ORAU TEAM

Dose Reconstruction

Project for NIOSH

Oak Ridge Associated Universities I Dade Moeller I MJW Technical Services

Page 1 of 18

DOE Review Release 09/22/2010

Document Title:

Los Alamos National Laboratory –

Occupational Medical Dose

Document Number: ORAUT-TKBS-0010-3

Revision: 01

Effective Date: 09/14/2010

Type of Document: TBD

Supersedes: Revision 00

Subject Expert(s): Paul G. Johnson, Elyse M. Thomas, and Timothy Kirkham

Site Expert(s): N/A

Approval: Richard E. Merrill Signature on File for Approval Date: 09/02/2010

Donald N. Stewart, Document Owner

Concurrence: Signature on File Concurrence Date: 09/03/2010

John M. Byrne, Objective 1 Manager

Concurrence: Signature on File Concurrence Date: 09/02/2010

Edward F. Maher, Objective 3 Manager

Concurrence: Signature on File Concurrence Date: 09/09/2010

Kate Kimpan, Project Director

Approval: Signature on File Approval Date: 09/14/2010

James W. Neton, Associate Director for Science

New Total Rewrite Revision Page Change

FOR DOCUMENTS MARKED AS A TOTAL REWRITE, REVISION, OR PAGE CHANGE, REPLACE THE PRIOR 

REVISION AND DISCARD / DESTROY ALL COPIES OF THE PRIOR REVISION.
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 09/14/2010 Page 2 of 18

PUBLICATION RECORD

EFFECTIVE 

DATE

REVISION 

NUMBER DESCRIPTION

12/29/2004 00 Technical basis document for the Los Alamos National Laboratory –

Occupational Medical Dose. Incorporates comments from internal 

and NIOSH reviews. First approved issue. Initiated by Jack E. 

Buddenbaum.

09/14/2010 01 Revised to incorporate data captured since the last revision to better 

document what has come to be known about PFG at LANL, and to 

add skin doses for all projections and periods. Added references and 

included Attributions and Annotations Section. Incorporates formal 

internal and NIOSH review comments. Constitutes a total rewrite of 

the document. Training required: As determined by the Objective 

Manager. Initiated by Donald N. Stewart. 
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 09/14/2010 Page 3 of 18

TABLE OF CONTENTS

SECTION TITLE

Acronyms and Abbreviations ...............................................................................................................

PAGE

4

3.1 Introduction ..............................................................................................................................5

3.2 Examination Frequencies.........................................................................................................6

3.3 Equipment and Techniques......................................................................................................7

3.4 Organ Doses............................................................................................................................9

3.5 Uncertainty.............................................................................................................................10

3.6 Attributions and Annotations .................................................................................................. 16

References ........................................................................................................................................17

LIST OF TABLES

TABLE TITLE

3-1 Default frequency of occupational chest X-rays at LANL..........................................................

PAGE

6

3-2 X-ray equipment used at LANL ................................................................................................7

3-3 Technique factors used for each type of X-ray equipment........................................................ 8

3-4 Beam quality values used to determine dose conversion factors for dose 

calculations ..............................................................................................................................8

3-5 Organ dose equivalents for chest projections for all periods................................................... 11

3-6 Skin dose guidance for various chest projections and periods ............................................... 12

3-7 Skin dose from various chest projections, 1943–present........................................................ 13
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 09/14/2010 Page 4 of 18

ACRONYMS AND ABBREVIATIONS

cm centimeter

DCF dose conversion factor

DOE U.S. Department of Energy

EEOICPA Energy Employees Occupational Illness Compensation Program Act of 2000

ENSD Entrance Skin Dose

ERDA Energy Research and Development Administration

EXSD Exit Skin Dose

Gy Gray

HVL half value layer

ICRP International Commission on Radiological Protection

in. inch

IREP Interactive RadioEpidemiological Program

kerma kinetic energy released in matter

kVp peak kilovoltage

LANL Los Alamos National Laboratory

LAT lateral

mA milliampere

mGy milligray

mm millimeter

mrem millirem

NCRP National Council on Radiation Protection and Measurements

NIOSH National Institute for Occupational Safety and Health

ORAU Oak Ridge Associated Universities

PA posterior-anterior

PFG photofluorography

POC probability of causation

RSD Remote Skin Dose

s second

SSD source-to-skin distance

SRDB Site Research Database

TBD technical basis document

U.S.C. United States Code

§ section or sections
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 09/14/2010 Page 5 of 18

3.1 INTRODUCTION

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 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

The statute also 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 excludes Naval Nuclear Propulsion Facilities from being covered under the Act, 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 covered facilities 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 occupational radiation exposures are considered valid for inclusion in a 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 (NIOSH 2007):

] 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, 42 C.F.R. Pt. 82) define “performance of duty” for 

DOE employees with a covered cancer or restrict the “duty” to nuclear weapons work (NIOSH 2007).

• Background radiation, including radiation from naturally occurring radon present in 

conventional structures

• Radiation from X-rays received in the diagnosis of injuries or illnesses or for therapeutic 

reasons

 1 The U.S. Department of Labor (DOL) is ultimately responsible under the EEOICPA for determining the POC.
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 09/14/2010 Page 6 of 18

3.1.1

The purpose of this TBD is to describe the occupational medical X-ray screening program and 

practices at Los Alamos National Laboratory (LANL). Dose reconstructors will use this information as 

needed to assign medical X-ray doses to workers’ EEOICPA claims at LANL.

Purpose

3.1.2

LANL had an occupational health program starting in 1949. The purpose of the program was to 

medically screen new personnel, perform termination physicals, discover disease, and periodically 

examine workers exposed to hazards (Hempelman 1945; Shipman 1949; Shipman et al. 1951). 

These medical examinations typically included chest X-rays (LANL 1947). The doses from these 

radiographic procedures depended not only on the characteristics of the X-ray machine and the 

procedures used, but also on the frequency of the examinations. This TBD describes the technical 

aspects of X-ray dose from screening X-rays administered before employment and periodically 

thereafter as a condition of employment at LANL.

Scope

3.2 EXAMINATION FREQUENCIES

Table 3-1 lists frequencies of chest X-rays through the years for specific groups of workers. Workers 

received preemployment and termination chest X-rays. Hempelman recommended annual chest 

X-rays for workers exposed to radiation and every 6 months for workers handling uranium, plutonium, 

polonium, and beryllium oxide (Hempelman 1944, pg. 5). Workers in the glass-blowing shop,

because of their exposure to silica flour and ground glass, were also to be X-rayed every 6 months 

(Grier and Hardy 1949). 

Table 3-1. Default frequency of occupational chest X-rays at LANL.

Period Frequency Workers Chest X-ray projections

1943–1956 Preemployment All workers. Single-projection PFG (Shipman 

1955,1958)

Semiannual Workers handling uranium, 

plutonium, polonium, and 

beryllium oxide, and glass 

blowers (Hempleman 1944; Grier 

and Hardy 1949)

Single-projection PFG (Shipman 

1955,1958)

Annual Workers exposed to radiation 

(Hempelman 1944)

Single-projection PFG (Shipman 

1955, 1958)

Termination All workers. Single-projection PFG (Shipman 

1955, 1958)

1957–1976 Preemployment All workers (Shipman 1958) PA

Every 3 years All workers (Shipman 1958) PA

Termination All workers. PA

1977–present Annual Asbestos and beryllium workers, 

and workers >45 years old (ERDA

1975; Voelz et al. 1981) 

PA and LAT (Gutierrez and Haynie 

1977, Haynie and Gutierrez 1978)

Biennial All workers <45 years old (ERDA

1975)

PA and LAT (Gutierrez and Haynie 

1977; Haynie and Gutierrez 1978)

2002–present Every 5 years All workers (Antonsen 1998) PA and LAT

Shipman states that photofluorography (PFG) was used unless factors dictated that a 14- by 17-in.

film would be better (Shipman 1955, p. 23). Several historical monthly progress reports document the 

number of PFG and 14- by 17-in. films performed by the occupational medical service and, in almost 

all cases, the number of PFGs exceed the number of 14- by 17-in. films in a given period, indicating 

the common use of this imaging technique at LANL (Shipman 1948, 1950, 1955; Grier 1949, p. 18). It 

appears that both the PFG and the 14- by 17-in. chest films consisted of a single posterior-anterior 
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 09/14/2010 Page 7 of 18

(PA) projection in the earliest period (Shipman 1948) [1]. Dose reconstructors should be able to 

identify the PFG examinations in the claim file records when a “film number” is recorded on the X-ray 

record. The film number indicates the use of roll film (rather than sheet film) commonly used in the 

PFG camera apparatus. PFG at LANL ended in 1956 (Shipman 1958, p. 35).

Shipman writes that the periodic examinations were done every 3 years unless conditions indicated 

otherwise (Shipman 1958, p. 34). Starting in about 1977, two chest projections [PA and lateral (LAT)] 

were being performed routinely for screening (Gutierrez and Haynie 1977; Haynie and Gutierrez 

1978). No more information is available for the X-ray screening frequency after the late 1970s, 

although documents (e.g., LASL 1979) refer to being in compliance with Chapter 0528 of the Energy 

Research and Development Administration (ERDA) Contractor Occupational Medical Program 

manual, which required annual X-ray screening for workers more than 45 years old, and biennial Xray screening for workers less than 45 years old (ERDA 1975). An analysis of X-ray records 

submitted by LANL shows that, on average, workers were X-rayed about every 2 years [2]. In 2002, 

when the Food and Drug Administration performed a survey of the X-ray equipment, the survey 

questionnaire indicated that LANL was no longer routinely performing chest X-ray screening on 

workers (Antonsen 1998).

A couple of historical documents mention the existence of mammography equipment (Valentine 1989, 

p. 95) and mammography screening (LANL 1991). Mammography screening was likely offered to 

employees as a convenience to them [4]. Dose from mammography is not included as part of 

occupational medical dose in this TBD since mammography screening is commonplace in the general 

population, and risk from exposure to mammography screening is assumed to be included in the risk 

models of IREP [5].

LANL medical records, including X-ray records, are available from LANL on special request. In the 

absence of X-ray records, dose reconstructors should assume the frequencies from Table 3-1. The 

records state if the X-ray was “routine” (i.e., screening, sometimes abbreviated “Rt”), or “special” (i.e.,

diagnostic – not screening). The records also provide the worker’s employer at LANL (Zia, ERDA, 

Atomic Energy Commission, University of California, etc.).

3.3 EQUIPMENT AND TECHNIQUES

Organ doses from occupational medical X-rays administered at LANL are presented for all the types 

of X-ray equipment employed over the operational period. The types of X-ray equipment used over 

time are listed in Table 3-2. Tables 3-3 and 3-4 list the specific technique factors reported by LANL, 

and measured or estimated beam qualities for the different machines.

Table 3-2. X-ray equipment used at LANL.

Technique Period Equipment

PFGa 1943–1956 Unknown, 70-mm fluororoentgenogram, single exposure. Default values from 

ORAUT (2005) for a single, non stereo exposure are used for this period.

Type I (a) 1943–1969 Unknown. Default values for 14- by 17–in. radiographic chest from ORAUT (2005) 

are used for this period.

Type I (b) 1970–1975 Unknown. Default values for 14- by 17–in. radiographic chest from ORAUT (2005) 

are used for this period.

Type II 1976–1984 General Electric KX810; 4-mm total filtration will be assumed for this period.

Type III 1985–1994 General Electric DXD 350Il Control, Single-Phase Generator, Auto Collimator, 12:1 

Grid, 3-mm Al equivalent total filtration. Kodak X-Omatic 90-s cold water processor, 

400 speed film-screen system, Kodak Lanex cassettes-rare earth. Fuji Ortho G film. 

(Antonsen 1998; Shalkowski, Richardson, and Schlapper 1990) 

Type IVb 1995–2002 General Electric DXD 350Il Control, Single-Phase Generator, Auto Collimator, 12:1 

Grid, 3-mm Al equivalent total filtration. Kodak X-Omatic 90-s cold water processor, 

400 speed film-screen system, Kodak Lanex cassettes-rare earth. Fuji Ortho G film. 
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(Antonsen 1998)

Type V 2003–

present

Quantum Medical Imaging Cosmos 22 Control, High Frequency Generator, Varian 

X-ray tube, Heustis medical collimator. 2.5-mm Al equivalent total filtration. 

CXDI22 Canon sensor-digital camera. (Velarde 2009)

a. PFG = Photofluorography

b. Type IV equipment same as Type III, different technique factors used.

Table 3-3. Technique factors used for each type of X-ray equipmenta.

Machine Projection

Current

(mA)

Voltage

(kVp)

Exposure 

time(s)

Type I(a) 1943–1969 Unknown Unknown Unknown Unknown

Type I(b) 1970–1975 Unknown Unknown Unknown Unknown

Type II 1976–1984b PA chest 300 90 1/30

Type III 1985–1994c PA chest 200 102 1/30

Type IV 1995–2002d PA chest 200 114 1/60

Type V 2003 PA chest 200 104 1/30

a. PA indicates a posterior/anterior projection; the average PA chest measures 24 cm, the 

average lateral chest measures 36 cm. 

b. Gutierrez and Haynie (1976).

c. Shalkowski, Richardson, and Schlapper (1990).

d. Antonsen (1998).

Table 3-4. Beam quality (HVL) values used to determine dose conversion factors (DCFs) for dose 

calculations.

Machine 

type Dates of use

Total filtration 

[Al equiv., mm] 

(reported or estimated)

HVL, based on 

filtration and kVp 

(NCRP 1989)

HVL used for DCF selection 

(ICRP 1982)

PFG 1943–1956 Unknown (2.5 mma) 2.5 mm 2.5 mm

Type I(a) 1943–1969 Unknown (2.5 mma) 2.5 mm 2.5 mm

Type I (b) 1970–1975 Unknown (2.5 mma) 2.5 mm 2.5 mm

Type II 1976–1984b 3.75 mm 3.3 mm at 90 kVp 3.5 mm

Type III 1985–1994c 3.5 mm 3.4 mm at 100 kVp 3.5 mm

Type IV 1995–2002d 3.5 mm 3.7 mm at 110 kVp 4.0 mm

Type V 2003–present 2.5 mm 3.4 mm 3.5 mm

a. Based on ORAUT (2005). 

b. Gutierrez and Haynie (1976).

c. Shalkowski, Richardson, and Schlapper (1990).

d. Antonsen (1998).

As mentioned above, PFG was performed from 1943 to 1956 (Shipman 1955, 1958). During this 

time, chest X-rays were also performed on 14- by 17-in. film (Shipman 1954), but nothing is known 

about this equipment, other than it was probably in the hospital (Shipman 1952). The first mention of 

a specific brand and model of X-ray equipment is in Gutierrez and Haynie (1976). The General 

Electric X-ray machine is mentioned, along with the technical information collected during a survey of 

that machine in the new occupational medical building. Even though Gutierrez and Haynie shows a 

possible total filtration of 6.75-mm Al equivalent resulting from the summation of the individual 

component filtration equivalents, it seems doubtful that this much filtration was actually used for the 

following reasons [3]: 

1. To obtain the possible total of 6.75-mm Al eq., the equivalent filtration of the collimator and the 

removable filters were added together. Removable filters (placed in a slot) were usually used 

with a cone-type beam limiting device because such a device did not have any inherent 

filtration. However, an adjustable collimator does have some inherent filtration. Apparently, 

an adjustable light-localizing collimator was added to this machine (Guitierrez and Haynie 

1976), making removable filters unnecessary. When the thickness of the removable filters is 
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 09/14/2010 Page 9 of 18

left out of the summation, the total is about 3.75-mm Al eq., which is a much more believable 

amount.

2. It is extremely doubtful that a radiologist would have accepted radiographs produced with 

6.75-mm Al filtration. With that much filtration, there would have been little differential 

absorption in tissue and little contrast in the image. 

For these reasons, the total filtration for this period is assumed to be 3.75-mm Al eq., resulting in a 

half value layer (HVL) of 3.3-mm Al at 90 kVp.

Another General Electric machine, the GE DXD 350ll, was installed in 1985 and used until 

approximately 2003 (Antonsen 1998). In 2003, a Quantum Medical Imaging Odyssey X-ray machine 

was installed (Velarde 2009). 

3.4 ORGAN DOSES

This section presents X-ray organ doses for occupational X-rays administered at LANL for all types of 

equipment and all periods. 

Dose values for PFG at LANL are based on the default values for PFG in Dose Reconstruction from 

Occupationally Related X-Ray Procedures (ORAUT 2005), except the doses are calculated for a 

single-exposure PFG (not stereo exposures) and reproduced in Table 3-5. Dose reconstructors 

should be able to identify the PFG examinations in the claim file records when the examination

occurred between 1943 and 1956, and when a “film number” is recorded, indicating the use of roll 

rather than sheet film. Dose reconstructors should assume a two-exposure stereo PFG only when the 

words “serial 1 and 2” appear on the record or radiologist’s interpretation.

Dose values for conventional 14- by 17-in. chest radiography for LANL from 1943 to 1975 are also 

based on the default values for chest radiography in Dose Reconstruction from Occupationally 

Related X-Ray Procedures (ORAUT 2005).

Dose values for the remaining periods are calculated using average air kerma rates from Table B.3 of 

National Council on Radiation Protection and Measurements (NCRP) Report 102 (NCRP 1989). The 

data in Table B.3 were corrected to a source-to-skin distance (SSD) of 154 cm, and for the actual 

voltage, current, and phase of the machines used at LANL for the various periods. For both PA and 

LAT chest projections, a standard source-to-image distance of 72 in. (183 cm) was assumed for all 

periods. Entrance air kerma in air from the LAT chest projection is estimated at 2.5 times more than 

the PA entrance kerma (ORAUT 2005). It is assumed that all the X-ray machines were single-phase 

except the high-frequency Type V unit. International Commission on Radiological Protection (ICRP)

Publication 34 (ICRP 1982) contains 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) and selected 

beam qualities (i.e., various HVLs). The organ doses are found by multiplying the ICRP organ DCFs

by the entrance air kerma in air. The resulting organ doses for all machines and periods are listed in 

Table 3-5. 

Skin doses were calculated using the method described in ORAUT-OTIB-0006 (ORAUT-2005). Table 

3-6 lists the skin dose guidance for various areas of skin for various projections. Table 3-7 lists skin 

doses from all machines and periods calculated according to the guidance.

Doses were generally determined by analogy with anatomical location for organs not listed in ICRP 

Publication 34 (ICRP 1982) but specified in the Interactive RadioEpidemiological Program (IREP) 

computer program, according to the guidance in ORAUT-OTIB-0006 (ORAUT 2005). 
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3.5 UNCERTAINTY

ORAUT-OTIB-0006 (ORAUT 2005) lists the major sources of uncertainty in X-ray output intensity and 

subsequent effect on dose to the worker. The five sources of uncertainty are (1) X-ray beam 

measurement error (±2%); (2) variation in peak kilovoltage (±9%); (3) variation in X-ray beam current 

(±5%); (4) variation in exposure time (±25%); and (5) variation in SSD as a result of worker size 

(±10%). The 10% uncertainty in output intensity as a result of worker size was based on an inverse 
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 

09/14/2010 Page 11 of 18

Table 3-5. Organ dose equivalents (rem) for chest projections for all periods.

Organ Projection PFG 1943–1956a 1943–1969b 1970–1975b 1976–1984 1985–1994 1995–2002 2003–present

Thyroid PA 2.61E-01 3.48E-02 3.20E-03 1.55E-03 1.30E-03 9.05E-04 2.17E-03

LAT --- --- --- 9.44E-03 7.93E-03 4.76E-03 1.32E-02

Eye/brain PA 4.80E-02 6.40E-03 3.20E-03 1.55E-03 1.30E-03 9.05E-04 2.17E-03

LAT --- --- --- 9.44E-03 7.93E-03 4.76E-03 1.32E-02

Ovaries PA 1.25E-02 2.50E-02 1.00E-04 8.00E-05 6.72E-05 6.03E-05 1.12E-04

LAT --- --- --- 1.00E-04 8.40E-05 7.25E-05 1.40E-04

Urinary/bladder PA 1.25E-02 2.50E-02 1.00E-04 8.00E-05 6.72E-05 6.03E-05 1.12E-04

LAT --- --- --- 1.00E-04 8.40E-05 7.25E-05 1.40E-04

Colon/rectum PA 1.25E-02 2.50E-02 1.00E-04 8.00E-05 6.72E-05 6.03E-05 1.12E-04

LAT --- --- --- 1.00E-04 8.40E-05 7.25E-05 1.40E-04

Testes PA 2.50E-03 5.00E-03 1.00E-06 2.50E-07 2.10E-07 1.16E-07 3.50E-07

LAT --- --- --- 6.25E-06 5.25E-06 2.90E-06 8.75E-06

Lungs (male) PA 6.29E-01 8.38E-02 4.19E-02 1.41E-02 1.19E-02 7.28E-03 1.98E-02

LAT --- --- --- 1.73E-02 1.45E-02 9.08E-03 2.42E-02

Lungs (female) PA 6.77E-01 9.02E-02 4.51E-02 1.53E-02 1.28E-02 7.82E-03 2.14E-02

LAT --- --- --- 1.94E-02 1.63E-02 1.02E-02 2.71E-02

Thymus PA 6.77E-01 9.02E-02 4.51E-02 1.53E-02 1.28E-02 7.82E-03 2.14E-02

LAT --- --- --- 1.94E-02 1.63E-02 1.02E-02 2.71E-02

Esophagus PA 6.77E-01 9.02E-02 4.51E-02 1.53E-02 1.28E-02 7.82E-03 2.14E-02

LAT --- --- --- 1.94E-02 1.63E-02 1.02E-02 2.71E-02

Stomach PA 6.77E-01 9.02E-02 4.51E-02 1.53E-02 1.28E-02 7.82E-03 2.14E-02

LAT --- --- --- 1.94E-02 1.63E-02 1.02E-02 2.71E-02

Bone surface PA 6.77E-01 9.02E-02 4.51E-02 1.53E-02 1.28E-02 7.82E-03 2.14E-02

LAT --- --- --- 1.94E-02 1.63E-02 1.02E-02 2.71E-02

Liver/gall bladder/

spleen

PA 6.77E-01 9.02E-02 4.51E-02 1.53E-02 1.28E-02 7.82E-03 2.14E-02

LAT --- --- --- 1.94E-02 1.63E-02 1.02E-02 2.71E-02

Remainder organs PA 6.77E-01 9.02E-02 4.51E-02 1.53E-02 1.28E-02 7.82E-03 2.14E-02

LAT --- --- --- 1.94E-02 1.63E-02 1.02E-02 2.71E-02

Breast PA 7.35E-02 9.80E-03 4.90E-03 2.28E-03 1.91E-03 1.35E-03 3.19E-03

LAT --- --- --- 1.98E-02 1.66E-02 9.95E-03 2.77E-02

Uterus PA 1.25E-02 2.50E-02 1.30E-04 7.50E-05 6.30E-05 6.03E-05 1.05E-04

LAT --- --- --- 8.75E-05 7.35E-05 6.09E-05 1.23E-04
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 

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Organ Projection PFG 1943–1956a 1943–1969b 1970–1975b 1976–1984 1985–1994 1995–2002 2003–present

Bone marrow (male) PA 1.38E-01 1.84E-02 9.20E-03 3.65E-03 3.07E-03 2.06E-03 5.11E-03

LAT --- --- --- 3.81E-03 3.20E-03 2.20E-03 5.34E-03

Bone marrow 

(female)

PA 1.29E-01 1.72E-02 8.60E-03 3.53E-03 2.96E-03 2.00E-03 4.94E-03

LAT --- --- --- 3.00E-03 2.52E-03 1.71E-03 4.20E-03

Entrance skinc PA 2.03E+00 2.70E-01 1.35E-01 3.50E-02 2.94E-02 1.62E-02 4.90E-02

LAT --- --- --- 8.75E-02 7.35E-02 4.06E-02 1.23E-01

a. Doses for PFG are from ORAUT-OTIB-0006 (ORAUT 2005), but are halved because LANL did not typically perform stereo PFG.

b. Doses before 1976 are based on values in ORAUT-OTIB-0006 (ORAUT 2005).

c. Entrance skin dose is determined by multiplying the entrance air kerma in air by the backscatter factors of 1.35 and 1.40 for HVL of 2.5-mm Al and 3.0 or 4.0-mm Al, 

respectively, from NCRP Report 102 (NRCP 1989, Table B-8). Skin doses for all areas of skin are provided in Table 3-7. 

Table 3-6. Skin dose guidance for various chest projections and periods.

Area of skin PFG

PA 

before 1970

PA 

after 1970

LAT 

after 1970

Right front shoulder EXSD EXSD EXSD ENSD

Right back shoulder ENSD ENSD ENSD ENSD

Left front shoulder EXSD EXSD EXSD EXSD

Left back shoulder ENSD ENSD ENSD EXSD

Right upper arm to elbow 10% ENSD ENSD 10% ENSD ENSD

Left upper arm to elbow 10% ENSD ENSD 10% ENSD EXSD

Left hand ENSD ENSD 10% ENSD 10% ENSD

Right hand ENSD ENSD 10% ENSD 10% ENSD

Left elbow, forearm, wrist 10% ENSD ENSD 10% ENSD 10% ENSD

Right elbow, forearm, wrist 10% ENSD ENSD 10% ENSD 10% ENSD

Right side of head (including ear and temple) 10% ENSD 10% ENSD 10% ENSD 10% ENSD

Left side of head (including ear and temple) 10% ENSD 10% ENSD 10% ENSD 10% ENSD

Front left thigh RSD (0.52m) RSD (0.52 m) RSD (0.52 m) RSD (0.52 m)

Back left thigh RSD (0.52m) RSD (0.52 m) RSD (0.52 m) RSD (0.52 m)

Front right thigh RSD (0.52m) RSD (0.52 m) RSD (0.52 m) RSD (0.52 m)

Back right thigh RSD (0.52m) RSD (0.52 m) RSD (0.52 m) RSD (0.52 m)

Left knee and below RSD (0.86m) RSD (0.86 m) RSD (0.86 m) RSD (0.86 m)

Right knee and below RSD (0.86m) RSD (0.86 m) RSD (0.86 m) RSD (0.86 m)

Left side of face Eye/brain Eye/brain Eye/brain 10% ENSD

Right side of face Eye/brain Eye/brain Eye/brain 10% ENSD

Left side of neck 10% ENSD ENSD 10% ENSD 10% ENSD

Right side of neck 10% ENSD ENSD 10% ENSD 10% ENSD

Back of head 10% ENSD 10% ENSD 10% ENSD 10% ENSD

Front of neck Eye/brain Eye/brain Thyroid 10% ENSD

Back of neck 10% ENSD ENSD 10% ENSD 10% ENSD

Front torso: base of neck to end of sternum EXSD EXSD EXSD Lung
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Area of skin PFG

PA 

before 1970

PA 

after 1970

LAT 

after 1970

Front torso: end of sternum to lowest rib EXSD EXSD EXSD Lung

Front torso: lowest rib to iliac crest EXSD EXSD 10% EXSD 10% lung

Front torso: iliac crest to pubis 10% EXSD 10% EXSD 10% EXSD 10% lung

Back torso: base of neck to mid-back ENSD ENSD ENSD Lung

Back torso: mid-back to lowest rib ENSD ENSD ENSD Lung

Back torso: lowest rib to iliac crest ENSD ENSD 10% ENSD 10% lung

Back torso: buttocks (Iliac crest and below) 10% ENSD 10% ENSD 10% ENSD 10% lung

Right torso: base of neck to end of sternum ENSD ENSD ENSD ENSD

Right torso: end of sternum to lowest rib ENSD ENSD ENSD ENSD

Right torso: lowest rib to iliac crest ENSD ENSD 10% ENSD 10% ENSD

Right torso: iliac crest to pubis (right hip) 10% ENSD 10% ENSD 10% ENSD 10% ENSD

Left torso: base of neck to end of sternum ENSD ENSD ENSD EXSD

Left torso: end of sternum to lowest rib ENSD ENSD ENSD EXSD

Left torso: lowest rib to iliac crest ENSD ENSD 10% ENSD 10% EXSD

Left torso: iliac crest to pubis (left hip) 10% ENSD 10% ENSD 10% ENSD 10% EXSD

Table 3-7. Skin dose (rem) from various chest projections, 1943–present.

a

Area of skin

PFG

1943–

1956

PA 

1943–

1969

PA

1970–

1975

PA 

1976–

1984

LAT 

1976–

1984

PA 

1985–

1994

LAT 

1985–

1994

PA 

1995–

2002

LAT 

1995–

2002

PA 

2003–

present

LAT 

2003–

present

Right front shoulder 4.42E-02 5.9E-03 2.9E-03 1.0E-03 8.75E-02 9.E-04 7.35E-02 5.E-04 4.06E-02 1.4E-03 1.23E-01

Right back shoulder 2.03E+00 2.70E-01 1.35E-01 3.50E-02 8.75E-02 2.94E-02 7.35E-02 1.62E-02 4.06E-02 4.90E-02 1.23E-01

Left front shoulder 4.42E-02 5.9E-03 2.9E-03 1.0E-03 5.E-04 9.E-04 5.E-04 5.E-04 3.E-04 1.4E-03 8.E-04

Left back shoulder 2.03E+00 2.70E-01 1.35E-01 3.50E-02 5.E-04 2.94E-02 5.E-04 1.62E-02 3.E-04 4.90E-02 8.E-04

Right upper arm to elbow 2.03E-01 2.70E-01 1.35E-02 3.50E-03 8.75E-02 2.9E-03 7.35E-02 1.6E-03 4.06E-02 4.9E-03 1.23E-01

Left upper arm to elbow 2.03E-01 2.70E-01 1.35E-02 3.50E-03 5.E-04 2.9E-03 5.E-04 1.6E-03 3.E-04 4.9E-03 8.E-04

Left hand 2.03E+00 2.70E-01 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Right hand 2.03E+00 2.70E-01 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Left elbow, forearm, wrist 2.03E-01 2.70E-01 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Right elbow, forearm, 

wrist

2.03E-01 2.70E-01 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Right side of head 

including ear and temple

2.03E-01 2.70E-02 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Left side of head 

including ear and temple

2.03E-01 2.70E-02 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Front left thigh 6.E-04 8.E-05 4.E-05 1.E-05 2.E-05 1.E-05 1.E-05 6.E-06 9.E-06 2.E-05 2.E-05

Back left thigh 6.E-04 8.E-05 4.E-05 1.E-05 2.E-05 1.E-05 1.E-05 6.E-06 9.E-06 2.E-05 2.E-05

Front right thigh 6.E-04 8.E-05 4.E-05 1.E-05 2.E-05 1.E-05 1.E-05 6.E-06 9.E-06 2.E-05 2.E-05

Back right thigh 6.E-04 8.E-05 4.E-05 1.E-05 2.E-05 1.E-05 1.E-05 6.E-06 9.E-06 2.E-05 2.E-05
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 

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Area of skin

PFG

1943–

1956

PA 

1943–

1969

PA

1970–

1975

PA 

1976–

1984

LAT 

1976–

1984

PA 

1985–

1994

LAT 

1985–

1994

PA 

1995–

2002

LAT 

1995–

2002

PA 

2003–

present

LAT 

2003–

present

Left knee and below 2.E-04 3.E-05 1.E-05 5.E-06 6.E-06 4.E-06 5.E-06 2.E-06 3.E-06 6.E-06 9.E-06

Right knee and below 2.E-04 3.E-05 1.E-05 5.E-06 6.E-06 4.E-06 5.E-06 2.E-06 3.E-06 6.E-06 9.E-06

Left side of face 4.80E-02 6.4E-03 3.2E-03 1.6E-03 8.75E-03 1.3E-03 7.4E-03 9.E-04 4.1E-03 2.2E-03 1.23E-02

Right side of face 4.80E-02 6.4E-03 3.2E-03 1.6E-03 8.75E-03 1.3E-03 7.4E-03 9.E-04 4.1E-03 2.2E-03 1.23E-02

Left side of neck 2.03E-01 2.70E-01 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Right side of neck 2.03E-01 2.70E-01 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Back of head 2.03E-01 2.70E-02 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Front of neck 4.80E-02 6.4E-03 3.2E-03 1.6E-03 8.75E-03 1.3E-03 7.4E-03 9.E-04 4.1E-03 2.2E-03 1.23E-02

Back of neck 2.03E-01 2.70E-01 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Front torso: base of neck 

to end of sternum

4.42E-02 5.9E-03 2.9E-03 1.0E-03 1.94E-02 9.E-04 1.63E-02 5.E-04 1.02E-02 1.4E-03 2.71E-02

Front torso: end of 

sternum to lowest rib

4.42E-02 5.9E-03 2.9E-03 1.0E-03 1.94E-02 9.E-04 1.63E-02 5.E-04 1.02E-02 1.4E-03 2.71E-02

Front torso: lowest rib to 

iliac crest

4.42E-02 5.9E-03 3.E-04 1.0E-04 1.94E-03 9.E-05 1.6E-03 5.E-05 1.0E-03 1.4E-04 2.7E-03

Front torso: iliac crest to 

pubis

4.4E-03 6.E-04 3.E-04 1.0E-04 1.94E-03 9.E-05 1.6E-03 5.E-05 1.0E-03 1.4E-04 2.7E-03

Back torso: base of neck 

to mid-back

2.03E+00 2.70E-01 1.35E-01 3.50E-02 1.94E-02 2.94E-02 1.63E-02 1.62E-02 1.02E-02 4.90E-02 2.71E-02

Back torso: mid-back to 

lowest rib

2.03E+00 2.70E-01 1.35E-01 3.50E-02 1.94E-02 2.94E-02 1.63E-02 1.62E-02 1.02E-02 4.90E-02 2.71E-02

Back torso: lowest rib to 

iliac crest

2.03E+00 2.70E-01 1.35E-02 3.50E-03 1.94E-03 2.9E-03 1.6E-03 1.6E-03 1.0E-03 4.9E-03 2.7E-03

Back torso: buttocks 

(Iliac crest and below)

2.03E-01 2.70E-02 1.35E-02 3.50E-03 1.94E-03 2.9E-03 1.6E-03 1.6E-03 1.0E-03 4.9E-03 2.7E-03

Right torso: base of neck 

to end of sternum

2.03E+00 2.70E-01 1.35E-01 3.50E-02 8.75E-02 2.94E-02 7.35E-02 1.62E-02 4.06E-02 4.90E-02 1.23E-01

Right torso: end of 

sternum to lowest rib

2.03E+00 2.70E-01 1.35E-01 3.50E-02 8.75E-02 2.94E-02 7.35E-02 1.62E-02 4.06E-02 4.90E-02 1.23E-01

Right torso: lowest rib to 

iliac crest

2.03E+00 2.70E-01 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Right torso: iliac crest to 

pubis (right hip)

2.03E-01 2.70E-02 1.35E-02 3.50E-03 8.75E-03 2.9E-03 7.4E-03 1.6E-03 4.1E-03 4.9E-03 1.23E-02

Left torso: base of neck 

to end of sternum

2.03E+00 2.70E-01 1.35E-01 3.50E-02 5.E-04 2.94E-02 5.E-04 1.62E-02 3.E-04 4.90E-02 8.E-04
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 

09/14/2010 Page 15 of 18

Area of skin

PFG

1943–

1956

PA 

1943–

1969

PA

1970–

1975

PA 

1976–

1984

LAT 

1976–

1984

PA 

1985–

1994

LAT 

1985–

1994

PA 

1995–

2002

LAT 

1995–

2002

PA 

2003–

present

LAT 

2003–

present

Left torso: end of 

sternum to lowest rib

2.03E+00 2.70E-01 1.35E-01 3.50E-02 5.E-04 2.94E-02 5.E-04 1.62E-02 3.E-04 4.90E-02 8.E-04

Left torso: lowest rib to 

iliac crest

2.03E+00 2.70E-01 1.35E-02 3.50E-03 5.E-05 2.9E-03 5.E-05 1.6E-03 3.E-05 4.9E-03 8.E-05

Left torso: iliac crest to 

pubis (left hip)

2.03E-01 2.70E-02 1.35E-02 3.50E-03 5.E-05 2.9E-03 5.E-05 1.6E-03 3.E-05 4.9E-03 8.E-05

a. Values less than 1 mrem shown to one significant digit. 
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 09/14/2010 Page 16 of 18

square correction of output intensity changes resulting from differences of standard chest thickness of 

±7.5 cm. 

Information on worker thickness is rarely available, even in the medical literature. However, at the 

Savannah River Site, entrance skin dose measurements were made on nine workers of varying chest 

thicknesses (builds) (Cooley 1967). While Cooley did not report the measured chest thicknesses for 

these nine workers, the entrance skin doses were reported and reflect the increases in exposure 

needed to radiograph thicker body parts, in this case chests. Cooley reported the mean of the 

measured entrance skin doses as 27 mrem. The standard uncertainty of the range of measurements 

is 5.6, resulting in an uncertainty of 21% from this source. 

Substituting this value into the calculation for combined uncertainty described in ORAUT-OTIB-0006 

(ORAUT 2005) rather than the 10% value used in that document, the resultant standard uncertainty is 

34% from these five sources. Rounding this up to 35% would seem to provide an adequate and 

suitably conservative indication of uncertainty. 

3.6 ATTRIBUTIONS AND ANNOTATIONS

Where appropriate in this document, bracketed callouts have been inserted to indicate information, 

conclusions, and recommendations provided to assist in the process of worker dose reconstruction. 

These callouts are listed here in the Attributions and Annotations section, with information to identify 

the source and justification for each associated item. Conventional references, which are provided in 

the next section of this document, link data, quotations, and other information to documents available 

for review on the Project’s Site Research Database (SRDB).

[1] Thomas, Elyse M. ORAU Team. Principal Medical Dosimetrist. June 2010. 

Review of claims with submitted X-ray data show only one film number listed for PFG in most 

cases, and a single PA projection for the 14- by 17-in. chest films.

[2] Thomas, Elyse M. ORAU Team. Principal Medical Dosimetrist. June 2010.

Reviews of claims with submitted X-ray data show frequency of X-rays to be about every 2

years.

[3] Thomas, Elyse M. ORAU Team. Principal Medical Dosimetrist. June 2010.

The removable filtration placed in a slot was usually used with a cone-type beam limiting 

device, not with adjustable collimators. Apparently, this machine was modified with the 

addition of a light-localizing collimator. The removable filters were most likely removed when 

the adjustable collimator was added, leaving a total filtration of about 3.75-mm Al eq., a much 

more reasonable amount. It is extremely doubtful that a radiologist would have accepted 

reading very-low-contrast images that would have resulted from the use of such a heavily 

filtered beam as 6.75-mm Al eq. 

[4] Thomas, Elyse M. ORAU Team. Principal Medical Dosimetrist. June 2010. 

Mammography would not have been used to screen for occupational disease. It is not 

uncommon for mammography screening to be offered to women employees at the workplace, 

as a convenience to them, and to encourage them to be screened.

[5] Thomas, Elyse M. ORAU Team. Principal Medical Dosimetrist. June 2010. 

The IREP risk models include risk from x-ray exams in the general population, and therefore it 

is assumed that the risk from mammography, as a screening technique used in the general 

population, is included in IREP. 
Document No. ORAUT-TKBS-0010-3 Revision No. 01 Effective Date: 09/14/2010 Page 17 of 18

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