clarifications to the text in 

Sections 5.5.1 and 5.7; other minor editorial changes. 

4/18/2017 Lee A. Alleman 
 

 

 

 

 

 

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Table of Contents 

1. Purpose and Summary .................................................................................................... 5 

2. Scope.............................................................................................................................. 5 

3. Responsibilities .............................................................................................................. 6 

3.1 NTPR Researcher.................................................................................................6 

3.2 DTRA NTPR Program Manager/Radiation Dose Analyst.....................................6 

3.3 Radiation Dose Assessment Analyst.....................................................................6 

3.4 Quality Assurance Auditor...................................................................................7 

4. Definitions...................................................................................................................... 7 

5. Procedure: Detailed Activity/Task Description ............................................................... 9 

5.1 Initial Case File Review by NTPR Researcher .....................................................9 

5.2 Identification of Standard Organ ..........................................................................9 

5.3 Decision Summary Sheet Documentation by NTPR Researcher .........................11 

5.4 DTRA Analyst Case File Review.......................................................................11 

5.5 Identifying the Need for Further Evaluation of the Case .....................................12 

5.5.1 DTRA Analyst Additional Review .........................................................12 

5.5.2 Full Radiation Dose Assessment.............................................................13 

5.6 Assigning Default Expedited Processing Group Dose Components ....................13 

5.7 Assigning Dose Components from a full Radiation Dose Assessment ................13 

5.8 Completion of Decision Summary Sheet ............................................................14 

5.9 Quality Assurance Auditor Review ....................................................................14 

6. Data and Records Management......................................................................................14 

7. Quality Control and Quality Assurance..........................................................................15 

8. Referenced NTPR Standard Operating Procedures.........................................................15 

9. Reference Materials.......................................................................................................15 

Attachment 1 Expedited Processing Group (EPG) Doses for H&N Participants ...................16 
 

 

 

 

 

 

 

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RA05 – Expedited Processing of Radiation Dose Assessments for NTPR Hiroshima and Nagasaki Veterans 

Revision No.: 2.1 

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List of Figures 

Figure 1. H&N Dose Assessment Process Overview ................................................................10 

List of Tables 

Table A1-1. Whole Body and Internal Organ Expedited Processing Group (EPG) Doses for 

H&N Participants ....................................................................................................17 

Table A1-2. Eye Lens and Skin Expedited Processing Group (EPG) Doses for H&N Participants 

................................................................................................................................18 

Table A1-3. Expedited Processing Group (EPG) Total Organ Doses for H&N Participants ......19 
 

 

 

 

 

 

 

 

 

 

 

 

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RA05 – Expedited Processing of Radiation Dose Assessments for NTPR Hiroshima and Nagasaki Veterans 

Revision No.: 2.1 

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Standard Operating Procedure 

RA05 – Expedited Processing of Radiation Dose Assessments for NTPR Hiroshima and 

Nagasaki Veterans 

1. Purpose and Summary 

This standard operating procedure (SOP) describes the roles, responsibilities, and 

methodology for processing Department of Defense (DOD) Defense Threat Reduction 

Agency (DTRA) Nuclear Test Personnel Review (NTPR) radiation dose assessments 

(RDAs). These assessments are performed in response to requests from the U.S. 

Department of Veterans Affairs (VA) on behalf of NTPR Hiroshima and Nagasaki 

(H&N) veterans. In particular, the SOP provides specific criteria and detailed actions to 

accomplish expedited processing of the majority of H&N cases received by DTRA. 

Expedited processing involves assignment of upper-bound group-based estimated 

radiation doses to veterans with qualifying potential radiation exposure scenarios. 

Expedited processing of H&N RDAs supports more timely response to VA requests and 

more timely decision-making for veterans’ claims than if individual-specific, full RDAs 

were performed for every case. For H&N cases not qualifying for expedited processing 

under the criteria in this SOP, direction is provided for conducting full RDAs for those 

cases, including reference to appropriate DTRA NTPR SOPs. Finally, requirements and 

procedures for data and records management, and associated quality assurance (QA) 

activities are provided for completion of case processing. 

This SOP is written for qualified NTPR researchers, DTRA analysts, RDA analysts, and 

QA auditors who process and evaluate H&N veteran cases received from the VA, and for 

managers who oversee the entire dose assessment process. The SOP conforms with 

procedures, methods, quality standards of assessment products, and established NTPR 

policies and guidelines. 

2. Scope 

This SOP applies to all radiation dose assessments for H&N participants, defined as 

veterans with qualifying exposure scenarios resulting from participation as World War II 

(WWII) Prisoners of War (POW) in Japan, or as members of the post-WWII occupation 

forces that moved in or around Hiroshima and Nagasaki, Japan. All H&N participant 

cases are initially evaluated for eligibility for expedited processing, and qualifying cases 

are processed according to the detailed methodology described herein. The doses to be 

assigned under expedited processing described in this SOP are well below the doses that 

would result in service connection for a claimant. Cases that do not initially qualify for 

expedited processing under the criteria in this SOP require more individualized dose 

assessment as discussed in this SOP. The SOP is applicable primarily to cases involving 

cancers of one or more internal organs or skin, but is also applicable to non-cancerous 

conditions. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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The expedited processing methodology addresses all aspects of radiation dose 

determination to satisfy the requirements of Title 38, Code of Federal Regulations, Part 3, 

§ 3.309 Disease subject to presumptive service connection and § 3.311 Claims based on 

exposure to ionizing radiation. The methodology described in this SOP assures that 

radiation dose assessments provide full consideration of benefit of the doubt as 

implemented in response to DTRA’s guidance for assuring consistency with Department 

of Veterans Affairs requirements in 38 CFR 3.102 (VA, 1985). 

3. Responsibilities 

3.1 NTPR Researcher 

The NTPR researcher is responsible for conducting the initial case review. The NTPR 

Researcher completes the input fields of the DTRA Decision Summary Sheet (DSS) that 

provide historical and dose-related information from the Nuclear Test Review 

Information System (NuTRIS) database. The NTPR researcher shall also summarize 

veteran’s comments with clarifications and responses based on historical and dose-related 

information from records and document any special considerations in the DSS. 

3.2 DTRA NTPR Program Manager/Radiation Dose Analyst 

The DTRA NTPR Program Manager or designee in the position of DTRA NTPR 

radiation dose analyst (DTRA analyst) performs the majority of tasks required to assign 

Expedited Processing (EP) doses, including: 

• reviewing veteran-provided, historical, NTPR-developed, and other radiation-related 

information pertinent to the veteran’s potential exposure; 

• determining the need for additional, veteran-specific information; 

• determining the applicability of the EP dose assignments to an individual veteran’s 

case; 

• determining the need for, and if necessary, providing or requesting further evaluation 

of a case to determine the applicability of the EP dose assignments; 

• documenting the radiation dose assignment evaluation and decision-making process 

in the DTRA DSS and/or the VA response letter; 

• assigning EP doses, if applicable, and documenting the assignment in the DTRA DSS 

and/or VA response letter; and 

• reviewing the results of QA auditor reviews, as applicable. 

3.3 Radiation Dose Assessment Analyst 

At the request of the DTRA analyst, the RDA analyst provides consultative discussions 

during any further evaluation of a case by the DTRA analyst, to assist in determining the 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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applicability of the EP dose assignment. In addition, the RDA analyst may be requested 

to perform a full RDA in accordance with SOP RA01 (DTRA, 2017). 

3.4 Quality Assurance Auditor 

The quality assurance auditor (QA auditor), with the assistance of a QA reviewer as 

requested, performs and documents independent quality assurance/quality control 

(QA/QC) reviews of the decision-making process and the resulting dose assignment as 

documented in the DTRA DSS and/or RDA documentation to assure that they are clear, 

complete, and prepared in accordance with NTPR policies and procedures. The QA 

auditor documents the results of the review on a QA/QC Review Report for Decision 

Summary Sheet. 

4. Definitions 

DOD 

Dose component 

DSS 

DTRA 

EP 

EPG 

EPG Dose 

Full RDA 

Department of Defense 

Potential contributors to total organ dose, including: 

 neutron dose; 

 initial gamma dose; 

 external gamma dose from residual radiation; 

 external dose from other sources (e.g., check sources, 

calibration sources); 

 internal alpha dose; and/or 

 internal beta-plus-gamma dose. 

Decision summary sheet (DTRA, 2017, SOP RA02, 

Attachment 4), an electronic NuTRIS database report 

documenting key information and results of the DTRA NTPR 

dose assignment process, including: 

 historical veteran participation and dose-related information 

from the NuTRIS database; 

 a summary of veteran comments with DTRA NTPR 

clarifications and responses based on historical and doserelated information from records; 

 documentation of the DTRA NTPR evaluation and decisionmaking process for dose assignment; and 

 the assigned doses. 

Defense Threat Reduction Agency 

Expedited processing. 

Expedited processing group as documented in McKenzie-Carter 

and Egbert (2015). 

Expedited processing group dose, the estimated upper-bound 

dose value for external gamma, internal alpha, and internal beta 

plus gamma radiation. 

An RDA developed by an RDA analyst that uses veteran-specific 

dose parameter values to estimate doses and upper-bound doses in 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Further evaluation 

H&N 

LD 

NIOSH-IREP 

NTPR 

NTS 

NuTRIS 

POW 

PPG 

PM 

QA 

QC 

RDA 

SOP 

Surrogate organ 

Target organ 

TOD 

VA 

VBDR 

XP 

accordance with SOP RA01. A full RDA is performed for cases 

that are excluded from expedited processing. 

Case file evaluation beyond the initial review by the DTRA 

analyst. Further evaluation of an H&N case may include: 

 an additional documented DTRA analyst review, 

supplemented with a consultation with an RDA analyst as 

needed, or 

 a full RDA prepared in accordance with SOP RA01 (DTRA, 

2017). 

Hiroshima and Nagasaki, locations included in the NTPR 

program for selected World War II POWs and post-World War II 

occupation forces during specified time periods. 

Limiting dose, radiation dose values taken from 

McKenzie-Carter and Egbert (2015) 

National Institute of Occupational Safety and Health Interactive 

RadioEpidemiological Program, a computer code used to 

calculate the probability that a cancer was caused by a radiation 

dose. 

Nuclear Test Personnel Review 

Nevada Test Site, a site of U.S. atmospheric nuclear weapons 

testing. 

Nuclear Test Review Information System, a computer database 

of veteran information and assigned doses and upper-bounds. 

Prisoner of war; a veteran held as a prisoner by the Japanese 

during World War II. 

Pacific Proving Ground, a site of U.S. atmospheric nuclear 

weapons testing. 

Program manager 

Quality assurance 

Quality control 

Radiation dose assessment (see “Full RDA” above) 

Standard Operating Procedure 

An NTPR standard organ used for dose calculations as a 

substitute organ when no published dose conversion factors are 

available for the requested disease or medical condition. 

The biological organ or tissue that is associated with the specific 

medical condition for which a radiation dose determination has 

been requested by the VA. 

Total organ dose, the total of all external and internal dose 

components for a target organ. 

U.S. Department of Veterans Affairs 

Veterans’ Advisory Board on Dose Reconstruction 

Expedited processing methodology as documented in SOP RA02 

(DTRA, 2017). 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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5. Procedure: Detailed Activity/Task Description 

The methodology for expedited processing of qualified NTPR H&N cases described in 

this SOP utilizes the expedited processing group (EPG) upper-bound doses documented 

in McKenzie-Carter and Egbert (2015). These EPG upper-bound doses were developed 

for three broadly-defined groups of exposed individuals: participants of the occupation of 

Hiroshima, participants of the occupation of Nagasaki, and former POWs in Japan. The 

EPG doses are not intended to be representations of doses actually received by an H&N 

veteran. However, the EPG doses bound the actual doses received by any individual 

included in the EPGs. 

The major SOP activities are shown in the process overview diagram (Figure 1). The 

responsible NTPR personnel and more detailed activities are described in the narrative 

below. 

5.1 Initial Case File Review by NTPR Researcher 

The decision to expedite or otherwise respond to a VA claim inquiry starts with review 

by the NTPR researcher of the program participant’s identified diseases and the request 

and receipt of required records and other information in accordance with the NTPR 

Program Support SOP (DTRA, 2015). 

The NTPR researcher reviews case file information that may include, but is not limited 

to: 

• veteran-provided information, including comments, identification of unusual 

exposure conditions, and answers to follow-up questions regarding the exposure; 

• VA-furnished information, particularly the diseases or target organs for which the 

doses are requested; 

• other historical veteran- and operation-specific information; and 

• previously-determined veteran-, cohort-, and/or operation-specific radiation doses. 

5.2 Identification of Standard Organ 

The NTPR researcher uses the VA dose request, which specifies the target organ, tissue 

or disease, to identify the corresponding NTPR standard organ. This is done using SOP 

RA02, Attachment 2 (DTRA, 2017). The identified NTPR standard organ is either the 

same as the target organ, or in the case where the target organ or disease is not an NTPR 

standard organ, it is a surrogate organ for the specified target organ, tissue, or disease. 

The NTPR researcher documents the identified standard organ in Part 2 of the DSS. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DTRA / NTPR - Standard Operating Procedures Manual 

RA05 – Expedited Processing of Radiation Dose Assessments for NTPR Hiroshima and Nagasaki Veterans 

DTRA Analyst 

• Conduct further evaluation of the case, including consultative 

discussions with RDA analyst as necessary 

• Request full RDA from RDA analyst if necessary 

• Document results of the further evaluation of the case, to include 

a summary of any consultation with RDA analyst 

RDA Analyst (if requested) 

• Review case file 

• Consult with DTRA analyst, transmit record of discussion to 

DTRA analyst 

• Perform full RDA and document in RDA report with associated 

dose calculations 

DTRA Analyst 

• Review full RDA report, if applicable 

• Assign upper-bound doses as applicable 

• Complete dose assignment items in DTRA DSS and/or draft VA 

response letter 

QA Auditor 

• Review case file with completed DTRA DSS, draft or final VA 

response letter, and any RDA analyst information from further 

evaluation of the case; 

• Document QA review on QA/QC Review Report for transmittal 

to NTPR researcher and DTRA analyst 

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NTPR Researcher 

• Review case file 

• Identify target/surrogate 

organ(s) 

• Enter DTRA DSS items 

• Forward Case File with draft 

VA response letter and DSS 

to DTRA analyst 

DTRA Analyst 

• Review case file 

• Determine need for 

additional, veteran-specific 

information 

• Determine if there is a need 

for further evaluation of the 

case 

• Complete DTRA DSS items 

for case evaluation, 

decision-making process and 

Analyst’s Comments, 

including reason(s) for 

further evaluation of the 

case, if applicable 

No 

Yes 

Is further 

evaluation 

of the case 

needed? 

Figure 1. H&N Dose Assessment Process Overview 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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5.3 Decision Summary Sheet Documentation by NTPR Researcher 

Following initial case review, the NTPR researcher completes Part 1 of the DTRA DSS 

shown in SOP RA02 (DTRA, 2017), Attachment 4. In completing Part 1, the NTPR 

researcher summarizes veteran comments, particularly those that might pertain to, or that 

the veteran might expect to pertain to, potential radiation exposure. The NTPR researcher 

clarifies or responds to issues raised by the veteran when pertinent historical information 

is available to do so. 

The NTPR researcher also completes applicable items on Part 2 of the DSS, and 

identifies the EPG doses corresponding to the target organ reported in Table A1-1 and 

Table A1-2 (Attachment 1 of this SOP). 

The NTPR researcher prepares a draft response letter for reporting NTPR assigned doses 

to the VA. For VA dose requests that are for a specific disease instead of a physical 

location or organ, such as chronic lymphocytic leukemia (CLL), the requested disease 

should be indicated in the draft VA response letter. 

The NTPR researcher then forwards the case file, including the DTRA DSS and the draft 

VA response letter, to the DTRA analyst for evaluation and dose assignment. 

5.4 DTRA Analyst Case File Review 

The DTRA analyst reviews available case file information, including Part 1 and 

completed portions of Part 2 of the DTRA DSS. During this review, the DTRA analyst: 

• reviews the case file, including as applicable the NTPR researcher-summarized 

information, veteran comments, and clarifications and responses to the veteran’s 

comments that are documented in the DSS; 

• verifies that the NTPR standard organ is correctly identified and, if necessary, 

requests an expert medical opinion. If there is a question regarding the applicable 

standard organ or the radiogenicity of a medical condition, the DTRA analyst 

should seek a medical opinion from a qualified physician knowledgeable in 

radiogenic illnesses; 

• determines the applicable EPG(s); and 

• determines the need for and, if needed, requests additional veteran-specific 

information. 

Following review and any subsequent actions as identified below, the DTRA analyst 

completes the remaining items in Part 2 of the DSS to include the Dose Decision, Analyst 

Comments, External and Internal Organ dose assignments, and the required approval. For 

VA dose requests that are for a specific disease instead of a physical location or organ, 

such as CLL, the Standard Organ from SOP RA02, Attachment 2 (DTRA, 2017), should 

be used for the Internal Organ(s) on Part 2 of the DSS. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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5.5 Identifying the Need for Further Evaluation of the Case 

During review of the case file, the DTRA analyst determines whether the applicable EPG 

Total Organ Dose (TOD) can be assigned, or if the case requires further evaluation in 

order to assign the appropriate dose components. The case requires further evaluation if it 

involves any of the following: 

• the applicable EPG Total Organ Dose (TOD) is greater than the corresponding 

Limiting Dose (LD), as identified in Table A1-3; 

• the veteran was permanently assigned to RadSafe duties, or 

• the veteran incurred unique exposures not consistent with the associated EPG 

scenario and parameter assumptions in McKenzie-Carter and Egbert (2015) that 

could have resulted in higher doses, 

Note that cases involving one-time or occasional contact with or handling of a 

potentially-contaminated item do not necessarily require any further evaluation. For 

example, some veterans have claimed that they picked up small items from one of the 

cities and carried them around or kept them as souvenirs, or that they climbed onto 

potentially contaminated structures; these cases have been previously evaluated with the 

conclusion that potential doses are below the EPG doses contained herein. 

When further evaluation of a veteran’s case is required in order to determine the 

appropriate dose components, it will involve additional review by a DTRA analyst, 

and/or a full RDA. These actions are described in the following subsections. 

5.5.1 DTRA Analyst Additional Review 

A DTRA analyst may be required to conduct a more detailed review of available 

information in order to determine the appropriate dose assignment. Typically this more 

detailed review is used to determine if the veteran’s specific exposure scenario clearly 

indicates that the EPG TOD is bounding to the veteran’s actual TOD, or if there is a need 

to perform a full RDA due to indications of potential exposure beyond the conditions that 

define the applicable EPG. 

The DTRA analyst may request informal consultation with an RDA analyst during this 

additional review. This consultation will normally consist of only brief discussions and 

possibly minimal calculations or data evaluation, in order for the DTRA analyst to be 

able to determine if the EPG doses are adequate to assign or if a full RDA is required. If 

the RDA analyst is consulted during the review, the RDA analyst transmits a brief 

communication to the DTRA analyst to document the consultation. 

If, after additional review, the DTRA analyst determines that EPG doses are adequate to 

assign (the veteran’s actual TOD is less than both the EPG dose and the LD), the DTRA 

analyst documents a brief summary of the review in Part 2 of the DTRA DSS. All 

pertinent results of the DTRA analyst review are documented in the Analyst Comments 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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of the DTRA DSS. If the EPG doses cannot be assigned, the case is excluded from 

expedited processing and the case is referred to an RDA analyst for a full RDA. 

5.5.2 Full Radiation Dose Assessment 

When the DTRA analyst determines that the case is excluded from expedited processing, 

a full RDA is conducted by an RDA analyst. A full RDA addresses all radiation dose 

components using detailed assumptions and calculations and is performed and 

documented in accordance with SOP RA01 (DTRA, 2017). This requirement will 

typically be limited to cases excluded from expedited processing based on the doses 

listed in Attachment 1 or where the veteran claims an unusual radiation exposure scenario 

that is inconsistent with the generic NTPR default assumptions used for Hiroshima, 

Nagasaki or POW dose assessments. 

If a full RDA is required, the DTRA analyst documents the reason(s) for the full RDA 

requirement in Part 2 of the DSS. The RDA analyst transmits the completed RDA report 

and accompanying calculations to the DTRA analyst for review and inclusion in the case 

file. 

5.6 Assigning Default Expedited Processing Group Dose Components 

If the participant is not excluded from Expedited Processing per Section 5.5, the DTRA 

analyst performs dose assignment using the following guidance unless otherwise 

documented in the Analyst Comments of the DSS. 

• For cases with only H&N participation, the DTRA analyst assigns the applicable EPG 

dose components for the requested organ(s), disease, and/or skin sites. These H&N 

EPG doses are reported in Table A1-1 and Table A1-2 (Attachment 1 of this SOP). If 

the case involves multiple H&N participations, the EPG TODs from each of the 

participations are compared and the higher value is assigned for each medical 

condition. 

• For cases with both H&N participation and PPG and/or NTS participation, the DTRA 

analyst follows the guidance in SOP RA02 (DTRA, 2017). 

• For cases involving benign thyroid nodular disease, the DTRA analyst assigns the 

dose components for the thyroid for this disease. This assignment is supported by 

expert medical opinion indicating that radiation doses from 25–36 rem would be 

unlikely to change the probability of causation for benign thyroid nodular disease 

from “unlikely” to “as likely as not” (Reeves, 2012). 

5.7 Assigning Dose Components from a full Radiation Dose Assessment 

If a full RDA has been completed, the DTRA analyst performs dose assignment using the 

following guidance unless otherwise documented in the Analyst Comments of the DSS. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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• For cases with only H&N participation, the DTRA analyst assigns all dose 

components from the RDA for the veteran’s H&N participation. If the case involves 

multiple H&N participations, the RDA must include all periods of participation. 

• For cases with both H&N participation and PPG and/or NTS participation, the DTRA 

analyst assigns all H&N RDA dose components for the veteran’s H&N participation, 

and then follows the guidance in SOP RA02 (DTRA, 2017). 

5.8 Completion of Decision Summary Sheet 

For dose assignments not requiring a full RDA, the DTRA analyst completes applicable 

sections of Part 2 of the DSS using researcher-documented information from Part 1, 

veteran-provided information, and other relevant information from the case file. In Part 2, 

(Justification), the DTRA analyst documents the reference document (typically this or 

another RDA SOP) that is the basis for the decision. In Analyst Comments, the DTRA 

analyst documents any specific EPGs used in the decision-making and additional 

exposure scenarios that are consistent with historical records, different than those of the 

comparable EPG, and that could potentially result in radiation doses greater than those of 

the EPG. The DTRA analyst determines and documents whether any such additional 

exposure scenarios could increase the veteran’s radiation total dose above the EPG TOD. 

The DTRA analyst also summarizes the rationale used for the dose assignment, pertinent 

historical and dose information, and veteran comments and applicable responses in the 

Analyst Comments section. If further evaluation of the case results in a dose assignment 

other than the EPG doses, the DTRA analyst documents the dose assignment in Part 2 of 

the DSS. 

5.9 Quality Assurance Auditor Review 

The QA auditor reviews the case file and documents the performance of the quality 

review of the decision-making process, the DTRA DSS, the draft VA response letter, 

RDA analyst documentation (if applicable), and the resulting dose assignment for clarity, 

completeness, and conformance to NTPR policies and procedures. The QA auditor may 

be assisted by a QA reviewer in this review. The QA auditor documents the results of the 

review on a QA/QC Review Report for Decision Summary Sheet. If corrections or 

changes are recommended by the QA auditor, actions described above may be repeated 

as appropriate for the completion and documentation of the dose assignment and 

reporting of results to the VA. 

6. Data and Records Management 

Documentation resulting from implementation of this SOP is added to the case file and 

may include any of the following: 

• Relevant documentation obtained or developed in accordance with DTRA (2015); 

• NTPR researcher additions to the DTRA DSS; 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

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• DTRA analyst additions to the DTRA DSS; 

• Results of consultation with an RDA analyst, consisting of a brief summary of any 

communications; 

• An RDA Report and supporting radiation dose calculations, in accordance with SOP 

RA01 (DTRA, 2017) if a full RDA is performed; 

• QA auditor QA/QC Review Report for Decision Summary Sheet; 

• Draft and/or final VA response letter. 

7. Quality Control and Quality Assurance 

Independent review of the records, process, and results related to radiation dose 

assignment, including both expedited processing and full RDAs, is performed and 

documented by the QA auditor. Results of case processing and quality reviews are 

reported to DTRA NTPR program management during semi-annual NTPR Program 

Management Reviews and in a Quarterly Quality Report with associated Reported 

Quality Issues (RQIs) spreadsheet. Areas in need of corrective action are identified and 

tracked through to correction on the RQI. 

8. Referenced NTPR Standard Operating Procedures 

(1) RA01 – Radiation Dose Assessment for Cases Requiring Detailed Analysis 

(2) RA02 – Expedited Processing of Radiation Dose Assessments for Atmospheric Nuclear 

Weapons Testing Veterans 

9. Reference Materials 

(1) DTRA (Defense Threat Reduction Agency), 2015. NTPR Program Support SOP. CDRL 

– A008, Defense Threat Reduction Agency. Fort Belvoir, VA. March 27. 

(2) DTRA (Defense Threat Reduction Agency), 2017. Nuclear Test Personnel Review, 

Standard Operating Procedures for Radiation Dose Assessments – List and Overview, 

Update: January 2017. DTRA-SOP-17-01, Defense Threat Reduction Agency, Fort 

Belvoir, VA. January 13. 

(3) McKenzie-Carter, M. and Egbert, S. 2015. Technical Basis for Expedited Processing of 

Radiation Dose Assessments for NTPR Hiroshima and Nagasaki Participants. DTRATR-15-044, Defense Threat Reduction Agency, Fort Belvoir, VA. November 16. 

(4) Reeves, G. to Murray, B. 2012. Electronic mail (email), Subject: Expedited doses for 

non-malignant thyroid disease. June 28. 

(5) VA (U.S. Department of Veterans Affairs), 1985. 38CFR3.102: Title 38 - Pensions, 

Bonuses, and Veterans’ Relief. Chapter 1 – Department of Veterans Affairs (Continued). 

Part 3 – Adjudication. Section 3.102 - Reasonable doubt. 50 FR 34458, Aug. 26, 1985, 

as amended at 66 FR 45630, Aug. 29, 2001. 
 

 

 

 

 

 

DTRA / NTPR - Standard Operating Procedures Manual 

RA05 – Expedited Processing of Radiation Dose Assessments for NTPR Hiroshima and Nagasaki Veterans 

Revision No.: 2.1 

Date: 4/18/2017 

Page 16 of 19 

Attachment 1 

Expedited Processing Group (EPG) Doses 

for H&N Participants 
 

 

 

 

 

 

DTRA / NTPR - Standard Operating Procedures Manual 

RA05 – Expedited Processing of Radiation Dose Assessments for NTPR Hiroshima and Nagasaki Veterans 

Revision No.: 2.1 

Date: 4/18/2017 

Page 17 of 19 

Table A1-1. Whole Body and Internal Organ Expedited Processing Group (EPG) 

Doses for H&N Participants 

External Whole-Body Gamma Doses (rem) 

Organ or Tissue Hiroshima Nagasaki POW 

All 0.22 0.74 2.2 

Internal Organ Doses (rem) 

Hiroshima Nagasaki POW 

Internal Organ Alpha 

Beta plus 

Gamma Alpha 

Beta plus 

Gamma Alpha 

Beta plus 

Gamma 

Adrenals <0.001 0.051 0.030 0.31 0.004 0.074 

Bone surface 0.001 0.026 17 2.6 2.0 0.30 

Brain <0.001 0.010 0.030 0.24 0.004 0.040 

Breast <0.001 0.051 0.030 0.25 0.004 0.044 

Stomach wall <0.001 0.032 0.031 0.90 0.004 1.6 

Small intestine wall <0.001 0.024 0.032 1.9 0.004 2.4 

Upper large intestine wall <0.001 0.038 0.043 8.4 0.004 7.4 

Lower large intestine wall <0.001 0.069 0.068 23 0.004 12 

Kidneys <0.001 0.025 0.070 0.36 0.009 0.20 

Liver <0.001 0.053 3.6 0.47 0.43 0.18 

Extra-thoracic region <0.001 0.34 0.12 0.50 0.020 1.5 

Lung <0.001 0.64 0.25 1.6 0.043 1.7 

Muscle <0.001 0.026 0.030 0.31 0.004 0.078 

Pancreas <0.001 0.041 0.030 0.33 0.004 0.11 

Red marrow <0.001 0.032 0.81 1.3 0.097 0.17 

Spleen <0.001 0.041 0.030 0.31 0.004 0.085 

Testes <0.001 0.009 0.23 0.29 0.028 0.060 

Thymus <0.001 0.060 0.030 0.27 0.004 0.053 

Thyroid <0.001 0.025 0.030 2.3 0.004* 17* 

Urinary bladder wall <0.001 0.013 0.030 0.47 0.004 0.48 

* POW cases with thyroid cancer are excluded from expedited processing. However, these doses should be 

assigned for all other POW claims for which the thyroid is the target or surrogate organ, including benign thyroid 

nodular disease. 
 

 

 

 

 

 

 

 

 

 

 

DTRA / NTPR - Standard Operating Procedures Manual 

RA05 – Expedited Processing of Radiation Dose Assessments for NTPR Hiroshima and Nagasaki Veterans 

Revision No.: 2.1 

Date: 4/18/2017 

Page 18 of 19 

Table A1-2. Eye Lens and Skin Expedited Processing Group (EPG) Doses 

for H&N Participants 

External Beta + Gamma Doses (rem) 

Organ/Tissue/Disease Hiroshima Nagasaki POW 

Lens of Eye (posterior 

subcapsular cataract) 0.23 1.8 4.1 

Hiroshima Nagasaki POW 

Organ/Tissue/Disease 

All sites 

above the 

ankle 

Foot or 

ankle All skin sites 

Top of 

head, neck, 

waist, 

foot/ankle 

All sites except 

top of head, 

neck, waist, 

foot/ankle 

Skin: Malignant Melanoma 

and Basal Cell Carcinoma 3.4 * * * * 

Skin: Squamous Cell 

Carcinoma 3.4 7.3 68 * 170 

* Cases with these skin cancer/skin site combinations are excluded from expedited processing. 
 

 

 

 

 

 

 

 

 

 

 

 

DTRA / NTPR - Standard Operating Procedures Manual 

RA05 – Expedited Processing of Radiation Dose Assessments for NTPR Hiroshima and Nagasaki Veterans 

Revision No.: 2.1 

Date: 4/18/2017 

Page 19 of 19 

Table A1-3. Expedited Processing Group (EPG) Total Organ Doses 

for H&N Participants 

Total Organ Doses* and applicable Limiting Doses (rem) 

Organ or Tissue Hiroshima TOD Nagasaki TOD POW TOD Limiting Dose† 

Adrenals 0.28 1.1 2.3 30 

Bone surface 0.25 20 4.5 32 

Brain 0.23 1.0 2.3 30 

Breast 0.28 1.1 2.3 36 

Stomach wall 0.26 1.7 3.8 18 

Small intestine wall 0.25 2.7 4.6 44 

Upper large intestine wall 0.26 9.2 9.6 26 

Lower large intestine wall 0.29 24 14 26 

Kidneys 0.25 1.2 2.4 31 

Liver 0.28 4.8 2.8 7.7 

Extra-thoracic region 0.56 1.4 3.7 22 

Lung 0.86 2.6 3.9 30 

Muscle 0.25 1.1 2.3 34 

Pancreas 0.26 1.1 2.4 61 

Red marrow 0.26 2.8 2.5 14 

Spleen 0.27 1.1 2.3 44 

Testes 0.23 1.3 2.3 41 

Thymus 0.28 1.1 2.3 41 

Thyroid 0.25 3.1 20‡ 5.1 

Urinary bladder wall 0.24 1.3 2.7 33 

* Total Organ Doses were calculated by adding the upper-bound external dose to the upper-bound internal doses 

(alpha and beta+gamma), and rounding up to two significant digits. Neither occupation troops nor POWs were 

exposed to initial gamma radiation or neutron radiation from the bombs. All POW camps were at least 6 miles from 

the detonations. (McKenzie-Carter and Egbert, 2015) 

† The Limiting Dose corresponds to a probability of causation of approximately 40 percent at the upper 99 percent 

confidence level for primary cancers of the indicated organ or tissue. The values shown are the lowest doses for any 

disease for which the NTPR standard organ is used, based on the cross-reference list in SOP RA02 (DTRA, 2017, 

Attachment 2). 

‡ Cases for POWs with thyroid cancer are excluded from expedited processing and require a full RDA. These doses 

should be assigned for all other POW claims for which the thyroid is the target or surrogate organ, including benign 

thyroid nodular disease.