ORAU Team

Dose Reconstruction Project for NIOSH

Pinellas Plant - Occupational Medical Dose

Document Number:

ORAUT-TKBS-0029-3

Effective Date: 07/04/2006

Revision No.: 00 PC-1

Controlled Copy No.: ________

Page 1 of 23

Subject Expert: Paul J. Demopoulos

Document Owner

Approval: Signature on File Date: 05/05/2005

Mark D. Notich, TBD Team Leader

Approval: Signature on File Date: 05/06/2005

Judson L. Kenoyer, Task 3 Manager

Concurrence: Signature on File Date: 05/05/2005

Richard E. Toohey, Project Director

Approval: Signature on File Date: 05/06/2005

James W. Neton, Associate Director for Science

Supersedes:

None

TABLE OF CONTENTS

Section

ACRONYMS AND ABBREVIATIONS..................................................................................................

Page

4

3.0 INTRODUCTION AND OCCUPATIONAL MEDICAL DOSE........................................................ 5

3.1 EXAMINATION FREQUENCIES.................................................................................................7

3.2 EQUIPMENT AND TECHNIQUES..............................................................................................7

3.2.1 Photofluorography (1957-1960) .....................................................................................7

3.2.2 Pre-1972 (1961-1971)....................................................................................................8

3.2.3 Post 1972 (1972-1997) ..................................................................................................9

3.2.4 Medical X-ray Quality Control.........................................................................................9

3.2.5 Diagnostic X-ray Technique Generalizations 1957 to Date .......................................... 10

3.3 ORGAN DOSE CALCULATIONS ............................................................................................. 11

3.3.1 Photofluorography (1957-1960) ................................................................................... 12

3.3.2 Pre-1972 (1961-1971).................................................................................................. 12

3.3.3 Post 1972 (1972-1997) ................................................................................................ 12

3.4 UNCERTAINTY ........................................................................................................................14

3.5 DOSE RECONSTRUCTOR INSTRUCTIONS........................................................................... 16

3.6 ORGAN DOSE EQUIVALENTS FOR LUMBAR SPINE EXAMINATIONS................................. 16

3.7 ORGAN DOSE EQUIVALENTS FOR ABDOMINAL AND KUB EXAMINATIONS ..................... 17

REFERENCES..................................................................................................................................19

GLOSSARY.......................................................................................................................................20
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 2 of 23

LIST OF TABLES

Table 3.1-1 Medical X-rays with Parameters Utilized at the Pinellas Plant in 1983 .......................7

Table 3.2.2-1 Technique Factors Used for Each Type of X-ray Equipment......................................8

Table 3.2.3-1 Medical X-ray Equipment, Technique Factors, mR/mAs Measurements and HVL .....9

Table 3.2.3-2 Description of the X-ray Equipment Used at the Pinellas Plant ..................................9

Table 3.2.4-1 Medical X-ray Quality Assurance Parametersa ........................................................10

Table 3.2.4-2 Half Value Layer Limits............................................................................................10

Table 3.2.4-3 Entrance Skin Exposure Guidelines.........................................................................10

Table 3.2.5-1 Relationship of Beam Intensity and Various Technical Factors................................10

Table 3.3.3-1 Analogues for IREP Organs not Included in ICRP 34 ..............................................13

Table 3.3.3-2 Dose conversion factors in mGy/1 Gy of entrance kerma as a function of view 

and x-ray machine technique factors .......................................................................14

Table 3.6-1 Organ Dose Equivalents in Rem for Lumbar Spine Examinationsc ..........................16

Table 3.7-1 Organ Dose Equivalents in Rem for Abdominal and KUB Examinationsc

.................17

Table 3A-1 Dose Equivalents for Organs Identified in ICRP 34 (1982) for PA Views(f) ...............22

Table 3A-2 Dose Equivalent for IREP Organs not Included in ICRP 34 (1982) for PA Views(e) ..22

Table 3A-3 Dose Equivalents for Organs Identified in ICRP 34 (1982) Beam Quality for LAT 

Views(e)....................................................................................................................23

Table 3A-4 Dose Equivalent for IREP Organs not Included in ICRP 34 (1982) for LAT 

Views(d)....................................................................................................................23
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RECORD OF ISSUE/REVISIONS

ISSUE 

AUTHORIZATION 

DATE

EFFECTIVE 

DATE REV. NO. DESCRIPTION

05/06/2005 05/06/2005 00 New technical basis document for the Pinellas 

Plant – Occupational Medical Dose. First 

approved issue. Initiated by Mark D. Notich.

05/06/2005 07/04/2006 00 PC-1 Page change revision to incorporate introductory 

language from NIOSH on pages 5 and 6 in Section 

3.0. Deletes the uterus as an analogue/surrogate 

organ in Table 3.3.3-1 on page 13 in Section 3.3.3

as per Task 5 comment. No changes occurred as 

a result of formal internal review. Incorporates 

NIOSH formal and DOL review comments. No 

sections were deleted. This revision results in a 

reduction in assigned dose and no PER is 

required. Training required: As determined by the 

Task Manager. Initiated by Paul J. Demopoulos.

Approval:

Paul J. Demopoulos, TBD Team Leader

Signature on File________________05/25/2006

John M. Byrne, Task 3 Manager

Signature on File________________05/25/2006

Edward F. Maher, Task 5 Manager

Signature on File________________05/25/2006

Signature on File _______________ Kate Kimpan, Project Director06/20/2006

Signature on File________________ James W. Neton, Associate Director for Science07/04/2006
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 4 of 23

ACRONYMS AND ABBREVIATIONS

AAPM American Association of Physicists in Medicine

AP anterior posterior (x-ray view)

Al aluminum (x-ray machine filtration)

cGy centigray

cm centimeter

DCF dose conversion factor

DOE U.S. Department of Energy

EEOICPA Energy Employees Occupational Illness Compensation Program Act

ESE entrance skin exposure

ESEG entrance skin exposure guideline

FDA Federal Drug Administration

GEND General Electric Nuclear Devices (Pinellas plant)

Gy gray

HVL Half Value Layer

ICRP International Commission of Radiation Protection

IREP Interactive RadioEpidemiological Program

KUB Kidney, Ureter, Bladder

kVp kilovolts peak or peak kilovoltage

LAT lateral (x-ray view)

mA milliampere

mAs milliampere seconds

mGy milligrey

mm millimeter

mR milliRoentgen 

NCRP National Council on Radiation Protection and Measurements

NIOSH National Institute for Occupational Safety and Health

PA posterior anterior (x-ray view)

PFG photofluorographic

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 INTRODUCTION AND OCCUPATIONAL MEDICAL DOSE

Diagnostic x-ray procedures were a contributor to the occupational radiation exposure of the Pinellas 

Plant. The Pinellas plant required pre-employment physical examinations as part of their occupational 

health and safety program. In general, the dose from these exposures was not measured, considered 

or included as part of the occupational exposure of the employee, although it is clearly related. Under 

the EEOICPA program, diagnostic medical x-rays administered in conjunction with routine or special 

physical examinations required for employment are recognized as a valid source of occupational 

exposure. These medical examinations typically included diagnostic Posterior Anterior (PA) and 

infrequently Lateral (LAT) chest x-rays.

Technical basis documents and site profile documents are not official determinations made by the 

National Institute for Occupational Safety and Health (NIOSH) but are rather general working 

documents that provide historic background information and guidance to assist in the preparation of 

dose reconstructions at particular sites or categories of sites. They will be revised in the event 

additional relevant information is obtained about the affected site(s). These documents may be used 

to assist the NIOSH staff in the completion of the individual work required for each dose 

reconstruction.

In this document the word “facility” is used as a general term for an area, building, or group of 

buildings that served a specific purpose at a site. It does not necessarily connote an “atomic weapons 

employer facility” or a “Department of Energy [DOE] facility” as defined in the Energy Employees 

Occupational Illness Compensation Program Act [EEOICPA; 42 U.S.C. § 7384l(5) and (12)]. 

EEOICPA defines a DOE facility as “any building, structure, or premise, including the grounds upon 

which such building, structure, or premise is located ... in which operations are, or have been, 

conducted by, or on behalf of, the Department of Energy (except for buildings, structures, premises, 

grounds, or operations ... pertaining to the Naval Nuclear Propulsion Program)” [42 U.S.C. § 

7384l(12)]. Accordingly, except for the exclusion for the Naval Nuclear Propulsion Program noted 

above, any facility that performs or performed DOE operations of any nature whatsoever is a DOE 

facility encompassed by EEOICPA.

For employees of DOE or its contractors with cancer, the DOE facility definition only determines 

eligibility for a dose reconstruction, which is a prerequisite to a compensation decision (except for 

members of the Special Exposure Cohort). The compensation decision for cancer claimants is based 

on a section of the statute entitled “Exposure in the Performance of Duty.” That provision [42 U.S.C. § 

7384n(b)] says that an individual with cancer “shall be determined to have sustained that cancer in the 

performance of duty for purposes of the compensation program if, and only if, the cancer ... was at 

least as likely as not related to employment at the facility [where the employee worked], as 

determined in accordance with the POC [probability of causation1

As noted above, the statute includes a definition of a DOE facility that excludes “buildings, structures, 

premises, grounds, or operations covered by Executive Order No. 12344, dated February 1, 1982 (42 

U.S.C. 7158 note), pertaining to the Naval Nuclear Propulsion Program” [42 U.S.C. § 7384l(12)]. 

While this definition contains an exclusion with respect to the Naval Nuclear Propulsion Program, the 

section of EEOICPA that deals with the compensation decision for covered employees with cancer 

[i.e., 42 U.S.C. § 7384n(b), entitled “Exposure in the Performance of Duty”] does not contain such an 

exclusion. Therefore, the statute requires NIOSH to include all occupationally derived radiation 

exposures at the facility in its dose reconstructions for employees at DOE facilities, including radiation 

exposures related to the Naval Nuclear Propulsion Program. As a result, all internal and external 

] guidelines established under 

subsection (c) ...” [42 U.S.C. § 7384n(b)]. Neither the statute nor the probability of causation 

guidelines (nor the dose reconstruction regulation) define “performance of duty” for DOE employees 

with a covered cancer or restrict the “duty” to nuclear weapons work.

 

1 The U.S. Department of Labor is ultimately responsible under the EEOICPA for determining the POC. 
Effective Date: 07/04/2006 Revision No. 00 PC-1 Document No.: ORAUT-TKBS-0029-3 Page 6 of 23

dosimetry monitoring results are considered valid for use in dose reconstruction. No efforts are made 

to determine the eligibility of any fraction of total measured exposure for inclusion in dose 

reconstruction. NIOSH, however, does not consider the following exposures to be occupationally 

derived:

• Radiation from naturally occurring radon present in conventional structures

• Radiation from diagnostic X-rays received in the treatment of work-related injuries
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3.1 EXAMINATION FREQUENCIES

Review of about 10% of the medical x-ray files for the Pinellas plant indicates that since the start-up of 

the plant to closure in 1997 PA chest x-rays were given up to an annual basis with infrequent LAT 

chest x-rays. The medical x-ray file contains information about the actual type of x-ray acquired, 

number of views, type of view and frequency. This information is recorded on the outside storage 

envelope of the x-ray films. The dose reconstructor should refer to the claimants’ medical records for 

the most accurate information on the actual x-rays performed, number of views, type of view and 

frequency. Some of this information may not be recorded in the employee medical records. The policy 

for chest x-ray frequency may have been (no written policy has been located) every 5 years before 

age 40 and every 3 years > 40 years of age. 

Other x-rays that were offered to employees included KUB, lumbar spine, cervical spine, hand, ankle, 

foot, sinuses, and wrist. As far as it is known, these x-rays were not given in conjunction with 

employment and are not included in doses under EEOICPA. From 1969 to 1974 abdominal and KUB 

x-rays may have been given along with the typical PA chest x-ray as indicated in some claimant 

medical records.

Table 3.1-1 indicates the distribution of medical x-rays performed in 1983. This information was used 

to determine shielding requirements for the medical x-ray facility to account for proposed facility 

changes in 1984. It is not known why so many hand x-rays were given. The vast majority of x-rays 

were chest x-rays, about 64%. 

Table 3.1-1 Medical X-rays with Parameters Utilized at the Pinellas Plant in 1983

X-ray Type Number mR/mAsa mAs kVpb Distance 

(meters)

Chest 480 2.00 20 90 1.83

Cervical 6 1.00 20 70 1.83

Lumbar 5 7.00 70 90 1

Lumbar 5 5.00 100 80 1

Shoulder 12 5.00 20 80 1

Skull 1 5.00 20 80 1

Skull 1 6.00 40 85 1

Sinus 15 4.50 80 75 1

Ribs 5 4.50 20 75 1

Dorsal Spine 5 4.00 200 70 1

KUB 12 4.00 100 70 1

Ankle 20 3.50 5 65 1

Foot 24 3.00 5 60 1

Wrist 30 3.00 7.5 60 1

Hand 120 2.50 2.5 55 1

Knee 5 2.50 10 55 1

Total 746

a. mR/mAs – milliroentgen/milliampere seconds.

b. kVp – peak kilovoltage. 

Source: “Medical Facility Shielding Document”, 1984.

3.2 EQUIPMENT AND TECHNIQUES

3.2.1

Chest photofluorography, which resulted in 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 kVp and typically a 

Photofluorography (1957-1960)
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several fold greater exposure in terms of mAs. Exposure was regulated by photometers, which utilized 

the exposure to the film to determine the time of exposure. 

After the review of about 10% of the medical x-rays located at the Atlanta national archives there was 

no evidence of the use of photofluorography at the Pinellas plant. However, there was at least one 

occasion where photofluorography was conducted as evidenced from one claimant’s files. Unless 

otherwise indicated in the employee’s medical x-ray file, the use of photofluorography should be 

assumed to ensure conservative dose reconstructions from the time-period of 1957 through 1960. In 

the case where it is apparent that photofluorographic (PFG) films were not taken (no 4 inch x 5 inch 

films or two images on a 4 inch x 10 inch film are present), then the pre-1972 PA chest x-ray organ 

dose values should be utilized. 

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 

millimeter (mm) film (4 inch x 5 inch); 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, a HVL 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, which is likely an upper limit value based on a large patient and is consistent with 

an ESE of about 600-700 mR for a 24-30 mAs exposure at somewhat lower kVp. The Hanford 

measured value of 1.53R ESE is an upper limit and hence an overstatement of the actual exposure 

from photofluorography to the average patient, and thus this 1.53R ESE value times two views or 3.00 

R ESE as implied in the site wide TIB (Table 4.01 in ORAUT-OTIB-0006) should be used. 

3.2.2

The x-ray machine information and techniques utilized prior to 1972 are not available. The ESE was 

based upon the complex-wide x-ray Technical Basis Document (TBD) (ORAUT-OTIB-0006, rev02), 

guidance as presented in Table 3.2.2-1. Default dose values by procedure are presented in section 

3.3.3. An entrance air kerma of 200 mR for PA and 500 mR for Lat x-rays was utilized in the organ 

dose calculations.

Pre-1972 (1961-1971)

Table 3.2.2-1 Technique Factors Used for Each Type of X-ray Equipment

Machine

Assumed 

HVL (mm 

Ala)

Image 

Size 

(inches)

ESE (cGyb) PA View Currentc

(mA)

Voltagec

(kVp)

Exposure 

Timec

PA LAT (sec.)

1957-1960

(PFG)

2.5 4 x 5 3.0 NA Techniques unknown. No records were 

kept with regard to the technique factors 

used during this time period.

Pre-1972 

(1961-1971)

2.5 14 x 17 0.2 0.5 PAd Unknown

Post-1972 

(1972 – 1997)

3.5 14 x 17 0.035 0.0875 PA 200 85 1/10

a. Al – aluminum.

b. cGy – centrigray (equal to approximately 1 rem).

c. Manual technique factors obtained from GEND ”Medical Facility Shielding Document”, 1984.

d. PA indicates a PA view, the average PA chest measures 26 centimeters (cm). The average Lat. chest measures 34 cm. 
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3.2.3

The x-ray machine information from 1972 to the present is available from the following surveys: a) one 

survey conducted by the Pinellas county health department in 1972, b) a number of surveys 

conducted by Pinellas health physics department from 1975-1984 and c) one survey conducted by the 

Food and Drug Administration (FDA) in 1992. The highest measured mR/mAs value measured as 

listed in Table 3.2.3-1 is 1.20 mR/mAs which if multiplied by 20 mAs for a PA chest x-ray yields about 

24 mR. This value is utilized as the air kerma value. The entrance air kerma value (or ESE) is then 

calculated by estimating the air kerma at the skin of the patient. A summary description of the x-ray 

equipment used at the Pinellas plant is included in Table 3.2.3-2. A summary of the specific technique 

factors for these machines is presented in Table 3.2.2-1. 

Post 1972 (1972-1997) 

Table 3.2.3-1 Medical X-ray Equipment, Technique Factors, mR/mAs Measurements and HVL

Date View Current 

(mA)

Voltage 

(kVp)

Exposure 

time (sec.) mR/mAs HVL

1972a PA 200 85 1/10 1.20 3.20

1/1975 b PA 200 85 1/10 0.84 3.60

2/1975 b PA 200 85 1/10 0.96 3.25

6/1975 b PA 200 85 1/10 1.06 2.90

1/1976 b PA 200 85 1/10 0.86 3.50

6/1977 b PA 200 85 1/10 0.90 3.20

9/1978 b PA 200 85 1/10 1.02 3.20

9/1979 b PA 200 85 1/10 0.96 3.20

8/1982 b PA 200 90 1/10 0.87 3.20

5/1983 b PA 200 80 1/10 0.76 NR

1/1984 b PA 200 85 1/10 0.88 3.00

3/9/1992c PA 200 97 1/30 16.3 mR (using LuCal 

phantom)

a. Source: PCDH, 1972.

b. “GEND Medical x-ray Surveys (Health Physics Department)”, 1975-1984. Acquired from free in air Ion Chamber 

measurements.

c. FDA Medical x-ray survey, March 9, 1992 with a LuCal chest phantom, assuming a 23 cm PA chest size.

Table 3.2.3-2 Description of the X-ray Equipment Used at the Pinellas Plant

Technique Time period Equipment

Photofluorography 

(PFG)

1957-1960 No information available. 

Pre-1972 1961-1971 No information available. Probably the GE DXE-225, 200 

mA machine since this was the original and only unit.a

Post-1972 1972–1997 GE DXE-225, single phase, 2 pulse, 200 mA, 125 kVp, 

automated collimator, AFP 14XL automatic film processor

a. “Medical X-ray Unit (Survey)”, 1/1963.

3.2.4

The x-ray equipment that was used had been quality control checked for ESE by the Pinellas plant 

health physics group from at least 1975. Although all of the records for these Quality Assurance (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 the Entrance Skin Exposure Guide (ESEG) was achieved. A diagnostic medical x-ray survey 

checking the 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, 

Medical X-ray Quality Control
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beam collimation and alignment testing. Table 3.2-4-1 through Table 3.2.4-3 summarizes the 

parameters tested and the allowed tolerances.

Table 3.2.4-1 Medical X-ray Quality Assurance Parametersa

kVp and mA Requirements +/- 10 % combined deviation

Timing Requirements t +/- 20 % for t > 10 milliseconds 

Beam Alignment, Light and Radiation Field 

Congruence Requirements

Less than 2% of the source to image distance 

(SID) or 2 inches for PA chest.

a. “GEND Medical X-ray Surveys” (Health Physics Department), 1975-1984.

The limits for HVL are as follows: 

Table 3.2.4-2 Half Value Layer Limits

Measured kVp Minimum HVL (mm 

Al) Measured kVp Minimum HVL (mm Al)

50 1.3 110 3.0

60 1.3 120 3.2

70 1.5 130 3.5

80 2.3 140 3.8

90 2.5 150 4.1

100 2.7

Source: AAPM, 1978.

The ESE guidelines are as follows:

Table 3.2.4-3 Entrance Skin Exposure Guidelines

Projection ESEG (mR)

Chest (PA) 30

Skull (Lat) 300

Abdomen (AP) 750

Cervical Spine (AP) 250

Thoracic Spine (AP) 900

Full Spine (AP) 300

Lumbar-Sacral Spine (AP) 1000

Retrograde Pyelogram (AP) 900

Feet (D/P) 270

Source: AAPM, 1978.

3.2.5

For convenience and possible application to cases in which the standard Pinellas plant protocol was 

not followed, or for generic use, the effect of various technical factors has been tabulated below in

Table 3.2.5-1.

Diagnostic X-ray Technique Generalizations 1957 to Date 

Table 3.2.5-1 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 second Linear

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

Source: ORAUT-TKBS-0006-3 TBD 2003, p6.

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

plant from 1957 to 1997 revealed that only one diagnostic medical radiographic procedure was 

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

PA 14” x 17” chest film and sometimes a LAT chest x-ray. Lumbar spine and abdominal/KUB x-rays 

may have been included as a part of the routine or periodic medical examination. Accordingly, doses 

from these four views were evaluated. Any other radiographic examinations of Pinellas plant 

employees that might have occurred were probably 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, if there is no indication in the records that these other diagnostic radiographic examinations 

were administered as a part of the occupational medical program, then they should not be considered 

as part of the occupational dose.

3.3 ORGAN DOSE CALCULATIONS

International Commission of Radiation Protection (ICRP) Publication 34 (ICRP, 1982) provides tables 

of average absorbed dose (mGy) in selected organs for selected x-ray projections at 1 gray (Gy) 

entrance kerma (i.e., skin entrance air kerma without backscatter), for selected views (including PA), 

and for selected beam qualities (i.e., various HVLs). These tables provide the basic DCFs for 

converting skin entrance air kerma to organ dose. 

The organ doses are found by multiplying the ICRP 34 organ dose conversion factors (DCFs) by the 

entrance air kerma values. The resulting organ doses for all years are in Tables 3A-1 through 3A-4. 

The doses are shown in units of dose equivalent or rem, assuming a quality factor of 1.0 for x-rays. 

Records will indicate the view and in most cases only one view was taken per medical examination.

X-ray organ dose estimates for occupational x-rays administered at the Pinellas plant are made for 

PFG chest exams (possibly used from 1957 through 1960), PA and lat chest exams performed on pre 

1972 equipment (used from 1961 to 1971), and post 1972 equipment (used from 1972 to 1997). X-ray 

dose estimates are also made for lumbar spine and abdominal/KUB x-rays and presented in sections 

3.6 and 3.7 respectively. 

For the PA view, a standard SID of 72 inches (183 cm) was used. Additional information indicated that 

the x-ray machine was single phase (GE, 1980). QC checks of the machine indicated a 2.9 to 3.6 mm 

Al HVL as indicated in Table 3.2.3-1. A value of 3.5 mm Al HVL would be conservative for the post 

1972 calculations. Attachment 3A contains organ doses for PA 14” x 17” chest films (Tables 3A-1 and 

3A-2). 

For the LAT view, 2.5 times the PA ESE value was used to estimate the LAT ESE value. Tables 3A-3 

and 3A-4 in Attachment 3A list organ doses for LAT 14” x 17” chest films. 

Default values of ESE have been developed for the three most commonly used occupational medical 

diagnostic x-ray procedures: PA chest radiography; LAT chest radiography; PFG chest films when 

actual measurement data or knowledge of technique factors is absent and minimal 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 that the actual exposures from the specified procedures would not 
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 12 of 23

exceed the default values. 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 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 DCFs for poorly collimated beams as listed in the complex-wide x-ray TBD guidance 

document in Table 4.0-1 in ORAUT-OTIB-0006, rev 02, for years 1957-1960 (PFG), and 1961-1971. 

Post 1972 ESEs are based on actual measurements.

3.3.1

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 DCFs for the 

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

Photofluorography (1957-1960)

3.3.2

Prior to about 1972, x-ray measurement data, techniques, or beam port information may not be 

available to estimate the collimation of the x-ray beam. Due to the reported variation in the literature 

and measurement data on the effects of collimation, it is conservative 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 1972. 

Pre-1972 (1961-1971)

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

This necessitates the use of DCFs from ICRP 34 other than those for a PA or LAT chest x-ray, since 

ICRP 34 DCFs are based on properly collimated beams. For poorly collimated beams used prior to 

1972, the DCFs as listed in the complex-wide x-ray TBD guidance document in Table 4.0-1 were 

used. The ESE values for the pre-1972 x-ray machine that are used in the organ dose calculations 

are listed in Table 3.2.2-1. The calculation is analogous to the organ doses calculated for properly 

collimated beams as illustrated in section 3.3.3.

3.3.3

Based on the techniques in Table 3.2.2-1, the mAs for the types of equipment were calculated for 

each view:

Post 1972 (1972-1997)

Current (mA) × Exposure Time (sec) = Current for View (mAs) (3.3.3–1)

Example for post 1972 PA view: 200 mA × 1/10 second = 20 mAs 

One method of calculating the air kerma is by using the machine parameters and appropriate 

conversions. The air kerma rate for 85 kVp was determined to be 0.165 cGy per 100 mAs (see Table 

B.3 of NCRP, 1989) 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) (3.3.3–2)

Example for post 1972 PA view: 20 mAs × 0.00165 cGy/mAs = 0.033 cGy
Effective Date: 07/04/2006 Revision No. 00 PC-1 Document No.: ORAUT-TKBS-0029-3 Page 13 of 23

Multiply by 0.6 to account for 3.5 mm Al versus 2.5 mm Al Table B.3 (NCRP, 1989) (3.3.3–3)

is based upon; 0.6 X 0.033 cGy = 0.020 cGy 

This calculated air kerma is about equal to the measured 0.024 cGy air kerma as discussed in section 

3.2.3.

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 (3.3.3–4)

Example for post 1972 PA view: 0.024 cGy x (183 cm)2 ÷ (152 cm)2 = 0.035 cGy

Air kerma at skin entrance was multiplied by the DCFs in Table A.2 through A.8 of ICRP 

Publication 34 (ICRP, 1982) for PA chest and HVL of 3.5 mm Al equivalent.

Air Kerma (cGy ) x Dose conversion factor = Dose for View (cGy) (3.3.3–5)

Example for post 1972 PA view, dose to thyroid: 

0.035 cGy x 62 mGy/Gy x 1 Gy/100 cGy x 1 rad/10 mGy = 2.17E-3 rad

Specific organ doses to be attributed for PA chest x-rays calculated on the basis of the DCFs found in 

ICRP Publication 34 (ICRP, 1982) are given in Attachment A, Table 3A-1 and 3A-2. LAT DCFs are 

given in Attachment 3A, Table 3A-3 and 3A-4. For organs not listed in ICRP Publication 34 (ICRP, 

1982) but specified in the Interactive RadioEpidemiological Program (IREP) code, doses were 

determined by analogy with anatomical location (Table 3.3.3-1). Thus IREP code organs in the 

thoracic cavity, but not mentioned in the ICRP Publication 34 (ICRP, 1982) 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, because of geometry considerations and at least in the case of the brain, 

because of attenuation by the bony cranium. To ensure conservatism in the view of the variations in 

organ dose described in ICRP Publication 34 (ICRP, 1982, p. 51), the doses for females (lungs), 

which are slightly higher than those for males, were used and the doses for males (bone marrow), 

which are slightly higher than those for females, were used. Table 3.3.3-1 lists the reference organ 

used to approximate the organ analogue doses prior to 1972 for PA and LAT chest and PFG.

Table 3.3.3-1 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

Liver/Gall Bladder/Spleen

Remainder organs

Abdomen Ovaries Urinary Bladder

Colon/Rectum

Head and Neck Thyroid Eye/brain

Since at least 1972 beam collimation was checked and found adequate from annual surveys 

conducted from about 1972 though 1985 and verified by a FDA survey conducted in 1992. The 

Pinellas x-ray equipment was likely properly collimated since 1957 since the same x-ray machine and 

associated equipment was probably used from 1957-1997 and there is no evidence that the machine 

was altered significantly. However, some organs for Lumbar spine and abdominal/KUB x-rays will be 
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 14 of 23

considered to be in the primary beam before 1974 and for PA and LAT chest prior to 1972. The testes 

dose for the AP lumbar spine x-rays will be approximated by the abdominal/KUB testes dose 

conversion factor multiplied by the appropriate lumbar spine ESE. The testes dose for the LAT lumbar 

spine x-rays will be approximated by the LAT pelvis testes dose conversion factor multiplied by the 

appropriate lumbar spine ESE. The lumbar spine and abdominal/KUB breast dose was estimated by 

using the dose conversion factors for the AP and LAT UGI all years. Table 3.3.3-2 lists the dose 

conversion factors as a function of view and x-ray machine technique factors.

Table 3.3.3-2 Dose conversion factors in mGy/1 Gy of entrance kerma as a function of view and xray machine technique factors

 Examination Parameters

Projection View SID

(cm)

HVL 

(mm)

ESE

(R)

Thyroid Ovaries Testes Lungs Female 

Breast

Uterus 

(embryo)

Active 

bone 

marrow

Lumbar

Spine

1969-1997

AP 102 3.5 1.05 0.9 331 9 109 37

(AP 

UGI)

421 71

Lumbar 

Spine

1957-1968

AP 102 3.5 1.05 0.9 331 32

(ab/ 

KUB 

testes)

109 37(AP 

UGI)

421 71

Abdominal/

KUB

1975-1997

AP 102 3.5 .825 0.01 360 32 23 37

(AP 

UGI)

451 76

Abdominal/

KUB

1957-1974

AP 102 3.5 .825 0.01 360 125

(Pelvis

testes)

23 37(AP 

UGI)

451 76

Chest

Post 1972

PA 183 3.5 .035 62 3.2 0.01 610 91 3 146

Chest

Pre 1972

PA 183 2.5 0.20 174 125 25 451 49 125 92

Lumbar 

Spine

1975-1997

LAT 102 3.5 2.62 0.01 87 1.8 22 17 

(LAT 

UGI)

61 43

Lumbar 

Spine

1957-1974

LAT 102 3.5 2.62 0.01 87 7

(ab/ 

KUB 

testes)

22 17 

(LAT 

UGI)

61 43

Abdominal/

KUB

1975-1997

LAT 102 3.5 2.06 0.01 107 7 6.3 17

(LAT 

UGI)

82 47

Abdominal/

KUB

1957-1974

LAT 102 3.5 2.06 0.01 107 45

(Pelvis 

testes)

6.3 17 

(LAT 

UGI) 

82 47

Chest

Post 1972

LAT 183 3.5 .088 151 1.6 0.10 310 316 1.4 61

Chest

Pre 1972

LAT 183 2.5 0.50 137 65 12.5 220 255 65 37

3.4 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. 

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 
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 15 of 23

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. 

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 70 to 

90 kVp range used for diagnostic radiographs at the Pinellas plant. For conservatism, this is rounded 

up to ± 9%. 

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 Pinellas plant. 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%. 

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. Once again for conservatism, uncertainty in beam output attributable to timers will 

be assumed to have an upper limit of + 25%.

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 ESE. 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 perhaps 7.5 cm. Using 

Inverse Square, this indicates an uncertainty of ± 10% from this source. 

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 ESE or 
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 16 of 23

derived organ dose, an uncertainty of ± 30% 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-OTIB0006, rev02).

3.5 DOSE RECONSTRUCTOR INSTRUCTIONS

The information below provides instructions for dose reconstructors 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 (NIOSH, 2002). 

Dose should be assigned based upon recorded individual x-ray examination medical histories. This 

may or may not be recorded in the medical file but can be found in the medical x-ray files recorded on 

the file envelope. The assigned doses in Tables 3A-1 through 3A-4 and the number of examinations is 

a point estimate. Uncertainty should be applied as a normal distribution with an uncertainty of 30%. 

3.6 ORGAN DOSE EQUIVALENTS FOR LUMBAR SPINE EXAMINATIONS

Lumbar spine examinations have occurred throughout Pinellas plant operations. It does not appear to 

have been a frequent pre-employment or regular examination from the review of about 10% of the 

medical x-rays located at the Atlanta national archives and upon the review of a number of claimant 

medical records. In the interim, to be claimant favorable, any medical x-ray that cannot be directly 

connected to injury or illness should be considered occupational. There also seems to have been only 

one view taken, an AP view. However, the LAT organ doses have been calculated and presented in 

Table 3.6-1. As seen in Table 3.1-1 the frequency of lumbar spine x-rays was less than 2% in 1983. 

The best indication of lumbar spine x-ray frequency is the claimant medical x-ray file. The kerma value 

at the SID for the AP view is calculated from the measured 5.0 mR/mAs value multiplied by the 100 

mAs technique factor as listed in Table 3.1-1. This amounts to 500 mR air kerma rate. Correcting for a 

distance of the body of 26 cm and cassette thickness of 5 cm and noting that the SID = 102 cm yields

about a 1050 mR ESE. This also happens to be close to the guideline set in 1978 (see Table 3.2.4-3).

The HVL most likely was about 2.5 to 3.5 mm Al, but for conservatism we will use 3.5 mm. Utilizing 

the DCF for lumbar spine from Tables A2 through A9 from ICRP 34 (1982), Table 3.6-1 lists the dose 

equivalent in rem. See the last paragraph of section 3.3.3 and Table 3.3.3-2 for more information on 

the dose conversion factors used in the organ dose calculations. Note that the LAT view entrance 

kerma is approximated by multiplying the AP view entrance kerma by 2.5. 

Table 3.6-1 Organ Dose Equivalents in Rem for Lumbar Spine Examinationsc

Organ 1957-1968

AP lumbar spine

HVL 3.5 mm AL

ESE 1.05 rem

1957-1968

LAT lumbar 

spine

HVL 3.5 mm AL

ESE 2.625 rem

1969-1997

AP lumbar spine

HVL 3.5 mm AL

ESE 1.05 rem

1969-1997

LAT lumbar 

spine

HVL 3.5 mm AL

ESE 2.625 rem

Bone Marrow 7.46 x 10-2 1.13 x 10-1 7.46 x 10-2 1.13 x 10-1

Bone Surface 1.14 x 10-1 5.78 x 10-2 1.14 x 10-1 5.78 x 10-2 

Breast (Female)a

3.89 x 10-2 4.46 x 10-2 3.89 x 10-2 4.46 x 10-2 

Colon/Rectum 3.48 x 10-1 2.28 x 10-1 3.48 x 10-1 2.28 x 10-1

Esophagus 1.14 x 10-1 5.78 x 10-2 1.14 x 10-1 5.78 x 10-2

Eye/Brain 9.45 x 10-4 2.62 x 10-5 9.45 x 10-4 2.63 x 10-5

Liver/Gall 

Bladder/Spleen 1.14 x 10-1 5.78 x 10-2 1.14 x 10-1 5.78 x 10-2

Lungs 1.14 x 10-1 5.78 x 10-2 1.14 x 10-1 5.78 x 10-2

Ovaries 3.48 x 10-1 2.28 x 10-1 3.48 x 10-1 2.28 x 10-1 

Remainder 1.14 x 10-1 5.78 x 10-2 1.14 x 10-1 5.78 x 10-2

Skin 1.47 x 100 3.68 x 100 1.47 x 100 3.68 x 100
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 17 of 23

Organ 1957-1968

AP lumbar spine

HVL 3.5 mm AL

ESE 1.05 rem

1957-1968

LAT lumbar 

spine

HVL 3.5 mm AL

ESE 2.625 rem

1969-1997

AP lumbar spine

HVL 3.5 mm AL

ESE 1.05 rem

1969-1997

LAT lumbar 

spine

HVL 3.5 mm AL

ESE 2.625 rem

Stomach 1.14 x 10-1 5.78 x 10-2 1.14 x 10-1 5.78 x 10-2

Testesb 3.36 x 10-2 1.84 x 10-2 9.45 x 10-3 4.73 x 10-3

Thymus 1.14 x 10-1 5.78 x 10-2 1.14 x 10-1 5.78 x 10-2

Thyroid 9.45 x 10-4 2.62 x 10-5 9.45 x 10-4 2.63 x 10-5

Total Body 1.44 x 10-1 1.55 x 10-1 1.44 x 10-1 1.55 x 10-1

Urinary/Bladder 3.48 x 10-1 2.28 x 10-1 3.48 x 10-1 2.28 x 10-1 

Uterus 4.42 x 10-1 1.60 x 10-1 4.42 x 10-1 1.60 x 10-1

a. ICRP 34 (1982) does not provide dose conversion factors for the lumbar spine view for the breast. The lumbar 

spine breast dose was estimated by using the dose conversion factors for the AP and LAT UGI 

b. The testes dose was estimated using the abdominal/KUB AP and LAT dose conversion factors for the minimal 

collimation column (1957-1968).

c. Use a correction uncertainty factor of 1.3 to maximize the dose calculation.

3.7 ORGAN DOSE EQUIVALENTS FOR ABDOMINAL AND KUB EXAMINATIONS

There may have been abdominal or Kidney, Ureters, Bladder (KUB) x-rays performed as part of the 

routine or periodic physicals given at the Pinellas site. This may be indicated in the claim documents 

usually from 1969 through 1974. In the interim, to be claimant favorable, any medical x-ray that 

cannot be directly connected to injury or illness should be considered occupational.

The kerma value at the SID for the abdominal/KUB x-ray is calculated from the measured 4.0 

mR/mAs value multiplied by the 100 mAs technique factor as listed in Table 3.1-1. This amounts to 

400 mR air kerma rate. Correcting for a distance of the body of 26 cm and cassette thickness of 5 cm 

and noting that the SID = 102 cm yields 825 mR ESE. This also happens to be close to the guideline 

set in 1978 (see Table 3.2.4-3).

The HVL most likely was about 3.0 to 3.5 mm Al, but for conservatism we will use 3.5 mm. Utilizing 

the DCF for abdominal x-rays which include KUB views from Tables A2 through A9 from ICRP 34 

(1982), Table 3.7-1 lists the dose equivalent in rem. See the last paragraph of section 3.3.3 and Table 

3.3.3-2 for more information on the dose conversion factors used in the organ dose calculations. Note 

that the LAT view entrance kerma is approximated by multiplying the AP entrance kerma view by 2.5. 

Table 3.7-1 Organ Dose Equivalents in Rem for Abdominal and KUB Examinationsc

Organ 1957-1974

AP 

Abdominal/KUB

HVL 3.5 mm AL

ESE 0.825 rem

1957-1974

LAT 

Abdominal/KUB

HVL 3.5 mm AL

ESE 2.063 rem

1975-1997

AP 

Abdominal/KUB

HVL 3.5 mm AL

ESE 0.825 rem

1975-1997

LAT 

Abdominal/KUB

HVL 3.5 mm AL

ESE 2.063 rem

Bone Marrow 6.27 x 10-2 9.69 x 10-2 6.27 x 10-2 9.69 x 10-2

Bone Surface 1.90 x 10-2 1.30 x 10-2 1.90 x 10-2 1.30 x 10-2 

Breast (Female)a 3.05 x 10-2 3.51 x 10-2 3.05 x 10-2 3.51 x 10-2 

Colon/Rectum 2.97 x 10-1 2.21 x 10-1 2.97 x 10-1 2.21 x 10-1 

Esophagus 1.90 x 10-2 1.30 x 10-2 1.90 x 10-2 1.30 x 10-2 

Eye/Brain 8.25 x 10-6 2.06 x 10-5 8.25 x 10-6 2.06 x 10-5

Liver/Gall 

Bladder/Spleen 1.90 x 10-2 1.30 x 10-2 1.90 x 10-2 1.30 x 10-2 

Lungs 1.90 x 10-2 1.30 x 10-2 1.90 x 10-2 1.30 x 10-2 

Ovaries 2.97 x 10-1 2.21 x 10-1 2.97 x 10-1 2.21 x 10-1 
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 18 of 23

Remainder 1.90 x 10-2 1.30 x 10-2 1.90 x 10-2 1.30 x 10-2 

Skin 1.16 x 100 2.89 x 100 1.16 x 100 2.89 x 100

Stomach 1.90 x 10-2 1.30 x 10-2 1.90 x 10-2 1.30 x 10-2 

Testesb 1.03 x 10-1 9.28 x 10-2 2.64 x 10-2 1.44 x 10-2 

Thymus 1.90 x 10-2 1.30 x 10-2 1.90 x 10-2 1.30 x 10-2 

Thyroid 8.25 x 10-6 2.06 x 10-5 8.25 x 10-6 2.06 x 10-5

Total Body 1.14 x 10-1 1.28 x 10-1 1.14 x 10-1 1.28 x 10-1

Urinary/Bladder 2.97 x 10-1 2.21 x 10-1 2.97 x 10-1 2.21 x 10-1 

Uterus 3.72 x 10-1 1.69 x 10-1 3.72 x 10-1 1.69 x 10-1 

a. ICRP 34 (1982) does not provide dose conversion factors for the abdominal/KUB view for the breast. The 

abdominal/KUB breast dose was estimated by using the dose conversion factors for the AP and LAT UGI.

b. The testes dose was estimated using the AP and LAT pelvis dose for the minimal collimation column (1957-1974). 

c. Use a correction uncertainty factor of 1.3 to maximize the dose calculation.
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 19 of 23

REFERENCES

Energy Employees Occupational Illness Compensation Program Act of 2000, as amended, 42 U.S.C. 

§§ 7384-7385 (2005).American Association of Physicists in Medicine (AAPM), 1978, “Basic 

Quality Control in Diagnostic Radiology,” Report Number 4.

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

Federal Drug Administration (FDA), March 9, 1992, Medical X-Ray Survey, B. Collins, Bureau of 

Radiological Health Inspection.

General Electric (GE), 1980, “Single Phase Generators, DXE-225/DXD-350/DXD-525/DXS-650.”

General Electric (GE), 1984, “GEND Medical x-ray Surveys” (Health Physics Department), 1975-

1984. 

International Commission on Radiological Protection (ICRP), 1982, “Protection of the Patient in 

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

“Medical Facility Shielding Document”, 1984. 

“Medical x-ray Unit (Survey)”, 1/1963. National Institute for Occupational Safety and Health (NIOSH), 

August 2002, “External Dose Reconstruction Implementation Guideline,” OCAS-IG-001, rev 1. 

National Council on Radiation Protection and Measurements (NCRP), 1989, “Medical X-ray, Electron 

Beam and Gamma-Ray Protection for Energies Up To 50 MeV,” NCRP Report 102, Bethesda.

ORAUT-OTIB-0006, December 29, 2003, “Dose Reconstruction from Occupationally Related 

Diagnostic x-ray Procedures,” Ronald L. Kathern, Vernon E. Shockley, Elyse M. Thomas and 

Timothy D. Taulbee, rev02. 

ORAUT-TKBS-0006-3, November 16, 2003, “Technical Basis Document for the Hanford SiteOccupational Medical Dose.”

Pinellas County Department of Health (PCDH), December 15, 1972, “Report of Radiation Protection 

Survey (Medical x-ray) at GEND.”

Sante, L.R., 1954, Manual of Roentgenographic Technique, Ann Arbor: Edwards Brothers, p. 61.

Siebert, J. A., G. T. Barnes and R. G. Gould, 1991, Specification, Acceptance testing, and Quality 

Control of Diagnostic X-ray Imaging Equipment. Medical Physics Monography, No. 20, New York: 

American Institute of Physics.
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 20 of 23

GLOSSARY

absorbed dose

The energy imparted per unit mass by ionizing radiation to matter at a specified point. 

The SI unit of absorbed dose is joule per kilogram (J/kg). The special name for this unit 

is gray (Gy). The previously used unit of absorbed dose, rad is being replaced by the 

gray. 1 rad = 0.01 Gy. 1 Gy = 100 rad.

ampere

Electric current unit. One ampere is equal to one coulomb per second.

dose equivalent

The product of the absorbed dose in tissue, quality factor and all other necessary 

modifying factors at the location of interest. The SI unit for dose equivalent is the 

sievert. The historical unit for the dose equivalent is the rem. The ICRP defines dose 

equivalent as equivalent dose.

entrance kerma (or entrance skin kerma or ESE)

Refers to kerma without backscatter.

exposure

A measure of the quantity of x or gamma radiation based upon its ability to ionize air 

through which it passes. The SI unit for exposure is coulomb per kilogram. The 

historical unit for exposure is Roentgen (R).

film

A medium used to record an image.

filtration

Material in the useful beam that usually absorbs preferentially the less penetrating 

radiation.

gray (Gy)

The special name for the SI unit of absorbed dose, Kerma, and specific energy 

imparted equal to one joule per kilogram. One gray equals to one joule per kilogram.

half-value layer (HVL)

Thickness of a specified substance which, when introduced in the path of a given 

beam of radiation, reduces the Kerma rate by one-half.

kerma 

The sum of the initial kinetic energies of charged ionizing particles liberated by 

uncharged ionizing particles per unit mass of a specified material. Kerma is measured 

in the same units as absorbed dose. The SI unit of kerma is joule per kilogram and the 

special name is gray (Gy). Kerma can be quoted for any specified material at a point in 

free space, at the skin entrance or in an absorbing medium.

milligray (mGy)

1 mGy = 10 rad

phantom

An object used to simulate the absorption and scatter characteristics of the patient’s 

body for radiation measurement purposes.
Effective Date: 05/06/2005 Revision No. 00 Document No.: ORAUT-TKBS-0029-3 Page 21 of 23

radiography

The production of images on film by the action of x-rays transmitted through the 

patient.

rad

Historical unit for absorbed dose. One rad equals 100 ergs per gram. The word derives 

from radiation absorbed dose. 

roentgen

The previously used special unit of exposure. An exposure of one roentgen will 

produce 2.58 x 10-4 coulomb of ions of either sign per kilogram in air.

rem

Historical unit of dose equivalent. The word derives from roentgen equivalent (in) man.

sievert (Sv)

The special name for the SI unit of dose equivalent. One sievert equals one joule per 

kilogram. One sievert is equal to 100 rem.

source to image distance (SID)

The distance measured along the central ray from the center of the front of the surface 

of the source (x-ray focal spot) to the surface of the image detector.

source to skin distance (SSD)

The distance measured along the central ray from the center of the front surface of the 

source (x-ray focal spot) to the surface of the irradiated object or patient.

technique factors

Refer to x-ray machine settings used in am examination procedure. The factors 

include such terms as kilovolt peak, milliampere, and exposure time.

voltage

Electrical potential energy per unit charge. The SI unit volt (V). One volt is equal to a 

joule per coulomb. 
Effective Date: 

0

5/0

6/2005 Revision No. 00 Document No. ORAUT-TKBS-0029-3 Page 22 of 23

Attachment 3A

Table 3A-1 Dose Equivalents for Organs Identified in ICRP 34 (1982) for PA Views(f)

Time 

Period Frequency(g)

Organ dose Equivalents per PA Chest (rem)

Air Kerma at 

Skin 

Entrance(a)

Thyroid(d) Ovaries(d) Testes(d) Lungs(d) Breast(d) Uterus(d)

(Embryo)

Bone 

Marrow(d)

1957-1960

(PFG)(b) Annual 3.000

2.5 mm HVL 5.20 x 10-1 2.50 x 10-2 5.00 x 10-3

1.35 x 100

(1.26 x 100)

(e) 1.47 x 10-1 2.50 x 10-2 2.76 x 10-1

(2.58 x 10-1)

1961-1971

(Pre-1972)(c) Annual 0.200 minimal collimation 3.48 x 10-2 2.50 x 10-2 5.00 x 10-3 9.02 x 10-2(8.38x10-2)

(e) 9.80 x 10-3 2.50 x 10-2 1.84 x 10-2

(1.45 x 10-2)

1972-1997

(Post-1972) Annual 0.035

3.5 mm HVL 2.17 x 10-3 1.12 x 10-4 3.50 x 10-7 2.14 x 10-2

(1.98 x 10-2)

(e) 3.19 x 10-3 1.05 x 10-4 5.11 x 10-3

(4.94 x 10-3)

a. Air kerma at entrance skin in rem = ESE (R) x 0.00873 Gy/R ~ ESE (R) x 0.01 Gy/R. 

b. PFG chest entrance kerma (uncollimated ) (2.5 mm Al HVL) (ORAUT-OTIB-0006, Table 4.0-1).

c. Pre-1970 chest 99% confidence entrance kerma (uncollimated ) (2.5 mm Al HVL) (ORAUT-OTIB-0006, Table 4.0-1).

d. Organs identified in ICRP 34 (1982) for dose determination from entrance air kerma associated with chest radiography.

e. Male lung organ dose and female bone marrow organ dose is given in parenthesis. The dose in the parenthesis is less conservative than the dose outside of 

the parenthesis.

f. Use a correction uncertainty factor of 1.3 to maximize the dose calculation.

g. Use claim medical files for frequency information, if available.

Table 3A-2 Dose Equivalent for IREP Organs not Included in ICRP 34 (1982) for PA Views(e)

Time 

Period Freq.(f)

Organ dose Equivalents per PA Chest (rem)

Air Kerma 

at Skin 

Entrance

Thymus Esophagus

Stomach Bone 

Surface

Liver/Gall 

Bladder/

Spleen

Urinary 

Bladder

Colon/ 

Rectum Eye/Brain Skinc Remainder

1957-1960

(PFG)(a) Annual

3.000

2.5 mm

HVL

1.35 x 100

(1.26x100)

(d)

1.35 x 100

(1.26x100)

(d)

1.35 x 100

(1.26x100)

(d)

1.35 x 100

(1.26x100)

(d)

1.35 x 100

(1.26x100)

(d) 2.50 x 10-2 2.50 x 10-2 9.60 x 10-2 4.05 x 100 1.35 x 100

(1.26x100)

(d)

1961-1971

(Pre1972)(b) Annual

0.200

minimal 

collimation

9.02 x 10-2

(8.38x10-2)

(d)

9.02 x 10-2

(8.38x10-2)

(d)

9.02 x 10-2

(8.38x10-2)

(d)

9.02 x 10-2

(8.38x10-2)

(d)

9.02 x 10-2

(8.38x10-2)

(d) 2.50 x 10-2 2.50 x 10-2 6.40 x 10-3 2.70 x 10-1 9.02 x 10-2

(8.38x10-2)

(d

1972-1997

(Post1972) Annual

0.035

3.5 mm 

HVL

2.14 x 10-2

(1.98 x 10-2)

(d)

2.14 x 10-2

(1.98 x 10-2)

(d)

2.14 x 10-2

(1.98 x 10-2)

(d)

2.14 x 10-2

1.98 x 10-2)

(d)

2.14 x 10-2

(1.98 x 10-2)

(d) 1.12 x 10-4 1.12 x 10-4 2.17 x 10-3 4.90 x 10-2 2.14 x 10-2

(1.98 x 10-2)

(d)

a. PFG chest entrance kerma (uncollimated ) (2.5 mm Al HVL) (ORAUT-OTIB-0006, Table 4.0-1).

b. Pre-1970 chest 99% confidence entrance kerma (uncollimated ) (2.5 mm Al HVL) (ORAUT-OTIB-0006, Table 4.0-1).

c. Entrance skin dose is ESE calculated from air kerma, multiplied by a backscatter factor of 1.4 from NCRP, 1989, Table B-8.

d. Male organ dose is given in parenthesis. The dose in parenthesis is less conservative than the dose outside of the parenthesis.

e. Use a correction uncertainty factor of 1.3 to maximize the dose calculation.

f. Use claim medical files for frequency information, if available.
Effective Date: 

0

5/0

6/2005 Revision No. 00 Document No. ORAUT-TKBS-0029-3 Page 23 of 23

Table 3A-3 Dose Equivalents for Organs Identified in ICRP 34 (1982) Beam Quality for LAT Views(e)

Time Period Frequency(f)

Organ Dose Equivalents per LAT Chest (rem)

Air Kerma 

at Skin 

Entrance(a)

Thyroid(c) Ovaries(c) Testes(c) Lungs(c) Breast(c) Uterus(c)

(Embryo)

Bone 

Marrow(c)

1961-1971

(Pre-1972)(b)

Annual 0.500

uncollimated

6.85 x 10-2 1.30 x 10-2 2.50 x 10-3 1.10 x 10-1

(9.65x10-2)

(d)

1.28 x 10-1 1.30 x 10-2 1.85 x 10-2

(1.45 x 10-2)

1972-1997

(Post-1972)

Annual 0.0875

3.5 mm HVL

1.32 x 10-2 1.40 x 10-4 8.75 x 10-6 2.71 x 10-2

(2.42 x 10-2)

(d)

2.77 x 10-2 1.23 x 10-4 5.34 x 10-3

(4.20 x 10-3)

a. Air kerma at entrance skin in rem = ESE (R) x 0.00873 Gy/R ~ ESE (R) x 0.01 Gy/R.

b. Pre-1970 chest entrance kerma (uncollimated ) (2.5 mm Al HVL) (ORAUT-OTIB-0006, Table 4.0-1).

c. Organs identified in ICRP 34 (1982) for dose determination from entrance air kerma associated with chest radiography.

d. Male lung organ dose and female bone marrow organ dose is given in parenthesis. The dose in the parenthesis is less conservative than the dose outside of 

the parenthesis..

e. Use a correction uncertainty factor of 1.3 to maximize the dose calculation.

f. Use claim medical files for frequency information, if available.

Table 3A-4 Dose Equivalent for IREP Organs not Included in ICRP 34 (1982) for LAT Views(d)

Time Period Freq.(e)

Organ Dose Equivalents per LAT Chest (rem)

Air Kerma 

at Skin 

Entrance

Thymus Esophagus

Stomach Bone 

Surface

Liver/Gall 

Bladder/

Spleen

Urinary/ 

Bladder

Colon/ 

Rectum

Eye/

Brain Skin (b) Remainder

1961-1971

(Pre-1972)(a)

Annual 0.500

uncollimated

1.10 x 10-1

(9.65x10-2)

(c)

1.10 x 10-1

(9.65x10-2)

(c)

1.10 x 10-1

(9.65x10-2)

(c)

1.10 x 10-1

(9.65x10-2)

(c)

1.10 x 10-1

(9.65x10-2)

(c)

1.30 x 10-2 1.30 x 10-2 6.85 x 10-2 6.75 x 10-1 1.10 x 10-1

(9.65x10-2)

(c)

1972-1997

(Post-1972)

Annual 0.0875

3.5 mm 

HVL

2.71 x 10-2

(2.42 x 10-2)

(c)

2.71 x 10-2

(2.42 x 10-2)

(c)

2.71 x 10-2

(2.42 x 10-2)

(c)

2.71 x 10-2

(2.42 x 10-2)

(c)

2.71 x 10-2

(2.42 x 10-2)

(c)

1.40 x 10-4 1.40 x 10-4 1.32 x 10-2 1.23 x 10-1 2.71 x 10-2

(2.42 x 10-2)

(c)

a. Pre-1970 chest entrance kerma (uncollimated ) (2.5 mm Al HVL) (ORAUT-OTIB-0006, Table 4.0-1).

b. Entrance skin dose is ESE calculated from air kerma, multiplied by a backscatter factor of 1.4 from NCRP, 1989, Table B-8 

c. Male organ dose is given in parenthesis. This dose is less conservative than the female dose.

d. Use a correction uncertainty factor of 1.3 to maximize the dose calculation.

e. Use claim medical files for frequency information, if available.