Document Number:

ORAUT - TKSS-O01 5--3

Effective Date: 1/05/2004

Revision No.: 00

Controlled Copy No.:

Page 1 of 24

ORAU Team

NIOSH Dose Reconstruction Project

Technical Basis Document for Portsmouth Gaseous Diffusion

Plant - Occupational Medical Dose

T_o be used for EEOfCPA Dose ReconS!ru~on Project - -

Subject Expert Paul Demopoulos Supersedes:

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TABLE OF CONTENTS

Section ~

ACRONYMS AND ABBREVIATIONS , , 4

OCCUPATIONAL MEDICAL DOSE

5

EXAMINATION FREQUENCIES ""'.." 5

6

10

, 10

EQUIPMENT 3.2.1 3.2.1.1 Collimation Diagnostic AND TECHNIQUES x-ray Tethnique Generalizations 1954 to Date '

12

, e 12

13

e.e 13

, e e e.e 13

..e...ee 14

3.3.54 ORGAN 3.3.12 3.3.3 Type Pre-1910 Type Photofluorography DOSE III I Machine Machine CALCULATIONS machine (1961-1969 (1970-1978) (1979-1989) (190-present) (1954-1960) 

3.4 UNCERTAINTY 14

3.5 DOSE 3.5.1 Assignment of Organ Doses from X-ray Procedures: Approach for Dose RECONSTRUCTOR INSTRUCTIONS ,.""",,'."'."'.".."'."""""""""""".' 

16

Reconstructions ,..",..,'.."""." "..".'.'" 16

REFERENCES

18

APPENDIX 8 OCCUPATIONAL MEDICAL DOSE 20
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LIST OF TABLES 

Table 3.1-1 Frequency of Occupational Chest X-rays at the PORTS ......................................... 5
 

Table 3.2-1 Description of the X-ray Equipment Used at PORTS ............................................... 7
 

Table 3.2-2 Technique Factors Used for Each Type of X-ray Equipment ................................... 8
 

Table 3.2-3 Medical x-ray Quality Assurance Parameters/PORTS ............................................. 9
 

Table 3.2-4(d) Half Value Layer Limits ............................................................................................ 9
 

Table 3.2-5(e) Entrance Skin Exposure Limits ................................................................................ 9
 

Table 3.2.1-1a Relationship of Beam Intensity and Various Technical Factors ............................. 10
 

Table 3.3.1-1 Default Dose Values by Procedure ........................................................................ 12
 

Table 3.3.3-1 Default Dose Values by Procedure ........................................................................ 13
 

Table 3.3.5-1 Analogues for IREP Organs not Included in ICRP 34 ............................................ 14
 

Table 3.5.1-1 X-ray Doses (rem) for Three Organ Groups........................................................... 16
 

Table B.1-1 Dose Equivalents for Organs Identified in ICRP 34 (1982) Beam Quality for P/A 

Views...................................................................................................................... 21
 

Table B.1-2 Dose Equivalent for IREP Organs not Included in ICRP 34 (1982) Beam 

Quality for P/A Views.............................................................................................. 22
 

Table B.1-3 Dose Equivalents for Organs Identified in ICRP 34 (1982) Beam Quality for 

LAT Views .............................................................................................................. 23
 

Table B.1-4 Dose Equivalent for IREP Organs not Included in ICRP 34 (1982) Beam 

Quality for LAT Views............................................................................................. 24
 
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RECORD OF ISSUE/REVISIONS 

ISSUE 

AUTHORIZATION 

DATE 

EFFECTIVE 

DATE 

REV. 

NO. DESCRIPTION 

Draft 10/03/03 00-A New technical basis document for the Portsmouth 

Gaseous Diffusion Plant – Occupational Medical 

Dose. Initiated by Mark Notich. 

Draft 12/10/03 00-B Incorporates comments from internal and NIOSH 

review. Initiated by Mark Notich. 

1/05/2004 1/05/2004 00 First approved issue. Initiated by Mark Notich. 
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ACRONYMS AND ABBREVIATIONS 

AAPM American Association of Physicists in Medicine 

A/P Anterior Posterior (x-ray view) 

Al Aluminum (x-ray machine filtration) 

DEP Ohio State Department of Environmental Protection 

DOE U.S. Department of Energy 

ESE Entrance Skin Exposure 

ESEG Entrance Skin Exposure Guideline 

FDA/BRH Federal Drug Administration Bureau of Radiological Health 

GAT Goodyear Atomic Corporation Technical Report 

HVL Half Value Layer 

ICRP International Commission of Radiation Protection 

IREP Interagency Radiation Exposure Program 

kVp Kilovolts Peak or peak kilovoltage 

LAT Lateral (x-ray view) 

mA Milliampere 

mAs Milliampere seconds 

mR MilliRoentgen 

NCRP National Council on Radiation Protection and Measurements 

NIOSH National Institute for Occupational Safety and Health 

P/A Posterior Anterior (x-ray view) 

PORTS Portsmouth Gaseous Diffusion Plant 

RMS root mean square 

SID Source to Image Distance 

SSD Source to Skin Distance 

TBD Technical Basis Document 

QA Quality Assurance 
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3.0 OCCUPATIONAL MEDICAL DOSE 

The Portsmouth Gaseous Diffusion Plant (PORTS) required pre-employment physical examinations 

as part of their occupational health and safety program. These medical examinations typically 

included diagnostic chest x-rays. Medical x-rays during employment are offered every three years 

since 1989 but are not mandatory. The doses from these diagnostic x-ray procedures depended not 

only on the characteristics of the x-ray machine and the procedure used, but also on the frequency of 

the examination. Other types of x-rays such as lumbar, knee or ankle x-rays were given for on the job 

injuries at the discretion of the medical director but are not included in doses under EEOICPA. 

3.1 EXAMINATION FREQUENCIES 

X-ray examinations were conducted consistently for employees every three years from 1989 to 

present. Included in the medical procedures is the frequency of chest x-rays that were offered based 

upon worker age. Note asbestos and beryllium workers were required to have annual x-rays. After 

the pre-employment physical examination, chest x-rays were optional. This information may be 

recorded in the worker file provided by the U.S. Department of Energy (DOE). All occupational x-rays 

in the worker file are to be included in the reconstruction of occupational dose. 

Table 3.1-1 lists the frequencies of chest x-rays for different age groups through the years and also 

identifies specific groups of workers. Declared pregnant women were not x-rayed from at least 1989. 

Typically one Posterior/Anterior (P/A) view was taken but Anterior/Posterior (A/P) and Lateral (LAT) 

view(s) were possible. 

Table 3.1-1 Frequency of Occupational Chest X-rays at the PORTS 

Time period Frequency Comment 

1954–1989(a) Annually All employees. 

Annually Asbestos/Beryllium workers. 

1990–2003 Offered Every 10 years Employees up to 30 years old. 

Offered Every 5 years Employees up to and equal to 45 years old. 

Offered Every 3 years Employees greater than 45 years old. 

Annually Asbestos/Beryllium workers. 

PORTS medical records include notations in individual worker files regarding both the date and the 

purpose of the of x-ray examinations. Included in some of the more recent records is the number of 

views. The current Medical X-ray technician stated the number of re-takes was virtually none. This is 

because the employees had shown concern about how many x-rays they were given, (1993 – 

present). The complex-wide x-ray guidance Technical Basis Document (TBD) indicate a 3 % re-take 

rate based upon Trout et al (1973) in their analysis of the rejection rate of chest radiographs obtained 

during the Coal Mine “Black Lung” program reported an average rejection rate of 3% among 67,000 

radiographs. International Commission of Radiation Protection (ICRP) Publication-34 (ICRP-34) 

indicates a minimal value of 10 –12 % re-takes (ICRP 34, p 37). A 5 % re-take value will be used to 

be claimant favorable. 

Retakes should serve as a signal to give special consideration to the evaluation of technique factors, 

and hence the resultant dose calculations. A retake in a very large individual might serve as a signal 

that the initial radiograph was taken with technique factor settings suitable for a smaller person, and 

that the second radiograph reflected an additional and larger dose. 
3.2 

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About 80 % of the x-rays given were P/A chest x-rays. The others comprised of knee, hand, ankle 

legs and others mostly for injuries sustained at work. 

Specific organ doses to be attributed for P/A chest x-rays calculated on the basis of the dose 

conversion factors found in ICRP Publication 34 are given in Attachment B, Table B.1-1and B.1-2. 

LAT dose conversion factors are given in Attachment B, Table B.1-3 and B.1-4. For organs not listed 

in ICRP Publication 34 but specified in the Interagency Radiation Exposure Program (IREP) code, 

doses were determined by analogy with anatomical location (Table 3.3.5-1). Thus IREP code organs 

in the thoracic cavity, but not mentioned in the ICRP Publication 34 were assigned the same dose as 

the lungs; doses to the organs in the head and neck were assigned the same dose as the thyroid. 

The head and neck organ dose estimates (i.e. eye/brain), should be somewhat greater than doses 

actually incurred (hence claimant favorable), because of geometry considerations and at least in the 

case of the brain, because of attenuation by the bony cranium. To ensure claimant favorability in the 

view of the variations in organ dose described in ICRP Publication 34 (p. 51), the doses for females 

(lungs), which are slightly higher than those for males, were used. 

EQUIPMENT AND TECHNIQUES 

Photofluorography 

Chest photofluorography, which resulted in very much greater patient doses from a diagnostic 

procedure, was used sporadically until as late as the early 1960’s. Photofluorography used a smaller 

film (4 x 5 inches), a smaller source to skin distance (SSD) (42 inches), and both a higher peak 

kilovoltage (kVp) and typically a several fold greater exposure in terms of milliampere seconds (mAs). 

Exposure was regulated by photometers, which utilized the exposure to the film to determine the time 

of exposure. 

Even-though no evidence of the use of photofluorography was found at PORTS it is reasonable to 

presume that at least some of the occupational medical diagnostic chest x-rays with the DOE and its 

predecessor organizations were accomplished by photofluorography. The use of photofluorography 

should be assumed to ensure claimant favorable dose reconstructions from the time-period of 1954 

through 1960. 

Photofluorography differed from conventional radiography with film in that while kVp and milliampere 

(mA) settings could be manipulated by the technician, the exposure time was regulated by the amount 

of light generated in the photofluorographic unit, with a cutoff or maximum exposure time. An 

exposure of 15 mAs (150 mA for 0.1 second) was sufficient to produce a satisfactory image on 35 mm 

film (four by five inches); larger film required greater exposures (Sante 1954, p. 129). 

Typical operating parameters reported for 1950’s photofluorography were 24 mAs at 83 kVp at a 

target to film distance of 36 inches (Braestrup 1958, p. 143), and 30 mAs at 90 kVp with a target to 

film distance of 40 inches and 2.4 mm added filtration. In the absence of data, added filtration of 2.5 

mm should be assumed for dose determinations and is claimant favorable. Measurements at the 

Hanford site indicated that for a 60 mAs photofluorography exposure at 100 kVp, the entrance skin 

exposure (ESE) was 1.53 R (Rising and Soldat 1959), which is likely an upper limit value based on a 

large patient and is consistent with an ESE of about 600-700 milliroentgen (mR) for a 24-30 mAs 

exposure at somewhat lower kVp. The Hanford measured value of 1.53R ESE is likely an upper limit 

and hence an overstatement of the actual exposure from photofluorography to the average patient, 

and thus this 1.53R ESE value should be used in the absence of data to ensure claimant favorability. 
 

 

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Pre-1970 

The x-ray machine information prior to 1970 is not available. The ESE was based upon the complexwide x-ray TBD guidance as presented in Table 3.3-1. Default Dose Values by Procedure presented 

in section 3.3-1. An air kerma of 200 mR for P/A and 500 mR for Lat x-rays was utilized in the organ 

dose calculations. 

Type I (1970-1978) 

The x-ray machine information from 1970 - 1978 is not available. The ESE was based upon the 

complex-wide x-ray TBD guidance as presented in Table 3.3.1-1. Default Dose Values by Procedure 

presented in section 3.3.1. An air kerma of 200 mR for P/A and 500 mR for Lat x-rays was utilized in 

the organ dose calculations. 

Type II - III 

The x-ray machine at PORTS from 1979 to present has not been changed much. The imaging 

system and generator have been the only changes since 1979. Currently in use is a GE MVP Micro 

x-ray 60 with a model COLL-C-150 x-ray tube. It can operate up to 150 kVp in a single-phase mode 

and up to 320 mA. ESE measurements do exist in some cases from the Ohio State Department of 

Environmental Protection (DEP), the Federal Drug Administration Bureau of Radiological Health 

(FDA/BRH) currently the Center for Devices and Radiological Health, and the Health Physics group at 

PORTS. However it is more claimant favorable to utilize the ESE values as calculated from the 

technique factors. 

Records concerning the medical x-ray equipment at PORTS from 1954 to 1979 were not located. A 

conversation with a physician that worked at the PORTS medical center within this time frame 

indicated that the employees went to three area hospitals for x-rays including the Southern Ohio 

Medical center during this time period for annual chest x-rays (Dr. Spears, conversation 9/18/03). 

A summary description of the x-ray equipment used at PORTS is included in Table 3.2-1. A summary 

of the specific technique factors for these machines is presented in Table 3.2-2. 

Table 3.2-1 Description of the X-ray Equipment Used at PORTS 

Technique Time period Equipment 

Photofluorography 

(PF) 

1954-1960 No information available. 

Pre-1970 1961-1969 No information available. 

Type I 1970–1978 No information available. 

Type II 1979-1989 Hi-Speed Rare Earth Screens, Kodak X DMAT Model M-7B 

film Processor, GE Col C-150 x-ray Tube, Stationary 12:1 

Grid, Film Processor, Manual timer, Manual techniques 

Type III 1990–present Hi-Speed Rare Earth Screens, Kodak X DMAT Model M-7B 

film Processor, GE Col C-150 x-ray Tube (same as type II 

above), Stationary 12:1 Grid, Film Processor, Automatic 

timer, Phototimed exposures 
 

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Table 3.2-2 Technique Factors Used for Each Type of X-ray Equipment 

Machine View 

Current 

(mA) 

Voltage 

(kVp) 

Exposure time 

(sec.) 

Type I Techniques unknown. No records were kept with regard to the technique 

factors used during this time period. 

Type IIb P/Aa 200 110 1/10 

Type IIIb P/A 200 110 1/10 

a. P/A indicates a P/A view, the average P/A chest measures 26 cm. The average Lat. chest measures 34 cm. 

b. Manual technique factors obtained from PORTS medical x-ray technologist. 

Since no technique factors were identified by PORTS for Type I equipment, organ doses based on 

assumed technique factors were developed on the basis of x-ray techniques contemporary with the 

time period (i.e. 1970-1978) with due consideration given to claimant favorability. Accordingly, it was 

assumed that the operating kVp was 80, somewhat higher (and hence claimant favorable) than the 

kVp values typically used at the time (Morgan and Carrigan, 1955; Laughlin et. al. 1957). To offset 

this lower kVp, an increased exposure would be required as compared with Type II exposures, and 

this was conservatively taken to be 30 mAs, based on exposure time of 0.1 second at 300 mA. 

External filtration was assumed to be 1.5 mm Aluminum (Al) as compared with 2.5 mm Al used 

subsequent to 1979, which would further increase the dose. The SSD was assumed to be 152cm 

based on a Source to Image Distance (SID) of 183cm less a chest thickness of 26cm and an addition 

of 5cm to account for cassette thickness. {The Hanford TBD indicates a 79 mR ESE or 4 mR/mAs 

value for earlier era x-rays.} (ORAUT-TKBS-0003 TBD, 2003 and ORAUT-TKBS-0006-3 TBD 2003) 

Some measurement results follow. As can be seen it would be more claimant favorable to utilize 

technique factor information for all x-ray machines. One result for ESE (PORTS HP department 

measurement) at a SID of 178 cm, 124 kVp, 250 mA, 0.013 sec yielded 6.0 mR exposure or 1.84 

mR/mAs. (PORTS HP x-ray Quality Assurance (QA) survey, 1988) A second result for ESE (FDA 

8/24/92 measurement) at a SID of 178 cm, 23 cm chest LucAl phantom, 120 kVp, 200 mA, and 0.1 

sec yielded a 12.8 mR exposure or a 0.64 mR/mAs. A third result for ESE (FDA 8/24/92) at a SID of 

178 cm, 23 cm chest LucAl phantom at 110 kVp, 320 mA, 0.083 sec yielded a 16.7 mR exposure or 

0.62mR/mAs. 

The x-ray equipment currently in use has been QA checked for entrance skin exposure (ESE) by the 

manufacturer since 1979 and from the Health Physics group since 1985. Although all of the records 

for these QA checks on the x-ray equipment could not be found, the records available indicate that the 

x-ray equipment was working within FDA guidelines. American Association of Physicists in Medicine 

(AAPM) report number 4, “Basic Quality Control in Diagnostic Radiology” (1978), was followed to 

ensure Entrance Skin Exposure Guide (ESEG) was achieved. A diagnostic medical x-ray survey 

checking ESEG for different projection limits was followed. The QA of the x-ray machine included 

checks on the kVp, half value layer (HVL) determination for beam quality, exposure timing accuracy, 

beam collimation and alignment testing, and film-screen contact testing. Table 3.2-3 through Table 

3.2-5 summarizes the parameters tested and the allowed tolerances as stated in the PORTS 

procedure. (GAT S 39 1985) 
 

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Table 3.2-3 Medical x-ray Quality Assurance Parameters/PORTS 

kVp Requirements +/- 4 kVp (about 4%) 

Timing Requirements t +/- 5 % for t > 10 msec and t +/- 20 % 

for t < 10 msec 

+/- 10% is used at PORTS no matter 

what the time. 

Beam Alignment, Light and Radiation 

Field Congruence Requirements 

less than 2% of the source to image 

distance (SID) or 2 cm. 

The limits for HVL are as follows: 

Table 3.2-4(d) Half Value Layer Limits 

Measured kVp Minimum HVL (mm Al) 

50 1.3 

60 1.3 

70 1.5 

80 2.3 

90 2.5 

100 2.7 

110 3.0 

120 3.2 

130 3.5 

140 3.8 

150 4.1 

d. GAT S 39 – “Medical x-ray Quality Assurance Tests AC 

Bassett – 1985, p 4 

The ESE limits are as follows: 

Table 3.2-5(e) Entrance Skin Exposure Limits 

Projection ESEG (mR) 

Chest (P/A) 30 

Skull (Lat) 300 

Abdomen (A/P) 750 

Cervical Spine (A/P) 250 

Thoracic Spine (A/P) 900 

Full Spine (A/P) 300 

Lumbo-Sacral Spine (A/P) 1000 

Retrograde Pyelogram 

(A/P) 900 

Feet (D/P) 270 

e. GAT S 39 – “Medical x-ray Quality Assurance Tests AC 

Bassett – 1985, p 6 
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From 1979 to 1994 a manual technique setting of 0.1 sec at 200 mA and 110 kVp was utilized for 

chest P/A views. (Communication with medical x-ray technologist.) After 1994 the exposures were 

photo-timed. To be more claimant favorable the manual techniques are utilized for Type I through 

Type III machines. 

X-ray organ dose estimates for occupational x-rays administered at PORTS are made for Type I 

equipment (used from 1970 through 1978), Type II equipment (used from 1979 to 1989), and Type III 

equipment (used from 1990 to the present). 

For the posterior/anterior view (P/A), a standard SID of 72 inches (183 cm) was used. Additional 

information indicated that all of the x-ray machines were single phase and that there was no air gap 

between the patient and the film. QA checks of the Type II and III machine indicated a 3.3 mm Al 

HVL. A value of 3.5 mm Al HVL would be claimant favorable for types II - III. Tables B-1 and B-2 list 

organ doses for P/A 14” x 17” chest films. 

For the LAT, 2.5 times the P/A entrance kerma value was used to estimate the LAT entrance kerma 

value. Tables B-3 and B-4 list organ doses for LAT 14” x 17” chest films. 

3.2.1 Diagnostic x-ray Technique Generalizations 1954 to Date 

For convenience and possible application to cases in which the standard PORTS protocol was not 

followed, or for generic use, the effect of various technical factors has been tabulated below in Table 

3.2.1-1. 

Table 3.2.1-1a Relationship of Beam Intensity and Various Technical Factors 

Parameter Units Relationship with Intensity 

Applied voltage kVp Intensity proportional to 1.7 power of kVp 

Tube current mA Linear 

Exposure time s Linear 

Filtration mm Al Intensity decreases by ~40% for each additional mm Al 

Patient Size 

(chest thickness) 

25-27 mm 

> 27 mm 

Dose increased by factor of 1.5 

Dose increased by factor of 2 

Distance d Approximately inverse square relations (1/d2

) 

Uncertainty +30 % Assume all errors are positive, + 30% should be used 

Re-takes +5% Assume all workers had re-takes equal to 5% average 

a. ORAUT-TKBS-0006-3 TBD 2003, p6 

Air kerma was corrected for the thickness of the chest (26 cm) and for distance between the chest 

and the plane of the film (5 cm) to obtain the air kerma at skin entrance. The higher 3.5 mm Al 

filtration value was used since the dose conversion factors would be higher for 3.5 mm compared to 

lower values and thus more conservative and claimant favorable. 

3.2.1.1 Collimation 

Collimation refers to the size of beam. Early, the philosophy was to use a fairly large aperture (i.e. 

limited collimation) to ensure that the entire area of interest was included in the radiograph. 

Subsequently, because of patient protection concerns, beams were collimated such that the smallest 

beam consistent with the area of interest was used, thereby limiting the area of the patient exposed, 

and, in the case of chest radiography, minimizing dose to organs such as gonads, thyroid, and 
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gastrointestinal tract. Wochos et al. (1979) analyzed the 1972-1975 Nationwide Evaluation of X-Ray 

Trends (NEXT) data and found that at some facilities, primarily Internal Medicine and Medical GPs, 

the beam area to film area ratio could be as high as 2.0. 

In early years of operation (pre-1970), x-ray beam or scatter measurement data, techniques, or beam 

port information may not be available to estimate the collimation of the x-ray beam. Feldman et al. 

(1957) noted wide variation in their review of x-ray dose literature in 1957. Through measurements, 

Feldman et al. (1957) noted a factor of 10 increase in the gonadal dose when no external collimation 

was used. 

Due to the reported variation in the literature and measurement data on the effects of collimation, the 

claimant favorable assumption of no external collimation of the primary beam should be used when 

measurement data, technique, or other information to describe the collimation are not available for xrays taken prior to 1970. This is based on the following claimant favorable assumptions and 

professional judgment: 

1. In the late 1950s, there was significant research into the gonadal dose and the reasons for the 

observed variation in dose. This research described the effects of filtration, collimation, and 

centering. By the early 1960s, techniques were being modified incorporating additional 

collimation. While these techniques were likely fully incorporated at most DOE facilities by 

1965, to allow for the possibility that some smaller facilities might not have had the resources 

to update their equipment and to be claimant favorable, the year 1970 was selected. 

2. In 1968, the National Council on Radiation Protection and Measurements (NCRP) in Report 33 

updated their guidance on medical x-ray protection. While many DOE facilities had probably 

already incorporated the guidance in this report, some smaller facilities might not have 

incorporated the guidance by 1968. To ensure that these facilities were in fact in conformance 

with the 1968 recommendations, an additional two-year period was added. 

3. By the late 1950s, reports in the literature of most of the surveys of medical x-ray facilities 

revealed low gonadal doses, indicating adequate collimation. A few surveys clearly indicated 

the use of collimation was limited. Of the eight surveyed facilities at Oak Ridge, only one 

(13%) had a moderately high male gonadal dose (5 mrad). All of the other facilities, the male 

gonadal dose was less than 2 mrad. Variation between the other facilities appeared to be the 

result of differences in the use of filtration and cone size. Since most facilities were using 

some form of collimation by the late 1950s, by the mid 1960s most, if not all, facilities were 

probably using some form of collimation. 

Since references as to when all facilities were using adequate collimation were not found, professional 

judgment was used to estimate this time-period to be the mid 1960s. To fully assure claimant 

favorability, this assumption has been further expanded by 5 years to 1970 to allow for the uncertainty 

in professional judgment. (ORAUT-OTIB-0006, section 2.4) 

Review of the available documentation pertaining to the occupational medical program at PORTS 

from 1954 to the present revealed that only one diagnostic medical radiographic procedure was 

administered in connection with pre-employment or regular post-employment medical examinations, 

Posterior-anterior (P/A) 14” x 17” chest film. The LAT chest film was included in case records that 

were not available indicate their usage. Accordingly, only doses from these two techniques were 

evaluated. Any other radiographic examinations of PORTS employees that might have occurred were 

non-occupational in the sense that these were necessitated by illness or injury and hence not a part of 

the employee physical examination process. Thus, there is no indication in the records that other 
 

Effective Date: 1/05/2004 Revision No. 00 Procedure No. ORAUT-TKBS-0015-3 Page 12 of 24 

diagnostic radiographic examinations were administered as a part of the occupational medical 

program. 

3.3 ORGAN DOSE CALCULATIONS 

ICRP Publication 34 (1982) provides tables of average absorbed dose (mGy) in selected organs for 

selected x-ray projections at 1 Gy entrance kerma (i.e., air kerma without backscatter), for selected 

views (including P/A), and for selected beam qualities (i.e., various HVLs). These tables provide the 

basic dose conversion factors for converting air kerma to organ dose. The average air kerma rates 

for the different machines are calculated using the cGy per mAs provided in NCRP No. 102, Table B.3 

(1989) for specific voltage, current, phase of the machine, and distance to the film. 

Finally, the PORTS organ doses are found by multiplying the ICRP 34 organ dose conversion factors 

by the entrance air kerma values. The resulting PORTS x-ray organ doses for all machines are in 

Tables B.01 through B.04. The doses are shown in units of dose equivalent or rem, assuming a 

quality factor of 1.0 for x-rays. PORTS records will indicate the view and in most cases only one view 

was taken per medical examination. 

The following formulas were used to calculate the doses in Table B.1-1. 

3.3.1 Photofluorography (1954-1960) 

Default values of entrance skin exposure have been developed for the three most commonly used 

occupational medical diagnostic x-ray procedures: P/A chest radiography; lateral chest radiography; 

photofluorographic chest films when actual measurement data or knowledge of technique factors are 

absent and un-collimation is assumed. The default values are considered to be maxima developed 

from review of patient doses as reported in the literature, machine characteristics, and knowledge of 

x-ray procedures used during the time periods indicated. Sufficient conservatism was included in the 

determination of the default values to ensure with near certainty (99+ per cent confidence) that the 

actual exposures from the specified procedures would not exceed the default values, thus ensuring 

claimant favorability. In determining these factors, it was assumed that a minimum of filtration was 

used along with low kilovoltage techniques, slow film speeds with standard development, and no 

additional collimation or use of cones. The default entrance kerma values for the three procedures 

are given in Table 3.3.1-1. 

Table 3.3.1-1 Default Dose Values by Procedure 

Period Entrance kerma, cGy Entrance kerma, cGy Entrance kerma, cGy 

P/A chest Lateral chest Photofluorographic chest 

Pre-1970 0.20 0.50 3.0 

The above default values can then be used as described above in lieu of actual measurement data or 

entrance kerma (ESE) derived from technique factors. These default ESE values were used in 

conjunction with uncollimated dose conversion factors as listed in the complex-wide x-ray TBD 

guidance document in Table 4.0-1 in ORAUT-OTIB-0006. 

Organ doses for chest photofluorography are calculated in an analogous manner to organ doses 

calculated for conventional radiography using the ESE values. Table 4.0-1 provides dose conversion 

factors for the ICRP organs based on a distance of 152 cm and beam quality of 2.5 mm Al HVL. 
 

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3.3.2 Pre-1970 (1961-1969) 

Prior to about 1970, x-ray measurement data, techniques, or beam port information may not be 

available to estimate the collimation of the x-ray beam. Several papers in the literature have 

considered the effects of cone size and centering on the organ dose, and concluded that filtration, 

kVp, and the smallest possible cone size were most important to reduce these doses (Feldman et al. 

1958). Due to the reported variation in the literature and measurement data on the effects of 

collimation, it is claimant favorable to assume minimal or no additional external collimation was used 

when measurement data, technique, or other information to describe the collimation are not available 

for x-ray procedures performed prior to 1970. 

Without collimation, organs normally outside of the primary beam are exposed to the primary beam. 

This necessitates the use of dose conversion factors from ICRP 34 other than those for a P/A or lat 

chest x-ray, since ICRP 34 dose conversion factors are based on properly collimated beams. For 

uncollimated beams used prior to 1970, the uncollimated dose conversion factors as listed in the 

complex-wide x-ray TBD guidance document in Table 4.0-1 were used. The entrance kerma values 

for pre-1970 x-ray machine that are used in the organ dose calculations are listed in Table 3.3.1-1. 

The calculation is analogous to the organ doses calculated for conventional radiography as illustrated 

in section 3.3.4. 

3.3.3 Type I Machine (1970-1978) 

Default values as presented in Table 3.3.3-1 were obtained from the site wide x-ray medical dose 

technical basis document. The default values were determined from a review of patient doses as 

reported in the literature, machine characteristics, and knowledge of x-ray procedures used during the 

time period indicated. In determining these factors it was assumed that a minimum of filtration was 

used along with low kilovoltage techniques, slow film speeds with standard development, and no 

additional collimation or use of cones (ORAUT-OTIB-0006 2003). An HVL of 2.5 mm was used in the 

organ dose calculations. 

Table 3.3.3-1 Default Dose Values by Procedure 

Period Entrance kerma, cGy Entrance kerma, cGy 

P/A chest Lateral chest 

1970-1978 0.20 0.50 

3.3.4 Type II Machine (1979-1989) 

Based on the techniques in Table 3.2-2, the mAs for the types of equipment were calculated for each 

view: 

Current (mA) × Exposure Time (sec) = Current for View (mAs) (3.3.4–1) 

Example for Type II P/A view: 200 mA × 1/10 s = 20 mAs 

The air kerma rate for 110 kVp was determined to be 0.25 cGy per 100 mAs (see Table B.3 of NCRP 

102) and the air kerma was calculated after converting the rate to air kerma per mA. 

Current for View (mAs) × Corrected Air Kerma Rate (cGy/mAs) = Air Kerma (cGy) (3.3.4–2) 

Example for Type II P/A view: 20 mAs × 0.0025 cGy/mAs = 0.05 cGy 
3.4 

Effective Date: 1/05/2004 Revision No. 00 Procedure No. ORAUT-TKBS-0015-3 Page 14 of 24 

Multiply by 0.6 to account for 3.5 mm Al versus 2.5 mm Al Table B.3 NCRP 102 is based upon; 

{see Table 3.2.1-1 } 0.6 X .05 cGy = .030 cGy (3.3.4–3) 

The air kerma was corrected for the thickness of the chest (26 cm) and for distance between the chest 

and the plane of the film (5 cm) to obtain the air kerma at skin entrance. 

Air kerma at 183 cm x SID squared ÷ SSD squared = air kerma at skin entrance (3.3.4–4) 

Example for Type II P/A view: 0.03 cGy x (183 cm)2

 ÷ (152 cm)2 = 0.043 cGy 

Air kerma at skin entrance was multiplied by the dose conversion factors in Table A.2 through A.8 of 

ICRP Publication 34 for P/A chest and HVL of 3.5 mm Al eq. 

Air Kerma (cGy ) x Dose conversion factor = Dose for View (cGy) (3.3.4–5) 

Example for Type II P/A view, dose to thyroid: 

0.043 cGy x 62 mGy/Gy x 1 Gy/100cGy x 1 rad/10 mGy = 2.67 E-3 rad 

3.3.5 Type III machine (1990-present) 

Based on the techniques in Table 3.2-2, the mAs for the types of equipment were calculated for each 

view in the same manner as presented in section 3.3.4 above. The use of this calculation is 

considered claimant favorable. Table 3.3.5-1 lists the reference organ used to approximate the organ 

analogue doses. 

Table 3.3.5-1 Analogues for IREP Organs not Included in ICRP 34 

Anatomical 

Location 

ICRP 34 Reference 

Organ IREP Organ Analogues 

Thorax Lung Thymus 

Esophagus 

Stomach 

Bone surface 

Remainder organs 

Abdomen Ovaries Liver/gall bladder 

Urinary/bladder 

Colon/rectum 

Uterus 

Head and neck Thyroid Eye/brain 

UNCERTAINTY 

Error, defined as deviation from the correct, true or conventionally accepted value of a quantity, and 

uncertainty, defined in terms of the potential range of a stated, measured, assumed or otherwise 

determined value of a quantity, provides an indication of the confidence of the dose estimates. Error 

implies knowledge of what the correct or actual value is, which is, of course, not known. Hence a 

more appropriate term is uncertainty, which is expressed in terms of a confidence level, e.g. 99% (i.e. 

that the correct or true value, although not actually known, has a 99% probability of falling within the 

range cited) and includes both precision or reproducibility of the measurement and accuracy, or how 

close the measurement or estimate of dose comes to the actual or correct value (ORAUT-TKBS-0003 

2003, p5). 
Effective Date: 1/05/2004 Revision No. 00 Procedure No. ORAUT-TKBS-0015-3 Page 15 of 24 

Although in theory a large number of factors can introduce uncertainties or affect the x-ray machine 

output intensity and dose to the patient, in practice only four factors can be reasonably considered to 

have an impact on dose uncertainty. These are 1) variation in applied kilovoltage, 2) variation in 

beam current, 3) variation in exposure time, and 4) distance from the patient to the source of the X 

rays (SSD). The influence of such other factors as use of screens, grids, reciprocity failure, film speed 

and development, while potentially variable, would not affect the beam output intensity (ORAUTTKBS-0003 2003, p5). 

For a given set of machine settings and parameters, x-ray output should theoretically be constant and 

unvarying. However, this is not true in practice; although output is essentially constant unless focal 

spot loading occurs such as might be the case when the power rating of the machine is exceeded. It 

is unlikely that power ratings were ever exceeded since so doing would be difficult to achieve in 

practice and would result in damage to the x-ray tube. However, even with the use of so-called 

constant voltage transformers to control line voltages, slight variations may occur in line voltage input 

or other internal voltages, which in turn could alter the kVp of the output beam. In general, for a given 

kVp setting, variation in kVp falls within ± 5% of the machine setting (Siebert et al. 1991). Since as 

noted above beam intensity is approximately proportional to the 1.7 power of the kilovoltage, this 

translates to an uncertainty of approximately ± 8.7%with respect to output beam intensity in the 80 to 

110 kVp range used for diagnostic radiographs at the PORTS Site . For conservatism, this is rounded 

up to ± 9% (ORAUT-TKBS-0003 2003, p 5 and ORAUT-TKBS-0006-3 2003, p 14). 

Similarly slight variations in tube current are normal; as a tube ages, or heats up from usage, tube 

current may change and typically will drop. Hence, all other factors remaining constant, beam 

intensity will be reduced, and in direct proportion to the change in tube current. Typically, the 

reduction in beam output from current variation is not more than a few per cent under normal 

operating conditions; large decreases in beam output will be readily detected and result in 

maintenance on the machine to restore the output or, as a temporary stopgap measure, increase in 

the current or kVp to provide the necessary intensity for proper radiography. There is no evidence to 

suggest that these stopgap measures were ever necessary or applied at the PORTS Site. For a 

given kVp setting, output of the beam is a function of the tube current, which in turn is measured by a 

milli-ammeter on the machine and measures average tube current. The measurement is subject to 

uncertainties, and in addition there may be minor changes in output as the tube heats up from normal 

usage. These variations are typically small, and hence uncertainty in beam output attributable to 

current variation has been estimated at ± 5% (ORAUT-TKBS-0003 2003, p 6). 

Another parameter that has potential to affect the dose, perhaps significantly, from a diagnostic 

radiograph relates to the time of exposure. This can be readily understood by noting that a full wave 

rectified machine produces 120 pulses per second of x-rays. For an exposure time of 1/20 of a 

second, only six pulses would result. A small error in the timer that resulted in a change of only ± 1 

pulse would correspondingly affect the output by ± 17%; for an exposure time of 1/30 of a second, the 

change in output corresponding to a deviation of ±1 pulse is ± 25%. Early mechanical timers were 

notoriously inaccurate, although timer accuracy improved significantly with the introduction of 

electronic timers. PORTS timer was held to a +/- 10 % criteria from about 1979. However, once 

again for conservatism, uncertainty in beam output attributable to timers will be assumed to have an 

upper limit of + 25% (ORAUT-TKBS-0003 2003, p 6). 

The final factor that is likely to affect patient dose relates to distance from the source of the x-rays, 

which is a determinant of the entrance skin exposure. For a given individual, the SSD will be 

determined largely by the thickness of the patient, and how accurate the positioning is. For a typical 

patient, this variation in SSD is estimated at no more than a few centimeters, with an upper limit of 
Effective Date: 1/05/2004 Revision No. 00 Procedure No. ORAUT-TKBS-0015-3 Page 16 of 24 

perhaps 7.5 cm. Using Inverse Square, this indicates an uncertainty of ± 10% from this source 

(ORAUT-TKBS-0003 2003, p 6). 

There are two approaches to determination of the combined uncertainty from the above four potential 

sources of uncertainty. The first, and most conservative in that it gives the greatest range, would be 

to assume that the uncertainties are additive, which would give an uncertainty range of up to 9 + 5 + 

25 + 10 = 49. However, a more reasonable approach would be to assume that the uncertainties are 

in fact random, and to compute the statistical root mean square (RMS) value. The RMS value is 

simply the square root of the sum of the squares, and computes as ± 28.8%. Thus, for any individual 

entrance skin exposure (ESE) or derived organ dose, an uncertainty of ± 30 % at the 99 % 

confidence level may be assumed; for further conservatism it may be appropriate to assume that 

errors are all positive, and only the + 30 % should be used (ORAUT-TKBS-0003 2003, p 6). 

3.5 DOSE RECONSTRUCTOR INSTRUCTIONS 

The information below provides instructions for dose reconstructor’s in determining organ doses from 

occupational medical (x-ray) procedures. For the purpose of evaluating probability of causation, x-ray 

doses are always considered acute, and are photons with energy E=30-250 keV. 

3.5.1 Assignment of Organ Doses from X-ray Procedures: Approach for Dose 

Reconstructions 

Maximizing Medical X-ray Dose 

Organ doses from x-ray procedures have been adapted from the information in Tables B-1 through B4. For convenience and to ensure claimant favorability, three organ groups have been identified. 

Group 1 includes the skin and not any other organ listed in Groups 2 or 3, Group 2 includes the 

thyroid, lung, thymus, esophagus, stomach, bone surface, and remainder organs. Group 3 includes 

the ovaries, testes, breast, red bone marrow, liver, eye lens, uterus, bladder and colon. (Note that 

group 1 > group 2 > group 3). 

The organ doses assigned for each x-ray procedure are the highest doses to any organ in the 

relevant group as listed in Tables B1-B4, multiplied by a factor of 1.3 to account for uncertainty and 

0.05 to account for re-takes. The resulting maximizing annual x-ray doses that may be applied in 

dose reconstructions for likely non-compensable cases are shown in Table 3.5.1-1. At least one x-ray 

per year or partial year of employment should be assumed taken in order to be claimant favorable. 

Table 3.5.1-1 X-ray Doses (rem) for Three Organ Groups 

Year Group 1 Group 2 Group 3 Year Group 1 Group 2 Group 3 

1954 4.050 1.350 0.504 1979 0.060 0.026 0.0063 

1955 4.050 1.350 0.504 1980 0.060 0.026 0.0063 

1956 4.050 1.350 0.504 1981 0.060 0.026 0.0063 

1957 4.050 1.350 0.504 1982 0.060 0.026 0.0063 

1958 4.050 1.350 0.504 1983 0.060 0.026 0.0063 

1959 4.050 1.350 0.504 1984 0.060 0.026 0.0063 

1960 4.050 1.350 0.504 1985 0.060 0.026 0.0063 

1961 0.270 0.090 0.069 1986 0.060 0.026 0.0063 

1962 0.270 0.090 0.069 1987 0.060 0.026 0.0063 

1963 0.270 0.090 0.069 1988 0.060 0.026 0.0063 

1964 0.270 0.090 0.069 1989 0.060 0.026 0.0063 

1965 0.270 0.090 0.069 1990 0.060 0.026 0.0063 
Effective Date: 1/05/2004 Revision No. 00 Procedure No. ORAUT-TKBS-0015-3 Page 17 of 24 

Year Group 1 Group 2 Group 3 Year Group 1 Group 2 Group 3 

1966 0.270 0.090 0.069 1991 0.060 0.026 0.0063 

1967 0.270 0.090 0.069 1992 0.060 0.026 0.0063 

1968 0.270 0.090 0.069 1993 0.060 0.026 0.0063 

1969 0.270 0.090 0.069 1994 0.060 0.026 0.0063 

1970 0.280 0.090 0.017 1995 0.060 0.026 0.0063 

1971 0.280 0.090 0.017 1996 0.060 0.026 0.0063 

1972 0.280 0.090 0.017 1997 0.060 0.026 0.0063 

1973 0.280 0.090 0.017 1998 0.060 0.026 0.0063 

1974 0.280 0.090 0.017 1999 0.060 0.026 0.0063 

1975 0.280 0.090 0.017 2000 0.060 0.026 0.0063 

1976 0.280 0.090 0.017 2001 0.060 0.026 0.0063 

1977 0.280 0.090 0.017 2002 0.060 0.026 0.0063 

1978 0.280 0.090 0.017 2003 0.060 0.026 0.0063 

Best Estimate of Medical X-ray Dose 

Organ doses from Medical x-rays are listed in Tables B-1 through B-4. The organ doses assigned for 

each x-ray as listed in Tables B-1 through B-4 should be multiplied by a factor of 0.5 to adjust for the 

more likely Entrance Skin Exposure (ESE). Actual measurements of ESE ranged from 6 mR to 17 

mR from about 1980 through 1995. This is about 50 % of the 43 mR ESE calculated from the 

technique factors of the x-ray machine used during this period of time. The ESE of Hanford sites 

photofluorography (PF) was about 1.53 R which is also about 50 % of the ESE utilized in the PF 

organ dose calculations of 3.0 R (ORAUT-OTIB-0006, p 14, Table 3.3-1). This is also the case for 

pre-1970, type I and type II calculations. One annual X-ray procedure for each full or partial year of 

before 1979 and only as indicated in the medical records after 1979 should be counted. However, if 

the dose reconstructor determines that more frequent procedures occurred or may have occurred, the 

annual organ doses can be raised accordingly. 

Underestimate of Medical X-ray Dose 

If an underestimate is desired, the best estimate procedure listed above can be used in conjunction 

with the use of a correction factor of 0.75 that would eliminate the uncertainty (30 %) and re-take (5%) 

corrections. 
Effective Date: 1/05/2004 Revision No. 00 Procedure No. ORAUT-TKBS-0015-3 Page 18 of 24 

REFERENCES 

American Association of Physicists in Medicine (AAPM) report number 4, “Basic Quality Control in 

Diagnostic Radiology”, 1978 

A.C. Bassett, “Medical x-ray Quality Assurance Tests”, GAT S 39, 1/15/85 (1 – 41) 

Braestrup, C. B. Radiation Protection. Charles C. Thomas, Springfield. 1958 

Cardarelli, J., H. Spitz, C. Rice, R. Buncher, H. Elson and P. Succop. 2002. “Significance of 

Radiation Exposure From Work-Related Chest X-Rays for Epidemiological Studies of Radiation 

Workers”. Amer. J. Indust. Med. 42:490-501. 

FDA Bureau of radiological health inspection dated 8/24/92. 

Feldman, A., Babcock, G. C. Lanier, R. R., and Morkovin, D. 1958. “Gonadal Exposure Dose from 

Diagnostic X-ray Procedures”. Radiology 71:197-207. 

GAT S 39, Bassett, A. C., “Medical x-ray Quality Assurance Tests”, 1985 

International Commission on Radiological Protection. “Protection of the Patient in Diagnostic 

Radiology”. ICRP Publication 34. Annals of the ICRP. 9(2/3):1-82. 

International Commission on Radiation Units and Measurements (ICRU). “Fundamental Quantities 

and Units for Ionizing Radiation”. ICRU Report 60. ” Bethesda: International Commission on 

Radiation Units and Measurements (1998). 

Laughlin, J. S., M. L. Muerk, I Pullman and R. S. Sherman. 1957. “Bone, Skin and Gonadal Doses in 

Routine Diagnostic Procedures. American Journal of Roentgenology, Radium Therapy and 

Nuclear Medicine 78:197-983 

Morgan, R. H. and K. E. Corrigan, Eds. Handbook of Radiology. Chicago: The Year Book 

Publishers, Inc. (1955) 

National Institute for Occupational Safety and Health NIOSH “External Dose Reconstruction 

Implementation Guideline”. OCAS-IG-001, rev 1, August 2002 

National Council on Radiation Protection and Measurements (NCRP). “Medical X-Ray and GammaRay Protection for Energies Up To 10 MeV”. NCRP Report No. 33. Washington: National 

Council on Radiation Protection and Measurements (1968). 

National Council on Radiation Protection and Measurements (NCRP). “SI Units in Radiation 

Protection and Measurement”. NCRP Report No. 82. Bethesda: National Council on Radiation 

Protection and Measurements (1985). 

National Council on Radiation Protection and Measurements (NCRP), “Medical x-ray, Electron Beam 

and Gamma-Ray Protection for Energies Up To 50 MeV”, NCRP Report 102. Bethesda (1989) 
Effective Date: 1/05/2004 Revision No. 00 Procedure No. ORAUT-TKBS-0015-3 Page 19 of 24 

ORAUT-OTIB-0006, “Dose Reconstruction from Occupationally Related Diagnostic x-ray 

Procedures”, Ronald L. Kathern, Vernon E. Shockley, Elyse M. Thomas and Timothy D. Taulbee, 

11/06/2003 

ORAUT-TKBS-0003, “Technical Basis Document for the Savannah River Site to be used for 

EEOICPA Dose Reconstructions”, 8/21/2003 

ORAUT-TKBS-0006-3, “Technical Basis Document for the Hanford Site – Occupational Medical 

Dose”, 9/16/2003 

Portsmouth Health Physics Department X-ray QA survey, 1988 

Sante, L. R. Manual of Roentgenographic Technique. Ann Arbor: Edwards Brothers. 1946. p. 61 

Seibert, J. A., G. T. Barnes and R. G. Gould. Specification, Acceptance testing, and Quality Control 

of Diagnostic x-ray Imaging Equipment. Medical Physics Monography No. 20. New York: 

American Institute of Physics. 1991. 

Trout, E. D., Jacobson, G., Moore, R. T., and Shoub, E. P. 1973. “Analysis of the Rejection Rate of 

Chest Radiographs Obtained During the Coal Mine “Black Lung” Program”. Radiology 109:25-27. 

Wochos, J. F., Detorie, N. A., and Cameron, J. R. 1979 “Patient Exposure from Diagnostic X-rays: An 

Analysis of 1972-1975 NEXT Data”. Health Physics 36:127-134. 
 

Effective Date: 1/05/2004 Revision No. 00 Procedure No. ORAUT-TKBS-0015-3 Page 20 of 24 

APPENDIX B OCCUPATIONAL MEDICAL DOSE 

B.0 PORTS Medical X-ray 

PORTS conducted pre-employment and annual physical examinations as part of their occupational 

health program. These examinations typically included a P/A chest x-ray. For some workers, and 

occupations, chest x-rays could be more frequent. 

B.1 Organ Doses from Medical x-rays 

X-ray organ dose equivalents for occupational x-rays at PORTS are estimated for all years from 1954 

to present. The schedule for these exams for all PORTS employees over this time period is shown in 

Table B.1-1 through B.1-4, along with the organ dose information. Tables B.11 and B.1-2 are for P/A 

views for listed and unlisted organs in ICRP 34. X-ray organ dose estimates were made for 

photofluorography (1954-1960), per-1970 (1961-1969), Type I equipment (used from 1970 to 1978), 

Type II equipment (used from 1979 to 1989) and Type III equipment (used from 1990 to present). 
Table B.1-1 Dose Equivalents for Organs Identified in ICRP 34 (1982) Beam Quality for P/A Views 

Time 

Period Frequency 

PORTS 

Employee 

Organ dose Equivalents per 14” x 17” P/A Che

Air kerma at 

skin 

entrance(a) Thyroid(d) Ovaries(d) Testes(d) Lungs(d) 

Breast( 

d) 

Uterus(d) 

(Embryo 

) 

1954-1960 

(PFG)(b) Annual All 

3.000 

uncollimated 1.04 0.504 0.0273 1.350 0.147 0.447 

1961-1969 

(Pre-1970)(c) Annual All 

0.200 

uncollimated 0.0694 0.0336 0.00182 0.0902 0.0098 0.0298 

1970-1978 

(Type I) Annual All 

0.200 

2.5 mm HVL 0.0064 0.0002 0.000002 0.0902 0.0098 0.00026 

1979-1989 

(Type II) Annual All 

0.043 

3.5 mm HVL 0.00267 0.000138 

0.0000004 

3 0.0262 

0.0039 

1 0.000129 

1990­

present 

(Type III) 

Offered 

Every 10 

years 

Employees up 

to 30 years old. 

0.043 

3.5 mm HVL 0.00267 0.000138 

0.0000004 

3 0.0262 

0.0039 

1 0.000129 

Offered Every 5 years 

Employees up to 45 years old. 

Offered Every 3 years 

Employees greater than 45 years old. 

Annually Asbestos 

/Beryllium workers. 

(a) Air kerma at entrance skin in rem. (b) Photofluorographic chest 99% confidence entrance uncollimated kerma (2.5 mm Al HVL) ORAUT-OTIB-0006, Table 4.0-1. 

(c) Pre-1970 chest 99% confidence entrance uncollimated kerma (2.5 mm Al HVL) ORAUT-OTIB-0006, Table 4.0-1. (d) Organs identified in ICRP 34 (1982) for dose determination from air kerma skin entrance dose equivalent associated with chest radi
Table B.1-2 Dose Equivalent for IREP Organs not Included in ICRP 34 (1982) Beam Quality for P/A Views 

Time 

period Frequency 

PORTS 

employee 

Organ dose Equivalents per P/A Chest (rem) 

Air kerma Thymus Esophagus Stomach 

Bone 

surface 

Liver/gall 

bladder 

Urinary/ 

bladder 

Colon/ 

rectum Eye/B

 1954­ 1960 

(PFG)(a) Annual All 

3.000 

uncollimated 1.35 1.35 1.35 1.35 0.504 0.504 0.504 0.0

1961­

1969 

(Pre1970)(b) Annual All 0.200 uncollimated 0.0902 0.0902 0.0902 0.0902 0.0336 0.0336 0.0336 0.00

1970­

1978 

(Type I) Annual All 

0.200 

2.5 mm HVL 0.0902 0.0902 0.0902 0.0902 0.0002 0.0002 0.0002 0.00

1979­

1989 

(Type II) Annual All 

0.043 

3.5 mm HVL 0.0262 0.0262 0.0262 0.0262 0.000138 0.000138 0.000138 0.00

1990­present 

(Type III) 

Offered Every 10 years 

Employees up to 30 years old. 

0.043 

3.5 mm HVL 0.0262 0.0262 0.0262 0.0262 0.000138 0.000138 0.000138 0.00

Offered Every 5 years 

Employees up to 45 years old. 

Offered Every 3 years 

Employees greater than 45 years old. 

Annually Asbestos 

/Beryllium workers. 

(a) Photofluorographic chest 99% confidence entrance uncollimated kerma (2.5 mm Al HVL) ORAUT-OTIB-0006, Table 4.0-1 

(b) Pre-1970 chest 99% confidence entrance uncollimated kerma (2.5 mm Al HVL) ORAUT-OTIB-0006, Table 4.0-1 (c) Entrance skin dose is entrance skin exposure calculated from air kerma, multiplied by a backscatter factor of 1.4 from NCRP 102, T
Table B.1-3 Dose Equivalents for Organs Identified in ICRP 34 (1982) Beam Quality for LAT Views 

Time 

period Frequency 

PORTS 

employee 

Organ Dose Equivalents per LAT Chest (re

Air kerma at 

skin 

entrance(a) Thyroid(c) Ovaries(c) Testes(c) Lungs(c) 

Breast( 

c) 

Uterus(c) 

(Embryo 

) 

1961-1969 

(Pre­ 1970)(a) Annual All 

0.500 

uncollimated 0.0685 0.0285 0.00165 0.1100 0.1280 0.0215 

1970-1978 

(Type I) Annual All 

0.500 

2.5 mm HVL 0.0575 0.0003 0.00005 0.1100 0.0128 0.0003 

1979-1998 

(Type II) Annual All 

0.108 

3.5 mm HVL 0.0162 0.000172 0.0000108 0.0333 0.034 0.000151 

1990­present 

(Type III) 

Offered Every 10 years 

Employees up to 30 years old. 

0.108 

3.5 mm HVL 0.0162 0.000172 0.0000108 0.0333 0.034 0.000151 

Offered Every 5 years 

Employees up to 45 years old. 

Offered Every 3 years 

Employees greater than 45 years old. 

Annually Asbestos 

/Beryllium workers. 

(a) Air kerma at entrance skin in rem. (b) Pre-1970 chest 99% confidence entrance uncollimated kerma (2.5 mm Al HVL) ORAUT-OTIB-0006, Table 4.0-1. (c) Organs identified in ICRP 34 (1982) for dose determination from air kerma skin entrance dose equivalent associated with chest radi
Table B.1-4 Dose Equivalent for IREP Organs not Included in ICRP 34 (1982) Beam Quality for LAT Views 

Time 

period Frequency 

PORTS 

employee 

Organ Dose Equivalents per LAT Chest (rem) 

Air kerma Thymus 

Esophagus Stomach Bone surface Liver/gall bladder Urinary/ bladder Colon/ rectum E

B

1961-1969 

(Pre1970)(a) Annual All 

0.500 

uncollimated 0.110 0.110 0.110 0.110 0.0285 0.0285 0.0285 0.

1970-1978 

(Type I) 

Annual All 

0.500 

2.5 mm 

HVL 0.110 0.110 0.110 0.110 0.0003 0.0003 0.0003 0.

1979-1989 

(Type II) 

Annual All 

0.108 

3.5 mm 

HVL 0.0333 0.0333 0.0333 0.0333 0.000172 0.000172 0.000172 0.

1990­present 

(Type III) 

Offered Every 10 years 

Employees up to 30 years old. 

0.108 

3.5 mm 

HVL 

0.0333 0.0333 0.0333 0.0333 0.000172 0.000172 0.000172 0.

Offered Every 5 years 

Employees up to 45 years old. 

Offered Every 3 years 

Employees greater than 45 years old. 

Annually Asbestos 

/Beryllium workers. 

(a) Pre-1970 chest 99% confidence entrance uncollimated kerma (2.5 mm Al HVL) ORAUT-OTIB-0006, Table 4.0-1 (b) Entrance skin dose is entrance skin exposure calculated from air kerma, multiplied by a backscatter factor of 1.4 from NCRP 102, T

multiplied by a factor of 2.67.