ORAU TEAM

Dose Reconstruction

Project for NIOSH

Oak Ridge Associated Universities I Dade Moeller I MJW Technical Services

Page 1 of 61

DOE Review Release 06/28/2011

Document Title:

Dose Reconstruction from Occupational 

Medical X-Ray Procedures 

Document Number: ORAUT-OTIB-0006

Revision: 04

Effective Date: 06/20/2011

Type of Document: OTIB

Supersedes: Revision 03 PC-1 

Subject Expert(s): Elyse M. Thomas 

Approval: Signature on File Approval Date: 06/17/2011

Elyse M. Thomas, Document Owner

Concurrence: Signature on File Concurrence Date: 06/16/2011

John M. Byrne, Objective 1 Manager

Concurrence: Signature on File Concurrence Date: 06/16/2011

Edward F. Maher, Objective 3 Manager

Concurrence: Vickie Short Signature on File for Concurrence Date: 06/20/2011

Kate Kimpan, Project Director

Approval: Signature on File Approval Date: 06/20/2011

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-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 2 of 61

PUBLICATION RECORD

EFFECTIVE 

DATE

REVISION 

NUMBER DESCRIPTION

11/14/2003 00 New document to establish the technical basis for the development 

of a generic document to use to perform dose reconstruction from 

occupationally related diagnostic X-ray procedures. First approved 

issue. Initiated by Judson L. Kenoyer.

12/08/2003 01 Revision that limits the use of this document to post 1970. Approved 

issue of Revision 01. Initiated by Judson L. Kenoyer

12/29/2003 02 Revision that includes information to re-instate the ability for the 

document to cover exposures pre-1970. Approved issue of 

Revision 02. Initiated by Judson L. Kenoyer

08/02/2005 03 Revision to add photofluorography use table and lumbar spine xrays. Deleted footnote b and adjusted footnote references in 

Table 8. Approved issue of Revision 03. No retraining required. 

Initiated by Vernon E. Shockley and Ronald L. Kathren.

12/21/2005 03 PC-1 Approved page change revision. Page change initiated to 

incorporate recent direction from NIOSH to include DOL review 

comments on page 8. Deletes two obsolete paragraphs on page 8 in 

Section 1.0. Corrects table number reference on page 20 in 

Section 4.0. No sections were deleted. No retraining is required. 

Initiated by Vernon E. Shockley and Ronald L. Kathren.

Judson L. Kenoyer, Task 3 Manager

Signature on File 12/14/2005

Kate Kimpan, Projector Director

Signature on File 12/14/2005

James W. Neton, Associate Director for Science

Signature on File 12/21/2005

06/20/2011 04 Revision to add organ dose data from lordotic and oblique chest Xrays, chest fluoroscopy, thoracic and cervical spine X-rays, and skin 

doses for all procedures. Lists additional references in the 

Reference Section. Incorporates formal internal and NIOSH review 

comments. Also addresses an additional NIOSH comment. 

Constitutes a total rewrite of the document. Training required: As 

determined by the Objective Manager. Initiated by Elyse M. Thomas.
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 3 of 61

TABLE OF CONTENTS

SECTION TITLE

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

PAGE

5

1.0 Introduction ..............................................................................................................................7

2.0 Occupational Medical X-Ray Dose To Be Included in Dose Reconstruction............................. 7

3.0 Technical Factors Affecting Medical X-Ray Dose..................................................................... 7

3.1 Kilovoltage, Filtration, and Type of High-Voltage Generator ......................................... 8

3.2 Current and Exposure Time........................................................................................ 10

3.3 Distance ..................................................................................................................... 10

3.4 Collimation.................................................................................................................. 11

3.5 Screens, Grids, and Other Factors ............................................................................. 12

4.0 Determining Incident Air Kerma.............................................................................................. 13

4.1 Using Beam Measurements ....................................................................................... 13

4.2 Using Technical Factors ............................................................................................. 14

4.3 Using Published Values from Medical Literature......................................................... 14

5.0 Determining Dose Equivalent to Organs Other Than Skin...................................................... 15

5.1 Substitute DCFs for Organs Not Listed In ICRP Publication 34 .................................. 15

5.2 Substitute DCFs for Poor Collimation ......................................................................... 16

6.0 Determining Dose Equivalent to Skin ..................................................................................... 17

6.1 Entrance Skin Dose Equivalent .................................................................................. 19

6.2 Exit Skin Dose Equivalent........................................................................................... 19

6.3 Skin Outside But Near Primary Beam......................................................................... 20

6.4 Remote Skin Dose Equivalent .................................................................................... 20

7.0 Types and Frequency of X-Ray Screening............................................................................. 20

7.1 Radiographic Chest.................................................................................................... 21

7.2 Photofluorographic Chest ........................................................................................... 22

7.3 Chest Fluoroscopy...................................................................................................... 24

7.4 Lumbar Spine ............................................................................................................. 26

7.5 Pelvis.......................................................................................................................... 28

7.6 Thoracic and Cervical Spine....................................................................................... 28

8.0 Uncertainty Analysis for Occupational Medical X-Ray Doses ................................................. 31

9.0 Attributions and Annotations .................................................................................................. 34

References ........................................................................................................................................35

ATTACHMENT A, ORGAN DOSE EQUIVALENT TABLES............................................................... 40
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 4 of 61

LIST OF TABLES

TABLE TITLE

1 Standard body dimensions, SIDs, and SSDs used for dose reconstruction............................

PAGE

11

2 Relationship of technical factors to X-ray beam output........................................................... 13

3 Published incident air kerma values by procedure and period................................................ 14

4 Organs without ICRP Publication 34 DCFs and their substitutes............................................ 17

5 Substitute DCFs for poorly collimated chest beams through 1970.......................................... 18

6 Substitute DCFs for poorly collimated spine and pelvis beams through 1970......................... 18

7 Typical protocols for thoracic and cervical spine examinations............................................... 29

8 Relevant technical factors for cervical spine projections......................................................... 31

A-1 Skin dose guidance for chest projections for the poor collimation period 

through 1970..........................................................................................................................41

A-2 Skin dose guidance for lumbar spine and pelvis projections for the poor 

collimation period through 1970 ............................................................................................. 42

A-3 Skin dose guidance for thoracic spine projections for the poor collimation 

period through 1970...............................................................................................................44

A-4 Skin dose guidance for cervical spine projections for the poor collimation 

period through 1970...............................................................................................................45

A-5 Skin dose guidance for chest projections for the good collimation period after 

1970.......................................................................................................................................46

A-6 Skin dose guidance for lumbar spine projections for the good collimation 

period after 1970....................................................................................................................47

A-7 Organ dose equivalents for chest projections for all periods................................................... 49

A-8 Skin dose equivalents from chest projections through 1970................................................... 51

A-9 Skin dose equivalents from various chest projections post-1970............................................ 52

A-10 Organ dose equivalents for lumbar spine and pelvis projections for all periods ...................... 54

A-11 Skin dose equivalent from lumbar spine and pelvis projections for all periods........................ 56

A-12 Organ dose equivalents for thoracic and cervical spine projections through 

1960.......................................................................................................................................57

A-13 Skin dose equivalent from thoracic and cervical spine projections through 

1960.......................................................................................................................................58

A-14 DCFs used in determining dose equivalents .......................................................................... 60

LIST OF FIGURES

FIGURE TITLE

1 Diagram of poor collimation....................................................................................................

PAGE

12

2 Diagram of the torso...............................................................................................................16

3 Essential components of a PFG unit ...................................................................................... 23

4 Typical General Electric PFG system..................................................................................... 23

5 Diagram of non-image-intensified fluoroscopy........................................................................ 25

6 Beam areas in relation to body anatomy for the AP lumbar spine .......................................... 27

7 Beam areas in relation to body anatomy for the AP pelvis...................................................... 29

8 Beam areas in relation to body anatomy for the AP thoracic spine......................................... 30

9 Beam areas in relation to body anatomy for the LAT cervical spine ....................................... 32
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 5 of 61

ACRONYMS AND ABBREVIATIONS

AP anterior-posterior (X-ray projection)

AWE Atomic Weapons Employer

C coulomb (unit of charge)

cGy centigray

cm centimeter

DAP dose area product

DCF dose conversion factor

DOE U.S. Department of Energy

EEOICPA Energy Employees Occupational Illness Compensation Program Act of 2000

eq. equivalent

ENSD entrance skin dose

ESE entrance skin exposure

EXSD exit skin dose

Gy gray (1 Gy = 1 J/kg)

HE Effective dose equivalent

HF high frequency 

HVL half value layer

ICRP International Commission on Radiological Protection

in. inch

IREP Interactive RadioEpidemiological Program

J Joule (unit of energy)

Ka,i incident air kerma (in air)

keV kilo-electron volt

kVp kilovolts peak

LAO left anterior oblique (X-ray position) 

LAT lateral (X-ray projection)

LPO left posterior oblique (X-ray position) 

m meter

mA milliampere

mAs milliampere-second

mGy milligray 

min minute

mm millimeter

mrad millirad

mrem millirem

NCRP National Council on Radiation Protection and Measurements

NEXT Nationwide Evaluation of X-Ray Trends

NIOSH National Institute for Occupational Safety and Health

OBL oblique (X-ray projection)
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 6 of 61

ORNL Oak Ridge National Laboratory

PA posterior-anterior (X-ray projection)

PFG photofluorography

R roentgen

RAO right anterior oblique (X-ray position) 

RPO right posterior oblique (X-ray position) 

RSD remote skin dose

s second

SID source to image distance

SSD source to skin distance

Sv Sievert, unit of dose equivalent

TB tuberculosis

TBD technical basis document

TIB technical information bulletin

U.S.C. United States Code

VA Veteran's Administration

§ section or sections
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 7 of 61

1.0

Technical information bulletins (TIBs) 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 concerning 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). TIBs may be used to assist NIOSH staff in the completion of 

individual dose reconstructions.

INTRODUCTION

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 of 2000 [42 U.S.C. § 7384l(5) and (12)].

2.0

The Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA) requires 

the assignment of external dose from medical X-ray examinations performed for occupational health 

screening and required as a condition of employment. According to 42 CFR Part 81, external doses 

received from occupational X-ray screening procedures that were provided to the energy employee as 

a condition of employment must be included in dose reconstruction, while those performed for 

diagnostic or therapeutic reasons are excluded. Screening X-rays are systematic examinations 

performed on asymptomatic people without history, complaint, physical findings, or physician 

evaluation. Diagnostic X-rays are careful examinations of people who already have suspicious signs 

or symptoms of a potential condition performed after physician evaluation (NIOSH 2010). Therapeutic 

X-rays are used to treat cancer and other conditions, and not as an aid to diagnosing those 

conditions.

OCCUPATIONAL MEDICAL X-RAY DOSE TO BE INCLUDED IN DOSE 

RECONSTRUCTION 

The purpose of this TIB is to describe medical X-ray dose reconstruction in general, and to provide 

organ dose equivalents that can be used complex-wide when site-specific information is specious or 

not available.

Many DOE/Atomic Weapon Employer (AWE) sites had their own medical clinics and equipment to 

perform medical X-ray screening of their workers. Sometimes, however, the DOE/AWE sites 

contracted with private physicians’ offices, clinics, or local community hospitals to provide this service 

to workers (ORAUT 2011). A recent NIOSH interpretation of the EEOICPA statute is that the statute 

defines covered radiation as the radiation received by a covered employee at a covered facility during 

a covered period (NIOSH 2010). This interpretation affects how X-ray dose should be assigned if the 

X-rays were taken at a site or location that is not defined under the statute as a covered facility, such 

as offsite locations including private physicians’ offices, clinics, or local community hospitals. Except 

in limited circumstances concerning residual radiation, only radiation that the employee received at a 

covered facility can be included in dose reconstruction. 

3.0

A number of factors determine the dose to the worker from an X-ray procedure. These factors include 

the X-ray machine settings (typically called technique factors) used for the exposure, such as the 

kilovoltage (or the kilovolts peak, kVp), the beam current in milliamperes (mA), and time of exposure 

(seconds). Other factors that can affect the dose to the worker are the X-ray source-to-image 

distance (SID), where the X-ray source is defined as the focal spot or target of the X-ray tube, the 

amount of filtration in the machine, the size of the X-ray beam (collimation), the type of high-voltage 

generator, the type and speed of the film and screens, the film development procedure, the use of 

TECHNICAL FACTORS AFFECTING MEDICAL X-RAY DOSE
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 8 of 61

grids, and the physical size of the worker. The effect of these factors on dose reconstruction is 

discussed in the following sections.

The dose to workers can be estimated with a reasonable degree of accuracy by several methods, 

depending on what is known about the specific X-ray machine used. Direct measurements of the 

X-ray beam itself can be used to determine dose to the worker from an X-ray procedure. Dose can 

also be determined using knowledge of the technique factors used on a given X-ray machine along 

with standard X-ray output tables in the open literature. Using either direct X-ray beam 

measurements or known technique factors obviates the need for detailed knowledge of some of the 

other factors that can affect dose. For example, the technique factors should include adjustments for 

the type and speed of the film and screens, film development, and use of grids. The uncertainty in the 

dose from many of these factors, including the uncertainty in the size of the worker, is discussed in 

Section 8. 

3.1 KILOVOLTAGE, FILTRATION, AND TYPE OF HIGH-VOLTAGE GENERATOR

The maximum energy of the X-ray beam is determined by the voltage applied between the cathode 

and anode of the X-ray tube. Increasing the kilovoltage (kVp) will increase the maximum energy of 

the X-ray photons and, therefore, the ability of the X-ray photons to penetrate thicker body parts. 

Increasing the kVp will increase the beam output, defined as the quotient of the air kerma at a 

specified distance by the product of tube current and exposure time in units of Gy/mAs (ICRU 2005). 

Numerous empirical studies of beam output as a function of kVp over the years show that increasing 

the kVp will increase the beam output according to the 1.7 power of the kilovoltage for a given amount 

of filtration (Handloser and Love 1951; Trout, Kelley, and Cathey 1952; BRH 1970). In the absence of 

specific measurements or empirical data, this relationship can be used to determine or adjust the 

beam output as a result of changes in kilovoltage.

The X-rays from a medical X-ray machine are predominantly of bremsstrahlung origin and, therefore, 

exit the beam port with a spectrum of energies. It is difficult to know the precise energy spectrum of 

an X-ray beam from a particular X-ray machine, so in practice it is common to refer to the "beam 

quality" as a simple surrogate for detailed information about the energy spectrum (ICRU 1937). The 

beam quality is a measure of the ability of the beam to penetrate matter (also known as beam 

hardness), and is expressed in terms of the half value layer (HVL) of the beam in millimeters of 

aluminum. The beam quality and the HVL are primarily a function of the target material, kVp, and 

total filtration in the X-ray machine. Some knowledge of the beam quality is necessary for dose 

reconstruction. Ideally, machine-specific HVL measurements are available. Without actual HVL 

measurements, estimates of the HVL can be made with knowledge of the kVp and total filtration in the 

machine, which is the sum of the inherent filtration in the tube itself and any added filtration.

All X-ray tubes have inherent filtration, which includes the window, aperture, or port in the tube 

enclosure through which the X-ray beam passes or emerges from the X-ray tube. The tube housing is 

shielded to eliminate leakage radiation from the tube other than through the port. In medical X-ray 

machines used for radiographic imaging, the window or beam port through which the useful beam 

emerges is purposely made very thin, typically equivalent to 0.5 mm Al in attenuation, and so provides 

little beam hardening. It was recognized early that placing additional filters in the X-ray beam to 

preferentially absorb the lower energy X-rays in the spectrum while allowing the higher energy X-rays 

to pass through had the potential to reduce the skin dose to the individual being radiographed. For 

this reason, minimum filtration requirements for medical X-ray machines have been in existence for a 

long time. 

Recommendations were made in 1937 by the International Committee for Radiological Units and 

Measurements (ICRU 1937), which specified aluminum filters for X-rays produced from 20 to 120 

kVp. The 1936 recommendation of the U.S. Advisory Committee on X-Ray and Radium Protection, 
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the forerunner of the National Council on Radiation Protection and Measurements (NCRP), called for 

total filtration (permanently mounted) of 0.5 mm of Al equivalent for radiographic installations, and 

1 mm Al equivalent for fluoroscopy (NBS 1936). Typical added filtration in the 1940s ranged from 

zero to 1 mm Al. In 1949, the National Bureau of Standards recommended 1 mm of Al added filtration 

for radiography of thick parts of the body such as the chest (NBS 1949). In 1955, the 

recommendation for medical radiographic machines called for 2.5 mm Al eq. total filtration (NBS 

1955). The recommended total filtration remained at 2.5 mm in 1968 for medical radiographic 

machines operating above 70 kVp (NCRP 1968). For machines already in operation, these 

recommended filter thicknesses might not have been used for some time after the date of the 

recommendation. Since 1974, X-ray machine manufacturers have been required by law to include 

minimum amounts of filtration (21 CFR Part 1020). In this TIB, an HVL of 2.0 mm Al is assumed for 

determination of dose equivalent from chest fluoro, lumbar, thoracic, cervical spine, and pelvis X-rays, 

2.5 mm Al for most other X-rays taken through 1985, and 4.0 mm Al for X-rays taken after 1985.

The relationship of beam output to kVp and to filtration is complex, to some extent machine-specific, 

and best determined empirically. However, in the absence of empirical data for a specific machine, 

adequate contemporary empirical and theoretical data exist on which to determine the machine output 

with a reasonable degree of certainty. For a given mAs setting on a machine, additional filtration

generally reduces the air kerma in an exponential manner. For a typical single-phase X-ray machine 

operating in the range of 80 to 100 kVp, each additional millimeter of Al filtration will effect a reduction 

of about 40% in the air kerma (Trout, Kelley, and Cathey 1952; Taylor 1957). Thus, the approximate 

reduction in air kerma afforded by any thickness of Al filtration can be determined by the following 

exponential equation:

I = Io e-0.4t

or

ln (I/I0) = - 0.4 t

where t is the thickness of Al in millimeters, and I and I0 are air kerma with and without the filter, 

respectively. In the absence of specific measurements or empirical data, this correction can be 

applied to determine the effect of filtration on air kerma.

The effects of filtration and kVp tend to offset one another; the addition of filtration reduces the air 

kerma per milliampere-seconds, while increasing the kVp increases the air kerma per milliampereseconds. Higher kVp radiographic techniques typically require fewer milliampere-seconds per

radiograph, and will result in lower entrance skin dose, but might increase dose to organs at greater 

depths in the body. 

High-voltage X-ray generators used for medical radiography since the 1940s are of three basic types: 

single-phase full-wave-rectified, typical of virtually all medical radiographic units used through the mid1980s; three-phase; and high-frequency (HF). A single-phase full-wave-rectified generator produces 

120 half sinusoidal pulses of X-rays per second, each with a duration of 1/120 second, with a 100% 

fluctuation in the voltage. A three-phase generator uses three single phase voltage lines, each 

slightly out of phase with the others, producing a more constant (i.e., less fluctuating) voltage (Selman 

1965, p. 214), therefore producing a greater beam output (approximately 20%) as compared with a 

single-phase full-wave-rectified machine operating at the same kVp and mAs. Three-phase 

generators were primarily installed in hospitals because they were expensive and required threephase wiring. An HF generator is the most modern type, and produces a voltage waveform with very 

little fluctuation (2%) in voltage to the X-ray tube (Amman 1991, p. 240). Three-phase and HF 

machines did not become commonplace until the 1980s and 1990s. For dose reconstruction and in 
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the absence of evidence to the contrary, X-ray machines will be assumed to be single-phase fullwave-rectified. 

3.2 CURRENT AND EXPOSURE TIME

The current in an X-ray tube refers to the number of electrons accelerated across the evacuated 

volume of the X-ray tube, flowing from the cathode to the anode. For a given kilovoltage, the number 

of X-ray photons and the air kerma will be directly proportional to the X-ray tube current. Exposure 

time refers to the time the beam was on or that the machine was producing X-rays. As with the tube 

current, the number of X-ray photons and the air kerma will be directly proportional to the exposure 

time for a given kilovoltage. The exposure needed for a radiograph is typically specified in terms of 

mAs, the product of X-ray tube current, and the exposure time. All other factors being equal (e.g., 

kVp, filtration, development, film/screen combination), air kerma is proportional to the mAs.

To avoid or minimize image blurring from involuntary organ motion such as the beating heart, 

exposure time is minimized, and the current proportionately increased to obtain the desired amount of 

radiation for a properly exposed radiograph. Earlier medical X-ray machines were equipped with 

mechanical timers whose accuracy was not as good as the accuracy of the electronic timers used on 

later machines. Gross bias errors in timer accuracy are unlikely in that these would have resulted in 

over- or underexposure of the radiograph and, thus, would have been quickly detected and corrected. 

Small random errors in the timers might not have been visible on radiographs, but might have 

produced uncertainties of perhaps ±20% in the air kerma. 

3.3 DISTANCE

X-ray beam output is a function of distance from the source of X-rays in the tube, approximating the 

inverse square law at large distances (i.e., more than a few tens of centimeters) from the tube. 

Radiographic chest radiographs are taken at a standard SID of 72 in. (183 cm) between the source 

and the plane of the film. Most other radiographs are taken at a standard SID of 36 in. to 40 in. (102 

cm). The distance between the source and the worker's body, expressed as the source-to-skin 

distance (SSD), is smaller than the SID because the worker is positioned between the source and the 

film cassette. 

The air kerma at the point where the X-ray beam enters the body, known as the incident air kerma 

(Ka,i) (ICRU 2005) is a reference point for determining organ dose. The Ka,i depends on the SID for 

the X-ray procedure, the body thickness of the person being radiographed, and the thickness of the 

cassette/film holder. While the size of the worker clearly affects the Ka,i, individual measurements 

(such as chest thickness) or individual technique factor settings (kVp, mA, and time) were rarely 

recorded at the time each X-ray was performed on a given worker. This is true not only at DOE/AWE 

sites, but also at any other clinical facility for the same period. As a result, and because the organ 

dose conversion factors in International Commission on Radiological Protection (ICRP) Publication 34 

(ICRP 1982) are based on standard body dimensions (Cahoon 1961; Wochos, Detorie, and Cameron 

1979; Kereiakes and Rosenstein 1980), dose reconstruction must be performed assuming the 

standard body dimensions. 

Table 1 provides the standard SIDs for the more commonly performed X-ray screening procedures 

and the commonly accepted body part thicknesses involved. Table 1 also provides the calculated 

SSDs used in dose reconstruction, assuming a standard 5 cm between the point where the X-ray 

beam exits the body and the plane of the film to account for the thickness of the cassette and/or 

cassette holder (Kereiakes and Rosenstein 1980, p. 189). 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 11 of 61

Table 1. Standard body dimensions, SIDs, and SSDs used for dose reconstruction. 

Procedure Projection

Part thickness 

(cm)a

Standard SID 

(in/cm)

Calculated SSDb 

(cm)

Chest PA (PFG) 23 40/102 74

PA 23 72/183 155

LAT 34 72/183 144

OBL 34 72/183 144

AP Lordotic 23 72/183 155

Lumbar spine AP and spot 23 40/102 74

LAT and spot 34 40/102 63

Thoracic spine AP 23 40/102 74

LAT 34 40/102 63

OBL 34 40/102 63

Cervical spine AP 15 40/102 82

LAT 15 72/183c 153d

OBL 15 40/102 82

Pelvis AP 23 40/102 74

a. The chest and abdomen are assumed to be 23 cm thick and 34 cm wide. The neck is assumed to 

be 15 cm thick and 15 cm wide.

b. The SSD = SID – Part thickness – 5 cm. A 5 cm gap between the worker and the plane of the film 

is included to account for the thickness of the cassette and/or cassette holder.

c. The 72-in. SID is used for the LAT cervical spine to reduce magnification. 

d. The SSD for the LAT cervical spine = 183 cm – 15 cm – 5 cm – 10 cm = 153 cm. The 10 cm 

accounts for the fact that during the LAT cervical spine, the shoulder is up against the cassette 

holder, and so the side of the neck is not actually in contact with the cassette holder, affecting the 

SSD calculation.

3.4 COLLIMATION 

Collimation refers to the limitation of the size of the X-ray beam. In the early years following the 

discovery of X-rays, the philosophy was to use a fairly large aperture (i.e., limited collimation) to 

ensure that the entire area of clinical interest was included in the radiograph. As a result of radiation 

protection concerns, beams began to be better collimated, limiting the area of the body exposed and 

minimizing the dose to organs outside the beam. Limiting the size of the X-ray beam had a beneficial 

effect on the image quality, because there was less scatter produced when smaller volumes of tissue 

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

primary beam. Figure 1 (from Price 1958) illustrates how poor collimation can unnecessarily irradiate 

organs outside the area actually imaged on the film.

Beam limiting cones were widely used for radiography from the 1940s to the 1960s (Cahoon 1961, 

p. 68). The cones produced circular beams, and were gradually replaced by variable aperture 

collimators that produced rectangular beams that more efficiently corresponded to the rectangular 

shape of the film (Cahoon 1961, p. 70). By the early 1960s, techniques were being modified to 

incorporate better methods of collimation. The NCRP, in Report 33 (NCRP 1968), updated its 

guidance on medical X-ray protection, including guidance for restriction of the X-ray beam to the area 

of clinical interest. While many DOE facilities had probably already incorporated the beam limitation 

guidance in NCRP Report 33, some smaller facilities might not have incorporated it into their practices 

for several years. 

Wochos, Detorie, and Cameron (1979) analyzed the 1972-1975 Nationwide Evaluation of X-Ray 

Trends (NEXT) data and found that at some facilities, primarily internal medicine and general 

practitioners, the beam area-to-film area ratio could be as high as 2.0, but noted that this ratio was 

significantly lower at hospitals and radiology facilities where more X-rays were done and personnel 

performing them were generally better trained. For dose reconstruction, it will be assumed that 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 12 of 61

Figure 1. Diagram of poor collimation. From Price (1958).

radiographs taken before approximately 1970 were poorly collimated compared with radiographs 

taken after 1970. If actual dose measurements or inspection of the radiographs from a particular site 

indicate that collimation was used before 1970, the site-specific evidence can be used in the 

development of organ doses in that site's Site Profile. However, in the absence of information to the 

contrary with respect to collimation before 1970, a beam area-to-film area ratio of 2.0 is assumed for 

dose reconstruction through 1970. This ratio would be achieved by exposure of an additional 3 in. in 

all directions around a 14-in. × 17-in. radiographic film.

An assumption of poor collimation of radiographs through 1970 might necessitate the use of dose 

conversion factors (DCFs) from ICRP Publication 34 (ICRP 1982) other than those for the intended 

examination, because ICRP Publication 34 DCFs are based on properly collimated beams. This is 

discussed in more detail in Section 5.2 of this TIB. 

3.5 SCREENS, GRIDS, AND OTHER FACTORS 

A number of other factors affects the X-ray exposure required to obtain a usable radiographic image 

and, therefore, has the potential to affect the dose to the worker. However, detailed knowledge of 

these factors is usually unnecessary for dose reconstruction if beam measurements are available or if 

the machine technical factors of kilovoltage (kVp), time (s), and current (mA) are known along with the 

amount of primary beam filtration. 

The exposure needed for a suitable radiographic image is a function of film/screen combination speed 

and development. Underdevelopment of films requires additional exposure to achieve satisfactory 

film density. Intensifying screens are used in the cassette to convert the radiation efficiently to light 

photons that subsequently expose the film. Because film is more sensitive to light photons than to 

X-ray photons, using screens and film in combination can reduce the amount of radiation needed to 

produce an image. Film and screen speeds have increased dramatically since the 1940s and are one 

of the reasons that dose per X-ray procedure generally shows a downward trend over this period. 

Grids are devices that are used in front of the film cassette to absorb scattered radiation before it 

reaches the film. The grid itself is comprised of very thin lead strips placed such that the diverging 

X-ray photons will pass between the strips. The strips will absorb radiation that is scattered at large 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 13 of 61

angles. Grids are typically used to radiograph thick body parts such as the abdomen, lumbar spine 

and, in recent times, the chest. The Potter Bucky diaphragm (also known as a Bucky grid) vibrates 

back and forth rapidly during the exposure, which minimizes the chance of the strips appearing on the 

film image. In any case, the above are all factored into the technique factors (i.e., kVp, mA, and time) 

used to produce images and, therefore, detailed knowledge of them is not always of importance in 

dose reconstruction. 

The effect of various technical factors on radiation output is listed in Table 2.

Table 2. Relationship of technical factors to X-ray beam output. 

Parameter Units Relationship to X-ray beam output

kilovoltage kV Air kerma proportional to 1.7 power of kVp

Tube current mA Air kerma proportional to tube current

Exposure time sec Air kerma proportional to exposure time

Filtration mm Al Air kerma decreases by ~40% for each additional mm Al added to the beam

Distance cm or in. Air kerma decreases by inverse square relationship (1/d2) 

4.0

One of the essential parameters used to determine organ dose equivalent is the incident air kerma, 

Ka,i (ICRU 2005), which is the air kerma from the primary beam on the central X-ray beam axis at the 

SSD (i.e., at the skin-entrance plane). Only the primary radiation incident on the skin and not the 

backscattered radiation is included in the definition of Ka,i (ICRU 2005, p. 28). The incident air kerma 

can be determined from actual X-ray beam measurements, knowledge of technical factors for the 

X-ray machine in question, or by using air kerma values from the literature and correcting to the SSD 

of interest. Each of these is discussed in the following sections. Before the quantity "exposure" 

became obsolete (ICRU 2005), the entrance skin exposure (ESE) was used to describe essentially 

the same quantity as incident air kerma.

DETERMINING INCIDENT AIR KERMA

4.1 USING BEAM MEASUREMENTS

Use of actual X-ray beam measurements is the simplest and most direct means of determining the 

incident air kerma, and is most likely to provide the most accurate estimates of organ dose equivalent 

from a given machine. Unfortunately, X-ray beam measurements are often unavailable, particularly 

before about 1980. Because actual measurements are the preferred method for determining incident 

air kerma, every effort to determine if such measurements have been made is justifiable. Beam 

measurements are typically quantified in units of roentgens (R) (now obsolete), coulombs per 

kilogram (C/kg), or Gray (Gy). Measurements with R-meters and ionization chambers, if properly 

performed, are reliable and have a low degree of uncertainty. In general, the uncertainty of properly 

performed measurements in the energy region of interest should not exceed +2% of the measured 

value (Kathren and Larson 1969).

Beam measurements in units of R must be converted to incident air kerma. Using the inverse square 

relationship listed in Table 2 and the standard SSDs from Table 1, the air kerma at any point on the 

central axis of the X-ray beam can be converted to the incident air kerma.

(1)

where

Ka,i is the incident air kerma to be used in organ dose calculations in units of cGy in air;

R is the exposure in roentgens at the skin entrance plane (i.e., ESE)

2.58E-4 C/kg R-1 is the conversion factor from R to C/kg

Ka,i = (R)(2.58E-4 C/kg R-1)(33.97 J/C)(100 cGy/Gy)(1Gy/1J kg-1)
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 14 of 61

33.97J/C is the amount of energy required to ionize air

4.2 USING TECHNICAL FACTORS

In the absence of suitable beam measurements, the incident air kerma can be determined using 

machine-specific technical factors for a given X-ray examination and projection, and for an individual 

with the same dimensions as those listed in Table 1. The technical factors are used with published 

X-ray output data that provide air kerma per mAs as a function of kVp, filtration (or HVL), and distance 

to determine the incident air kerma. X-ray beam output data are available from a number of 

publications, including NCRP Report 102 (NCRP 1997) and ICRP Publication 34 (ICRP 1982). 

Table B-3 in NCRP Report 102 (p. 99) provides average air kerma rates for medical X-ray equipment 

operating at various kVp with 2.5-mm Al eq. filtration at distances from 30 to 182 cm from the source. 

As an alternative, Figure B.1 in NCRP Report No. 102 (p. 109) and Figure A1 in ICRP Publication 34 

(p. 76) provide graphical representations of air kerma at 100 cm for various values of kVp and filter 

thickness greater than 2.5 mm Al eq. Using these tables or graphs, a reasonable estimate of incident 

air kerma can be obtained with knowledge of the mAs and the SSDs from Table 1.

4.3 USING PUBLISHED VALUES FROM MEDICAL LITERATURE

If both machine specific beam measurements and machine-specific technical factors are unknown or 

unreliable, values of incident air kerma from the general medical literature of the time can be used. 

These incident air kerma values are listed in Table 3. Published incident air kerma values are values 

from measurements reported in the literature for similar X-ray machines and X-ray procedures and for 

similar periods. Published incident air kerma values are used to calculate many of the organ dose 

equivalents published in this TIB, with a few exceptions where measured doses taken directly from 

medical literature are used. More detail about some of the incident air kerma values is provided in the 

sections on X-ray procedures.

Table 3. Published incident air kerma values by procedure and period. 

Procedure Projection

Through 1970 1971–1985 Post 1985

HVL (mm 

Al eq.)

Incident 

air kerma 

(cGy)

HVL (mm 

Al eq.)

Incident 

air kerma 

(cGy)

HVL (mm 

Al eq.)

Incident 

air kerma 

(cGy)

Chest PFG 2.5 2.27a --- b --- b --- b --- b

PA 2.5 0.20c 2.5 0.10 4.0 0.05

LAT 2.5 0.50c 2.5 0.25 4.0 0.13

OBL 2.5 0.50 2.5 0.25 4.0 0.13

AP lordotic 2.5 0.20 2.5 0.10 4.0 0.05

Fluoro (PA) 2.5 2.50d --- b --- b --- b --- b

Lumbar spine AP and spot 2.0 1.44e 2.5 0.91f --- b --- b

LAT and spot 2.0 3.79e 2.5 3.48f --- b --- b

Thoracic spine AP 2.0 0.985e --- b --- b --- b --- b

LAT 2.0 2.20e --- b --- b --- b --- b

OBL 2.0 2.20 --- b --- b --- b --- b

Cervical spine AP 2.0 0.432g --- b --- b --- b --- b

OBL 2.0 0.432g --- b --- b --- b --- b

LAT 2.0 0.261g --- b --- b --- b --- b

Pelvis AP 2.0 1.52e --- b --- b --- b --- b

a. Incident Air Kerma of 2.00 cGy is for stereo (two-exposure) PFG (Kirklin et al. ca. 1969; Rising and Soldat 1959).

b. Procedure not used for screening in this period.

c. From Stanford and Vance (1955, p. 270). 

d. Fluoro dose based on 5 R/min for 30 sec, with an HVL of 2.0 mm Al eq.

e. From Lincoln and Gupton (1958, pp. 212-213) and Equation 1 or 6 in this TIB. 

f. From Kereiakes and Rosenstein (1980, p. 213). 

g. Braestrup and Wycoff (1958, pp. 140-141). 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 15 of 61

5.0

The methodology of ICRP Publication 34 (ICRP 1982) is used to estimate many organ dose 

equivalents. This methodology is based on Monte Carlo calculations for a reference adult defined in 

Kereiakes and Rosenstein (1980, Table 94 and Figures 2 and 3) that appear to be more 

representative of the human body than the simple nonstandardized phantoms used in the 1950s for 

early studies on gonad dose to the population (Lincoln and Gupton 1958; Laughlin et al 1957; Billings, 

Norman, and Greenfield 1957). In ICRP Publication 34 methodology, organ dose is obtained as the 

product of entrance kerma and a DCF selected from Tables A2 to A8. Entrance kerma is defined in 

ICRP Publication 34 as “air kerma in air without backscatter.” For consistency in this TIB, the term 

incident air kerma (Ka,i) from ICRU (2005) will be used:

DETERMINING DOSE EQUIVALENT TO ORGANS OTHER THAN SKIN

(2) 

where

ODE is the organ dose equivalent in rem

Ka,i is the incident air kerma in cGy

DCF is the selected dose conversion factor

1 cSv/cGy is the conversion from absorbed dose to dose equivalent for X-ray photons. 1 cSv 

= 1 rem

Selection of the appropriate DCF from Tables A2 to A8 in ICRP Publication 34 (ICRP 1982) requires 

knowledge of the X-ray projection, the organ, and the X-ray beam quality expressed in terms of the 

HVL in millimeters of aluminum. If the kVp and total filtration are known, HVLs can be estimated from 

the data given in Tables A16 and A17 of ICRP Publication 34 (p. 77) or Table B.2 in NCRP Report 

102 (NCRP 1997, p. 98). 

5.1 SUBSTITUTE DCFS FOR ORGANS NOT LISTED IN ICRP PUBLICATION 34

Tables A2 to A8 in ICRP Publication 34 (ICRP 1982) do not include all the organs that correspond to 

the likely primary cancer site locations used in the Interactive RadioEpidemiological Program (IREP) 

computer program, which is used in dose reconstruction. Therefore, a substitute DCF must be 

selected for organs for which there is no corresponding DCF in ICRP Publication 34. For a properly 

collimated beam, the substitute DCF is usually selected according to anatomical proximity, with due 

consideration to other factors such as whether one or both organs are inside or outside the primary 

beam, organ depth, characteristics of overlying tissue, etc. Figure 2 illustrates the relationships 

between the locations of organs.

For properly collimated beams in general for chest, thoracic, and cervical spine X-rays, the DCF for 

lung is used for other organs in the thoracic or upper abdominal cavity (i.e., thymus, esophagus, 

stomach, and liver/gall bladder/spleen). Because an appreciable fraction of the skeleton is in the 

trunk, in particular the trabecular bone, which has a large surface-to-volume ratio, and the sternum, 

which is a primary location of the red marrow in the adult, the DCF for the lung is used to determine 

the dose to bone surfaces for chest, thoracic, and cervical spine X-rays. When the lung DCF is used 

as a substitute for other organs, the higher of the male or female lung DCF is used to determine the 

dose to these other organs for employees of both genders. Using the same logic, the DCF for the 

ovary is used as a substitute to determine the dose to organs in the lower abdomen such as the 

urinary bladder, prostate, and colon/rectum, regardless of employee gender. For the lumbar spine 

and pelvis, the DCF for the ovary is used as a substitute to determine the dose to the liver, gall 

ODE = (Ka,i )(DCF)(1cSv/cGy)
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 16 of 61

Figure 2. Diagram of the torso. Source: http://www.merck.com/ 

mrkshared/mmanuel_home/illus/1i1.jsp (Beers 2003, Section 1, 

Chapter 1).

bladder, spleen, urinary bladder, prostate, colon, rectum, stomach, bone surfaces (in the spine and 

pelvis), and the remainder organs regardless of employee gender. 

The thyroid DCF is usually selected as the substitute to determine the dose to the eye/brain. 

However, one important exception to this generality is made for determining eye/brain dose from 

photofluorography (PFG) examinations of the chest. Because of the shorter SID used in PFG (40 in.) 

compared with radiographic chests (72 in.), the thyroid is most likely to be in the primary beam for 

PFG, while the eye/brain is most likely to be outside the primary beam of PFG. A better choice of a 

substitute DCF for the dose to the eye/brain for PFG is then one where the thyroid (as a substitute for 

the eye/brain) is just outside the primary beam. The larger of the DCF for the posterior-anterior (PA) 

or lateral (LAT) skull or lungs for PA chest were selected as substitutes since the thyroid is just 

outside a properly collimated primary beam in those projections. Other exceptions to the general 

relationship listed in Table 4 are footnoted.

5.2 SUBSTITUTE DCFS FOR POOR COLLIMATION

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

beam. This necessitates the use of DCFs from ICRP Publication 34 (ICRP 1982) other than those for 

the intended procedure, because Publication 34 assumes properly collimated beams. For example, 

the thyroid is normally assumed to be outside the properly collimated beam of a PA chest projection 

(DCF = 32 mGy Gy-1 for HVL of 2.5 mm Al). However, a poorly collimated PA chest beam that is 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 17 of 61

about 2.0 times the size of the film must be assumed to include the thyroid in the primary beam. The 

dose to the thyroid can then be reasonably estimated by using a DCF for a projection in which the 

thyroid is clearly in the primary beam, such as the anterior-posterior (AP) cervical spine projection 

(DCF = 868 mGy Gy-1 for HVL of 2.5 mm Al). However, the thyroid is near the exit surface of the 

X-ray beam during a PA chest projection and near the entrance surface of the beam during an AP 

Table 4. Organs without ICRP Publication 34 DCFs and 

their substitutes.

a

 

IREP organ ICRP 34 substitute DCF

Thymus

Esophagus

Lung

Stomach

Bone surface

Liver/gall bladder/spleen

Remainder organs

Lungb or ovary

Urinary bladder

Colon/rectum, prostate

Ovary

Eye/brain Thyroidc

a. Applies to most properly collimated radiographic procedures.

b. The lung is not used as the substitute DCF for these organs for the 

pelvis or lumbar spine. Refer to Table 5-2 in ICRP Publication 34. 

c. The PA and/or LAT skull, or the PA chest DCF, whichever is larger, 

is used to determine the dose to the eye/brain resulting from the 

PFG chest.

cervical spine projection. A simple depth dose correction can be applied to the AP cervical spine DCF 

to account for the additional tissue attenuation in the neck when the thyroid is in the primary beam (as 

it is during an AP cervical spine projection), but nearer the exit surface of the beam (as it is during the 

PA chest projection). Depth dose factors from Table B.8 of NCRP Report 102 (NCRP 1997) are used 

to make this correction. The resulting modified DCF for the thyroid for poorly collimated beams is 

174 mGy Gy-1 assuming the thyroid is approximately 10 cm below the surface of the back of the 

neck, and using a depth dose factor of 0.2 for 2.5 mm Al HVL from Table B.8 of NCRP Report 102: 

868 mGy Gy-1 × 0.2 = 174 mGy Gy-1. 

The substitute DCFs selected to determine dose to unnecessarily exposed organs as a result of poor 

collimation are presented in Tables 5 and 6. They are further discussed in the sections that describe

the various screening procedures and projections. Note that only substitute DCFs are shown in this 

table. A complete table of DCFs is in Attachment A, Table A-14.

6.0

The dose equivalent to the skin surface in the primary beam can be calculated with the following 

equation:

DETERMINING DOSE EQUIVALENT TO SKIN

(3) 

where: 

D(skin surface) is the dose equivalent at the skin surface or the entrance skin dose equivalent 

(ENSD)

Dair = Incident air kerma in cGy

The ratio (μen/ρ) muscle (μen/ρ) air

-1 = 1.04 – 1.07 for the 40- to 140-kVp range, usually ignored 

(Wall, Harrison, and Spiers 1988)

D(skin surface) = (Dair) (μen/ρ) muscle (μen/ρ) air-1 (BSF)(1cSv/cGy)
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BSF is the backscatter factor from Table B.8 in NCRP Report 102 (NCRP 1997, p. 103), 

which provides BSF for different beam qualities and field sizes

1 cSv/cGy is the conversion from absorbed dose to dose equivalent for X-ray photons. 1 cSv 

= 1 rem

Table 5. Substitute DCFs for poorly collimated chest beams through 1970.

a,b

Organ of 

interest

PFG

(2.5 mm Al 

HVL)

Chest fluoro

(2.0 mm Al

HVL)

PA chest 

through 1970 

(2.5 mm Al 

HVL)

LAT/OBL chest 

through 1970 

(2.5 mm Al 

HVL)

AP lordotic 

chest through 

1970 (2.5 mm Al 

HVL)

Thyroid DCF for AP Cspine corrected 

for depth by 0.2.

DCF for AP Cspine corrected 

for depth by 0.2.

DCF for AP Cspine corrected

for depth by 0.2

DCF for lat skull DCF for AP Cspine

Eye/brain DCF for thyroid DCF for thyroid DCF for thyroid DCF for thyroid 

for lat skull

DCF for AP Cspine

Ovaries N/A N/A N/A DCF for AP 

abdomen

Liver, gall 

bladder, spleen

Urinary 

bladder/prostate

N/A N/A N/A DCF for AP 

abdomen

Colon/rectum N/A N/A N/A DCF for AP 

abdomen

Testes N/A N/A N/A DCF for AP 

abdomen

Lungs male

Lungs female

Thymus

Esophagus

Stomach

Bone surfaces

Remainder

Breast

Uterus N/A N/A N/A DCF for AP 

abdomen

Bone marrow 

male

Bone marrow 

female

a. Only substitute DCFs are shown in this table. A complete table of DCFs is in Attachment A, Table A-14.

b. N/A means that a measured dose from literature is used rather than a DCF.

Table 6. Substitute DCFs for poorly collimated spine and pelvis beams through 1970 (2.0 mm Al 

HVL).

a,b

Organ of interest

AP lumbar 

spine

LAT 

lumbar 

spine AP pelvis 

AP 

thoracic 

spine

LAT/OBL 

thoracic 

spine

AP/OBL 

cervical 

spine

LAT 

cervical 

spine

Thyroid DCF for 

LAT Cspine

Eye/brain 10% of 

thyroid 

DCFd

DCF for 

thyroid

Ovaries N/A N/A N/A N/A N/A N/A N/A

Liver, gall bladder, DCF for DCF for DCF for 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 19 of 61

spleen ovary ovary ovary

Urinary 

Bladder/prostate

DCF for 

ovary

DCF for 

ovary

DCF for 

ovary

DCF for 

ovary

DCF for 

ovary

N/A N/A

Colon/rectum DCF for 

ovary

DCF for 

ovary

DCF for 

ovary

DCF for 

ovary

DCF for 

ovary

N/A N/A

Testes N/A N/A N/A N/A N/A N/A N/A

Lungs male

Lungs female

Thymus

Esophagus

Stomach DCF for 

ovary

DCF for 

ovary

DCF for 

ovary

Bone surfaces DCF for 

ovary

DCF for 

ovary

DCF for 

ovary

Remainder DCF for 

ovary

DCF for 

ovary

DCF for 

ovary

Breast N/Ac N/Ac N/Ac DCF for 

lung

DCF for 

lung

Uterus N/A N/A

Bone marrow 

male

Bone marrow 

female

a. Only substitute DCFs are shown in this table. A complete table of DCFs is in Attachment A, Table A-14.

b. N/A means that a measured dose from literature is used rather than a DCF.

c. Used method from Huda and Bissessur (1990).

d. See section 7.6 on thoracic spine, and Kereiakes and Rosenstein 1980, p. 205. 

6.1 ENTRANCE SKIN DOSE EQUIVALENT

The entrance skin dose equivalent calculated using Equation 3 is the starting point for determining 

other skin dose equivalents. The ENSD is assigned to areas of skin in the primary beam on the beam 

entrance side of the body for a particular radiographic projection. Because the area of skin in the 

primary beam varies with the type of radiographic procedure, the projection, and collimation, standard 

areas of skin were defined for use in dose reconstruction. These standard areas are listed in 

Tables A-1 to A-6 of Attachment A, along with areas of skin that are assigned the ENSD for various 

procedures, projections, and periods.

6.2 EXIT SKIN DOSE EQUIVALENT

The exit skin dose (EXSD) equivalent is the dose equivalent to areas of skin where the X-ray beam 

exits the body. The EXSD is determined by dividing the ENSD by an absorption factor from Table B.7 

in NCRP Report 102 (NCRP 1997, p. 102) to account for attenuation in the body. The selection of 

absorption factor depends on the beam quality and the thickness (in centimeters) of overlying tissue. 

In this TIB, the standard body dimensions from Table 1 are used with the assumed beam qualities 

(2.0, 2.5, and 4.0 mm Al HVL). The absorption factor is decreased by 10% to allow for differences 

between the tabulated values and actual values, as specified in the footnote to Table B.7 in NCRP 

Report 102. The areas of skin that are assigned the EXSD for various procedures and projections are 

listed in Tables A-1 to A-6 of Attachment A for various procedures, projections, and periods. 

(4) 

where: 

EXSD is the exit skin dose

EXSD = (ENSD)(0.9 AF)-1
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 20 of 61

ENSD is the entrance skin dose

0.9 is an uncertainty factor in the tabulated AF 

AF is the absorption factor selected from Table B.7 in NCRP Report 102 (NCRP 1997, p. 102)

6.3 SKIN OUTSIDE BUT NEAR PRIMARY BEAM

Entrance and exit dose equivalent to portions of the skin outside but near the beam are assumed to 

be 10% of the doses in the neighboring region inside the beam. This is based on the finding that the 

dose to the testes is 10% of the central beam dose when the testes are just outside the beam 

(Kereiakes and Rosenstein 1980, p. 205). The areas of skin that are assigned the 10% of the ENSD 

or the EXSD are listed in Tables A-1 to A-6 of Attachment A for various procedures, projections, and 

periods.

6.4 REMOTE SKIN DOSE EQUIVALENT

The dose equivalent to areas of skin that are remotely located from the primary beam (entrance or 

exit) is estimated from the scatter that would be the sole source of irradiation to those areas of skin. 

The dose equivalent to these areas is called the remote skin dose (RSD) in this TIB. The RSD is 

estimated using the following equation:

(5) 

where: 

ENSD is the entrance skin dose equivalent from the primary beam calculated from Equation 3, 

The average depth dose is the fraction of the ENSD at a point at the mid-plane of the body 

from Table B.8 in NCRP Report 102 (NCRP 1997, p. 103)

The factor 1.1 accounts for differences between the SSD of 60 cm assumed in Table B.8 and 

other SSDs specified in the title of Table B.8 (NCRP 1997, p. 103) 

The factor 0.0005 is the ratio of scattered to incident exposure at 1 m from a 70-kVp primary 

beam that scatters 90° from the path of the incident X-ray beam from Table B-2 in NCRP 

Report 49 (NCRP 1976, p. 59)

The factor 1/r2 is a correction for the distance between the center of the primary beam to the 

remote skin area of interest. The distance is based on the reference adult worker defined in 

Kereiakes and Rosenstein (1980, Table 94 and Figures 2 and 3).

The areas of skin that are assigned the RSD for various procedures and projections are listed in 

Tables A-1 to A-6 of Attachment A. 

7.0

There is some variability from site to site as to which standard projections were included in screening 

protocols and how frequently they were performed, depending on physician or radiologist preference. 

The standard screening protocols for workers or small subsets of workers should be addressed in 

each Occupational Medical Dose technical basis document (TBD) for a particular DOE or AWE site. 

X-ray projections requested by the physician on a case-by-case basis in addition to the screening 

protocol fall into the diagnostic category (i.e., not screening) and should not be included in dose 

reconstruction in compliance with 42 CFR Part 81, with a few exceptions described in the sections 

below.

TYPES AND FREQUENCY OF X-RAY SCREENING

RSD = (ENSD) (Average Depth Dose) (1.1) (0.0005) (1/r2)
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The incidence of technically deficient films necessitating retakes is not known, but it is likely to have 

been very small, probably no more than a few percent. Trout et al. (1973) in their analysis of the 

rejection rate of chest radiographs obtained during the Coal Mine “Black Lung” program reported an 

average rejection rate of 3% among 67,000 radiographs. This low rejection rate occurred in a 

program that had fairly high standards of training for the radiologists interpreting the images in 

addition to standards for the image quality of the films. It is doubtful that the retake rate in the DOE 

complex would have been higher than this when the standards for the film readers and image quality 

were not formally in place in the DOE complex. Goldman and Beech (1979, p. 44) report that only 

about 3.64% of the examinations performed at the Baltimore Public Health Service Hospital involved a 

retake. 

In the DOE complex, Los Alamos National Laboratory reported a retake rate of 2.2% in 1998 

(Antonsen 1998, p. 26); Lawrence Berkeley National Laboratory reported a retake rate of 0% in 1991 

(Thomas 1991a, p. 3); no retake program was in place at Lawrence Livermore National Laboratory in 

1991 (Thomas 1991b, p. 4) or at Brookhaven National Laboratory in 1994 (Bernacki 1994, pp.13-14). 

The data cited above do not support the automatic inclusion of retakes as an additional source of 

exposure to each worker, but if dose reconstructors encounter records of retakes in individual claim 

file records, the dose from them should be included. 

7.1 RADIOGRAPHIC CHEST

The most commonly performed X-ray screening examination or procedure is the conventional 

radiographic chest, which was used in the DOE/AWE complex to screen for diseases of the lungs and 

heart, primarily tuberculosis (TB) and occupational lung diseases like asbestosis (Wirth 1951; Cantril 

1951). The PA chest projection was standard (Merrill 1949, p. 497), and sometimes accompanied by 

the LAT chest projection. The LAT chest was almost always a left LAT, performed with the left side of 

the body towards the film, to image the heart and the aorta (Merrill 1949, p. 507). Both of these 

projections were made on 14-in. × 17-in. film at a standard source to image distance of 72 in. (Merrill 

1949, p. 497). The PA chest was occasionally performed in stereo, meaning that exposures were 

made on two separate films, using slightly different X-ray tube angles, and viewed at the same time 

with a stereoscope (Selman 1965, p. 337). The significance of the word stereo for dose 

reconstruction is that two exposures were made and, therefore, organ doses should be doubled when 

dose reconstructors find claim file records in which stereo projections were obtained. In the complete 

absence of information about a site's chest X-ray screening protocol and standard projections 

(including the lack of X-ray records in the claim files), a preemployment, annual, and termination PA 

radiographic chest X-ray should be assumed for workers for screening (Wirth 1951, p. 28).

The oblique (OBL) chest projection is usually considered an additional projection because it is used to 

help a physician diagnose suspicious areas found on the PA or LAT chest projection. It is not typically 

performed on all workers as part of a screening protocol. However, there is evidence that OBL 

projections increase the diagnostic accuracy of asbestosis and, therefore, could have been included 

as a standard screening projection for asbestos workers (Baker and Greene 1982). The OBL chest 

projection is usually performed with the individual’s right or left anterior chest closest to the film, and 

referred to as the right anterior oblique (RAO) or left anterior oblique (LAO), respectively. The X-ray 

beam still enters the individual’s body from the back and exits the front (i.e., PA). Doses from the 

OBL chest projection should be included in dose reconstructions for asbestos workers if they are 

listed in the worker's claim file as having been performed. If only one OBL chest projection was

performed, dose reconstructors should assume that it was the RAO chest. 

The OBL chest projection uses essentially the same technical factors as those used for the LAT chest 

projection, because the body part thickness is approximately the same for the two projections. When 

organ doses for the OBL projection are not specified in TBDs, they can be assumed to be the same 

as those from the LAT projection, with the exception of skin, which will be different from those of the 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 22 of 61

LAT chest projection because of the beam entering on the left side of the body (for the RAO) rather 

than the right side (for the LAT). 

The lordotic chest projection (also known as the Lindblom position) was another additional projection 

requested by physicians to better visualize the apices (i.e., the uppermost portion) of the lungs (Merrill 

1949, p. 513), a common location for TB. The lordotic projection was most commonly performed AP, 

where the individual faced the X-ray tube and leaned backwards from the waist toward the cassette 

for the exposure (Merrill 1949, p. 513). It would not have been performed routinely on all workers as a 

standard screening projection. This is evidenced by the fact that at the Hanford Site, the number of 

lordotic chest projections is only 2% of the number of PA chest projections performed in the 10-year 

period from 1946 to 1956 (Kirklin 1969). Because active TB was a cause for rejection of a potential 

worker (i.e., not hiring) (Cantril 1951), and the lordotic projection might have been necessary to 

diagnose active TB, the dose from lordotic X-rays in the preemployment examination should be 

included in dose reconstruction. In the periodic screening examinations performed on workers after 

hire, the lordotic projection can be considered a diagnostic projection in accordance with the definition 

of screening, and not included in dose reconstruction. Organ doses from the lordotic chest projection 

are not provided after 1985 because it is unlikely to have been performed after that time with the 

increasing use of computed tomography scans.

The incident air kerma values used to determine organ dose equivalents in this TIB are listed in Table

3. The incident air kerma for a LAT chest X-ray is assumed to be 2.5 times that of a PA chest in this 

TIB, a conservative value based on measurements from Hanford (Kirklin et al. ca. 1969) where a 

factor of 1.94 was observed, and other measurements that suggest the ratio of incident air kerma from 

LAT and PA chest radiographs could have been somewhat greater than that (Stanford and Vance 

1955, p. 270).

The DCF for the female lung is higher than that for the male lung for all chest projections except the 

lordotic projection. The male lung DCF is higher than the female lung DCF for the lordotic chest 

projection (performed AP). Since the higher of the two lung DCFs is used to determine the dose to

the other organs in the chest cavity (see section 5.1), the female lung DCF is used to determine the 

dose to the esophagus, stomach, liver/gall bladder/spleen, bone surfaces, and remainder for all chest 

projections except the lordotic projection, and the male lung DCF is used to determine the dose to 

these organs for the lordotic projection. 

The organ dose equivalents from all chest projections are in Tables A-7 to A-9 in Attachment A. 

7.2 PHOTOFLUOROGRAPHIC CHEST

PFG, also known as mass miniature radiography, was used for mass chest screenings for TB starting 

around 1940 (Birkelo et al. 1947). PFG was a mass chest screening technique most suitable to large 

populations because it was time-efficient and cost-effective (American Trudeau Society 1957, p. 3). 

Some of the screening chest X-rays with DOE and its predecessor organizations occurred with PFG. 

Photofluorography should not be confused with fluoroscopy, which is discussed in Section 7.3.

PFG differed from conventional chest radiography on 14-in. × 17-in. film in that the X-ray image was 

miniaturized with a camera lens or mirror optics system to expose 35-mm film, 70-mm film, 4-in. × 

5-in. film, or 4-in. × 10–in. film for stereo views (two exposures) (Laughlin et al. 1957; Birkelo et al. 

1947). The worker was positioned in the same manner as for a conventional radiographic chest 

X-ray, that is, PA. Most PFG equipment was portable, semiportable, or installed in the limited space 

provided by a mobile bus (Van Allen 1951, p. 832). A diagram of PFG is provided in Figure 3, and a 

photograph of a General Electric PFG machine is provided in Figure 4. 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 23 of 61

Figure 3. Essential components of a PFG unit. From Selman 1965, p. 353. 

Figure 4. Typical General Electric PFG system. From 

GE 1963, p. 25.

PFG typically produces higher doses to workers than conventional chest radiography (Braestrup and 

Wyckoff 1958, p. 140; Laughlin et al. 1957; Moeller, Terrill, and Ingraham 1953). Moeller, Terrill, and 

Ingraham (p. 59) stated that the "largest single source of medical radiation exposure in the United 

States is the mass chest X-ray survey for tuberculosis." The resolution of PFG systems was not as 

good as conventional film screen systems; only 6 line/pairs per mm rather than about 9-10 line/pairs 

per mm (Goodwin, Quimby, and Morgan 1970, p. 108). In addition, the small size of the films made 

the images difficult to interpret. The higher dose and small film size with PFG, combined with lower

resolution and perfection of the Mantoux skin test for TB screening, eventually led to PFG becoming 

obsolete, probably in the mid-1960s. By the mid-1970s, it was recommended that “Whenever 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 24 of 61

possible, Federal agencies should not use photofluorographic equipment to perform X-ray 

examinations” (EPA 1976, p. 13). 

Typical operating parameters reported for 1950s PFG were 24 mAs at 83 kVp at a target-to-film 

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

distance of 40 in. and 2.4 mm added filtration. Phantom measurements in the literature indicate an 

entrance skin dose (including backscatter) of about 0.5 cGy (Laughlin et al. 1957) to 1.53 cGy (Rising 

and Soldat 1959). The incident air kerma value for PFG was derived from the measured skin dose in 

Rising and Soldat (1959) and Equation 6 below. 

The incident air kerma (Ka,i) corresponding to the published skin dose value is calculated by:

(6) 

where: 

Ka,i is the incident air kerma to be used in organ dose calculations in units of cGy in air;

ENSD is the entrance skin dose in rad [1.53 for PFG chest from Rising and Soldat (1959)

BSF is the backscatter factor from Table B.8 of NCRP Report 102 (NCRP 1997) (1.35 for 

2.5 mm Al HVL)

As a result of the shorter SID of PFG compared with conventional radiographic machines, the beam 

for PFG is estimated to include the thyroid, thoracic organs, and liver/gall bladder/spleen, but not the 

eye/brain, gonads, urinary bladder/prostate, or colon/rectum.

PFG was commonly performed as a stereo procedure, which required two projections from slightly 

different angles. Therefore, the organ dose equivalents in this TIB assume a stereo exposure. Dose 

reconstructors must pay attention to the size of the film in the claim file records and, if the 4-in. × 

10-in. film is noted to have been used, dose reconstructors should assume stereo projections and use 

the organ doses listed in Tables A-7 and A-8 in Attachment A. If the film size in the claim file records 

is 4-in. × 5-in., dose reconstructors should assume a single projection, and divide the organ doses 

listed in Tables A-7 and A-8 in half. 

Because PFG was primarily a mass screening technique most suitable to large populations, and 

therefore unlikely to have occurred on a mass scale at AWE sites, PFG should not be assumed to 

have occurred at AWE sites unless there is evidence to the contrary.

Organ dose equivalents from PFG chest X-rays are in Tables A-7 and A-8 in Attachment A. 

7.3 CHEST FLUOROSCOPY

Fluoroscopy, not to be confused with PFG, discussed in Section 7.2, involves real-time viewing of a 

fluorescent screen continuously activated by X-rays. This procedure was not generally amenable to 

mass examinations or preemployment screening of workers, and was not mentioned as a screening 

technique in a study to determine the most efficacious method for mass screening (Birkelo et al. 

1947). In a report on chest X-rays, surveys, and radiation exposure, the American Trudeau Society 

(1957, p. 3) states, 

Screening of groups by fluoroscopy should be strongly discouraged for several reasons: 

the results are not accurate for diagnostic purposes; there is no permanent film record 

of the examination; and the radiation exposure involved both for the subject and 

Kai = (ENSD rad)(BSF)-1 (1cGy rad-1

)
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 25 of 61

examiner is excessive. However, special fluoroscopic examination may be indicated for 

specific diagnostic purposes and for the determination of the dynamics of the chest. 

Although chest fluoroscopy was not a standard preemployment or occupational screening procedure 

for the chest, there are indications that fluoroscopic chest examinations were conducted and required 

by at least two sites (Linde Ceramics and Battelle King Avenue) and it is possible that such 

examinations were also conducted elsewhere (ORAUT 2009 and 2010). 

Given the era, the fluoroscopic equipment was most likely to have been "direct" or non-imageintensified fluoroscopy equipment, which is now considered obsolete. While incident air kerma rates 

for this type of equipment can be found in the literature, average fluoroscopy exposure times, 

especially for chest screening examinations, are not commonly found. However, a study of the 

incident air kerma rates, HVLs, and estimated fluoroscopy exposure times was conducted on nonimage-intensified fluoroscopy equipment in the modern era in Albania (Marshall et al. 2001). In this 

study, the exposure time for chest fluoroscopy screening was estimated to be about 20 seconds, with 

an average incident air kerma rate of about 4 cGy/min, and an average HVL of about 2.3 mm Al. 

Therefore, chest fluoroscopy dose equivalents in this TIB are calculated using an incident air kerma 

rate of 5 cGy/min for 30 seconds of fluoroscopy time and assumed HVL of 2.0 mm Al based on the 

Marshall et al. data. For chest fluoroscopy, the X-ray field is assumed to include the thoracic organs 

and the liver/gall bladder/spleen, but not the thyroid, gonads, urinary bladder/prostate, or 

colon/rectum, because of the short SSD (approximately 40 cm). However, the beam size is estimated 

to be similar to the beam for a poorly collimated radiographic chest X-ray to account for the fact that 

the field in chest fluoroscopy is dynamic and could expose a larger area of the body than the short 

SSD would initially imply. A diagram of non-image-intensified fluoroscopy is provided in Figure 5, and 

doses for chest fluoroscopy are included in Tables A-7 and A-8 in Attachment A. 

Figure 5. Diagram of non-image-intensified 

fluoroscopy. From Massey 1977, p. 90.
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7.4 LUMBAR SPINE

Lumbar spine radiographs have been used since the 1930s to determine the presence of back 

problems or to predict future occurrence of back problems (La Rocca, and Macnab 1969, p. 383). At 

some DOE and AWE sites, lumbar spine radiographs were required for certain classes of workers 

(usually males) whose work could entail heavy labor. Typically, if lumbar spine radiography was used 

for screening, it was performed as part of the preemployment physical examination, and for many 

workers this might have been the only occasion on which lumbar spine radiographs were taken. 

However, the possibility of periodic lumbar spine examinations, including a physical examination at 

the termination of employment should not be precluded. 

The number of lumbar spine projections per examination was likely to have varied from site to site, 

and should be documented in the TBD if they were performed. In a study of the number of lumbar 

spine projections performed to assess applicants for Veteran's Administration (VA) compensation for 

lumbar spine disease or injury, Eisenberg et al. (1980, p. 1073) found that on average, the number of 

lumbar spine projections performed at VA facilities was 4.2 per examination. In the absence of 

evidence to the contrary, a lumbar spine examination for screening should be assumed to consist of 4 

projections: AP, LAT, LAT spot of L4-5, and AP spot. The organ dose equivalents for the individual 

projections are provided, however, if claim file records indicate fewer than four projections, dose 

reconstructors can determine the total dose equivalent accordingly. While both the AP and LAT spot 

projections were likely to have been made on smaller size film and with smaller beam sizes, it is 

assumed for dose reconstruction that these were made on full size 14-in. × 17-in. film.

Eventually, the preemployment lumbar spine radiographs were shown to have low predictive value for 

future lumbar spine disability (La Rocca and Macnab 1969, p. 387), and various groups 

recommended that lumbar spine radiographs be discontinued for screening (American Occupational 

Medical Association, 1979).

There are several good studies of measured doses to the skin and gonads from the lumbar spine 

examination that were conducted in the 1950s, because of the concern at that time about gonad dose 

to the population as a whole (Lincoln and Gupton 1958; Laughlin et al 1957; Billings, Norman, and 

Greenfield 1957). Measured skin doses with phantoms (i.e., including backscatter) in these studies 

ranged from 0.25 to 3.9 cGy for the AP lumbar spine projection, and from 0.5 to 12.4 cGy for the LAT 

lumbar spine projection, depending on whether the facility used a low (50-70) or high (90-120) kVp 

technique. In this TIB, the measured skin and gonad doses from Lincoln and Gupton (1958, Table

VII) will be used because they appear to be in the middle of the range, and because several of their 

measurements were performed at DOE sites [Oak Ridge National Laboratory (ORNL) and the K-25

Plant]. 

The incident air kerma value for the lumbar spine projections through 1970 were derived from the 

average skin doses at ORNL listed in Lincoln and Gupton (1958, Table VII). The skin dose value for 

the AP lumbar spine is 1,900 mrad, measured with a phantom, and therefore includes backscatter. 

The incident air kerma is derived using Equation 6 above. The HVL of 2.0 was determined from the 

data in Lincoln and Gupton (1958, Tables VII and III). Table III shows that for a skin dose of 2,000 

mrad, the kVp was 80 and the filter (assumed to be the added filter) was 1.0 mm Al. Assuming a total 

filtration of 1.5 mm Al eq., the HVL is 1.8, rounded to 2.0 mm Al at 80 kVp from Table B.2 in NCRP 

Report 102 (NCRP 1997, p. 98). The incident air kerma for the LAT lumbar spine projection was 

determined in the same way, resulting in an incident air kerma value of 3.79 cGy.

The ovary and testes doses for the poor collimation period before 1970 also come directly from 

Lincoln and Gupton (1958, Table VII), because they were measured with a phantom and include 

backscatter. 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 27 of 61

X-rays of the lumbar spine were performed AP, often on 14-in. × 17-in. film in the lengthwise direction, 

and using a 40–in. SID. Figure 6 is an approximately scaled diagram of the poorly and properly 

collimated beams in relation to abdominal organs for the AP lumbar spine, and helps to visualize the 

beam for the proper selection of DCFs. The DCF for the ovary from ICRP Publication 34 (ICRP 1982) 

is used to determine the dose to the liver/gall bladder/spleen, the urinary bladder/prostate, the 

colon/rectum, bone surfaces, stomach, and remainder organs because these organs are likely to be in 

the primary beam. The DCFs are summarized in Table 6. 

Figure 6. Beam areas in relation to body

anatomy for the AP lumbar spine. 

The incident air kerma value for the lumbar spine projections after 1970 comes directly from 

Kereiakes and Rosenstein (1980, p. 213). These data are contemporaneous and relevant for use in 

this period. Again, the DCF for the ovary from ICRP Publication 34 (ICRP 1982) is used to determine 

the dose to the liver/gall bladder/spleen, the urinary bladder/prostate, the colon/rectum, bone 

surfaces, stomach, and remainder organs because these organs are likely to be in the primary beam.

There is no DCF in ICRP Publication 34 (ICRP 1982) for the breast from lumbar spine projections. 

ICRP Publication 34 (p. 57) states that the DCF is “not computed but small compared with projections 

listed.” Several methods of estimating breast dose equivalent have been used in some of the TBDs. 

In this TIB, a method described by Huda and Bissessur (1990) is used to determine the dose 

equivalent to the breast from the lumbar spine projections. Huda and Bissessur provide graphical 

representations of the effective dose equivalent (HE) per unit entrance skin dose (backscatter 

included) as a function of kVp for 12 common radiographic procedures, and values of dose equivalent 

per unit dose area product (DAP). The data are a result of individual organ doses obtained using a 

Monte Carlo method for reference man as a function of kVp and X-ray beam filtration (Huda and 

Bissessur 1990 p. 998). Huda and Bissessur provide the fraction of the total HE due to several 

organs, one of which is the breast. With knowledge of the DAP, and the fraction due to the breast 

dose, the HE and the dose to the breast can be derived (Huda and Bissessur 1990, p. 1001). The 

dose to the breast from lumbar spine projections for both periods was determined using this method.

Organ dose equivalents from lumbar spine X-rays are in Tables A-10 and A-11 in Attachment A. 
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7.5 PELVIS 

In 1932, skeletal fluorosis was discovered as an occupational disease in cryolite (natural fluoride of 

aluminum and sodium) workers in Copenhagen, Denmark (Grandjean 1982). Skeletal fluorosis 

exhibited a variety of radiologic patterns including increased bone density, calcification of ligaments, 

and periosteal changes (Chan-Yeung et al. 1983). During the early years of atomic weapons work, 

the Manhattan Engineering District and the U.S. Atomic Energy Commission sometimes required that 

X-rays of the pelvis be taken of personnel who worked with materials containing fluoride to detect 

bone changes due to fluorosis (Van Horn 1943; Osinski 1947).

X-rays of the pelvis were used in the 1940s for medical monitoring of workers with potential exposure 

to fluoride and fluoride compounds. It is assumed that by 1960 more specific and sensitive screening 

methods than spine and pelvis radiographs for fluorosis were available. 

Workers in the atomic weapons complex who might have been exposed to fluoride and fluoride 

compounds include workers at the gaseous diffusion plants. In the absence of specific fluorosis 

monitoring programs documented by individual sites and described in TBDs for those sites, organ 

doses for pelvis, lumbar, thoracic, and cervical spine X-rays should be included in dose 

reconstructions for workers exposed to fluoride and fluoride compounds if the employees’ records 

include evidence of these types of X-ray procedures. 

Lincoln and Gupton (1958) measured skin and gonad doses (including backscatter) using a tissueequivalent phantom for various examinations, including the AP pelvis. In this TIB, the measured skin 

and gonad doses from Lincoln and Gupton (1958, Table VII) will be used because they appear to be 

in the middle of the range, and because several of their measurements were performed at DOE sites 

(ORNL and K-25). An HVL of 2 mm Al is assumed based on the data in Lincoln and Gupton. The 

incident air kerma is derived using Equation 6 above, resulting in an incident air kerma value for the 

pelvis of 1.52 cGy.

X-rays of the pelvis were performed AP, often on 14-in. × 17-in. film placed in the crosswise direction, 

and using a 40–in. SID. Figure 7 is an approximately scaled diagram of the poorly and properly 

collimated beams in relation to abdominal organs for the AP pelvis, and helps to visualize the beam 

for the proper selection of DCFs. The DCF for the ovary from ICRP Publication 34 (ICRP 1982) is

used to determine the dose to the liver/gall bladder/spleen, the urinary bladder/prostate, the 

colon/rectum, stomach, bone surfaces, and remainder organs because these organs are likely to be in 

the primary beam. The DCFs are summarized in Table 6. 

There is no DCF in ICRP Publication 34 (ICRP 1982) for the breast from the AP pelvis. ICRP 

Publication 34 (p. 57) states that the DCF is “not computed but small compared with projections 

listed.” The method described by Huda and Bissessur (1990) in Section 7.4 is used to determine the 

dose to the breast from the AP pelvis. 

Organ dose equivalents from pelvis X-rays are in Tables A-10 and A-11 in Attachment A. 

7.6 THORACIC AND CERVICAL SPINE 

X-rays of the thoracic spine (also called dorsal spine) or cervical spine were used in the 1940s for 

medical monitoring of workers with potential exposure to fluoride and fluoride compounds similar to 

the X-rays of the pelvis described in Section 7.5. Organ dose equivalents for thoracic and cervical 

spine X-rays should, therefore, be included in dose reconstructions for workers exposed to fluoride 

and fluoride compounds if the employees’ records include evidence of these types of X-ray 

procedures. 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 29 of 61

Figure 7. Beam areas in relation to body anatomy 

for the AP pelvis. 

Routine protocols for thoracic and cervical spine X-rays are listed in Table 7. While it is possible that 

fewer exposures were made for fluorosis monitoring, organ doses for a complete set of projections 

should be assumed unless there is evidence to the contrary in the individual employee's record. 

Table 7. Typical protocols for thoracic and cervical spine examinations. 

Procedure Projections

Thoracic spine AP and LAT, right and left posterior obliques, total of 4.

Cervical spine AP and LAT, right and left posterior obliques, total of 4.

The incident air kerma for the thoracic spine is derived from measured skin dose (1.3 and 2.9 rad for 

the AP and LAT/OBL, respectively) in Lincoln and Gupton (1958, Table VII), and Equation 6, resulting 

in an incident air kerma of 0.985 cGy and 2.20 for the AP and LAT/OBL, respectively, and an HVL of 

2.0 mm Al. It is assumed that all four projections were taken on 14-in. × 17-in. film with a poorly 

collimated beam. Figure 8 illustrates the approximately scaled poorly and well-collimated beams for 

the AP thoracic spine.

DCFs were selected from ICRP Publication 34 (ICRP 1982) tables according to the location of the 

organs in relation to the poorly collimated beam. The thyroid is assumed to be in the poorly 

collimated beam, but not the eye/brain, the dose to which is usually determined using the DCF for the 

thyroid. For thoracic spine procedures, the dose equivalent to the eye/brain is assumed to be 10% of 

the dose equivalent to the thyroid. This estimate is based on the finding that scattered radiation 

produces a dose to the testes equal to 10% of the central beam dose when the testes are just outside 

a beam (Kereiakes and Rosenstein 1980, p. 205). The dose equivalents for the ovaries and testes 

are taken directly from measured doses reported in Lincoln and Gupton (1958, Table VII). The dose 

equivalents for the urinary bladder, prostate, colon, and rectum are based on the DCF for the ovary 

because these organs are all assumed to be outside the poorly collimated beam. The dose 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 30 of 61

Figure 8. Beam areas in relation to body anatomy for 

the AP thoracic spine. 

equivalents to the lungs, liver, gall bladder, spleen, thymus, esophagus, stomach, bone surfaces and 

remainder organs are all based on the DCF for the lungs.

The DCF for the thyroid for the LAT thoracic spine does not seem to reflect irradiation by the primary 

beam. Thus, for the LAT thoracic spine projection, the thyroid dose equivalent is based on the DCF 

for the LAT cervical spine, where the thyroid is definitely in the primary beam. The dose equivalent to 

the eye/brain seems to be approximately 10% of the dose equivalent to the thyroid simply by using 

the DCF for the thyroid for the LAT thoracic spine and, therefore, that DCF was used.

The right posterior oblique (RPO) and left posterior oblique (LPO) of the thoracic spine are positioned 

similarly to the LAT thoracic spine position (i.e., about 20° from the LAT). The organ dose 

equivalents, then, are assumed to be the same for the LAT thoracic spine and the RPO and LPO. 

The skin dose equivalents, however, are different depending on whether the right or left side is closest 

to the beam. 

Organ dose equivalents for the thoracic spine are provided in Table A-12, and the skin dose 

equivalents are in Table A-13 in Attachment A. 

There is much less data in the literature for the cervical spine. Data on technical factors for cervical 

spine X-rays were obtained from Braestrup and Wyckoff (1958, Tables VI and VII, pp. 140-141). The 

pertinent data from these tables is excerpted in Table 8. 

Incident air kerma values for the AP, LAT, and OBL cervical spine projections were derived from the 

Braestrup and Wyckoff data in Table 3 and Equation 7.

(7) 

where 

Ka,i (cGy)(air) = (R/100mAs)(actual mAs)(SID/SSD)2 (2.58E-4 C/kg R-1) (33.97 J/C)(100cGy/Gy)(1Gy/1J kg-1)
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 31 of 61

Ka,i is the incident air kerma to be used in organ dose calculations in units of cGy in air; 

R/100mAs from Table 7 

Actual mAs from Table 7 

(91cm/SSD)2 is the inverse square correction for the exposure measured at 91 cm from 

Table 7 to the SSD of interest from Table 3 

2.58E-4 C/kg R-1 is the conversion factor for converting exposure in R to C/kg 

33.97J/C is the mean energy expended per ion pair formed in air

Table 8. Relevant technical factors for cervical spine projections. 

Projection

Technique factorsa R/100 

mAsa,b SSDc

HVL 

(mm Al)d kVp mAs SID (cm)

AP C-spine 58 100 91 0.4 82 2.0

LAT C-spine 70 150 152e 0.2 153f 2.0

Posterior OBL C-spine -- -- 91 -- 82 2.0

a. Excerpted data from Braestrup and Wyckoff (1958, Tables VI and VII, pp. 140-141).

b. Interpolated for the kVp closest to the kVp listed in the technique factor column, and for the listed SSD.

c. SSD from Table 1. 

d. Based on kVp and 2.5 mm Al equivalent total filtration reported in Braestrup and Wyckoff (1958).

e. Longer SID used for the LAT cervical spine to reduce magnification.

f. The SSD for the LAT cervical spine = 183 cm – 15 cm – 5 cm – 10 cm = 153 cm. The 10 cm accounts for the fact that 

during the LAT cervical spine, the shoulder is against the cassette holder, so the side of the neck is not actually in 

contact with the cassette holder, affecting the SSD calculation.

When positioned for a LAT cervical spine radiograph, the worker's shoulder is against the cassette 

holder, and the neck is assumed to be another 10 cm away from, and not in contact with, the cassette 

holder, affecting the SSD calculation. Incident air kerma for the posterior OBL cervical spine is 

estimated to be the same as the incident air kerma for the AP projection because the position is 

similar and the tissue thickness of the neck is the same. The HVL is based on the kVp listed in 

Table 7, and 2.5 mm Al equivalent total filtration from Braestrup and Wyckoff (1958, Table VI). It is 

assumed that all four projections were taken on 10-in. × 12-in. film with a poorly collimated beam. 

Figure 9 illustrates the approximately scaled poorly and well-collimated beams for the LAT cervical 

spine.

The DCF values in ICRP Publication 34 (ICRP 1982) for the cervical spine are based on the 

assumption that the image receptor is 102 cm from the X-ray source, and the beam is collimated to an 

image receptor size of 25.4 cm × 30.5 cm (where 30.5 cm represents the dimension parallel to the 

height of the worker). DCFs for the breast are not computed in ICRP Publication 34 for the cervical 

spine procedure. The DCF for the lungs was used instead. The DCFs used for dose reconstruction 

in this TIB are provided in Table 5.

Measured doses for the ovaries and testes are again used, this time from published values in 

Braestrup and Wyckoff (1958). The measured dose for the ovary is also assigned to the urinary 

bladder, prostate, colon, rectum, and uterus. Organ dose equivalents for the cervical spine are 

provided in Table A-12, and the skin dose equivalents are in Table A-13 in Attachment A. 

8.0

Error (deviation from the correct, true, or conventionally accepted value of a quantity) and uncertainty 

(potential range of a stated, measured, assumed, or otherwise determined value of a quantity) provide 

an indication of the confidence of the dose estimates. Error implies knowledge of what the correct or 

UNCERTAINTY ANALYSIS FOR OCCUPATIONAL MEDICAL X-RAY DOSES
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 32 of 61

Figure 9. Beam areas in relation to body anatomy for the 

LAT cervical spine. 

actual value is, which is, of course, not known. Therefore, the more appropriate factor is uncertainty, 

which is expressed in terms of a confidence level (e.g., a 99% confidence level indicates that the 

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

range). Uncertainty includes both precision (reproducibility of the measurement) and accuracy (how 

close the measurement or estimate of dose comes to the actual or correct value).

In theory, a large number of factors can introduce uncertainties or affect the X-ray machine output and 

dose to the worker. However, in practice only five factors can be reasonably considered to have a 

meaningful or significant impact on dose uncertainty. These are: 

1. Measurement error

2. Variation in kilovoltage (kVp)

3. Variation in beam current (mA)

4. Variation in exposure time (s)

5. Distance from the worker to the source of the X-rays (SSD)

The influence of such other factors as use of screens, grids, film speed, and development, while 

potentially variable, do not affect the beam output per se except indirectly as these can influence the 

machine settings (i.e., kVp, mA, and time).

The organ dose equivalents in this TIB are based on incident air kerma values from published 

literature. These actual X-ray beam measurements were made with R-meters or similar ionization 

chamber instruments suitably designed for measurement of photons in the medical X-ray energy 

range. If properly calibrated and used, R-meters and similar instruments typically and historically 

have had an uncertainty of +2% for photon energies below 400 keV (Kathren and Larson 1969). 

Although more recent versions of these instruments might provide a somewhat smaller uncertainty, 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 33 of 61

perhaps on the order of +1% (NBS 1985; Lamperti, Loftus, and Loevenger 1988), for conservatism, 

the uncertainty range of +2% will be applied to measurements of air kerma.

For a given set of machine settings and parameters, X-ray output is theoretically constant. In general, 

for a given kVp setting, variation in kVp falls within +5% of the machine setting (Seibert, Barnes, and 

Gould 1991). As noted above, beam intensity is approximately proportional to the 1.7 power of the 

kilovoltage; this translates to an uncertainty of approximately ±8.6% in output beam intensity in the 80- 

to 100-kVp range used in medical radiography. For conservatism, this is rounded up to +9%.

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

can change and typically drops. With all other factors constant, beam output will be reduced in direct 

proportion to the change in tube current. The reduction in beam output from current variation is not 

more than a few percent under normal operating conditions; large decreases are readily detectable 

and result in maintenance on the machine to restore the output or, as a temporary measure, an 

increase in the current or kilovoltage to provide the necessary exposure for proper film density. The 

estimated uncertainty in beam intensity or output attributable to current variation is +5%. 

Another parameter that has potential to affect the dose from a radiographic procedure, perhaps 

significantly, is the time of exposure. A single-phase, full-wave-rectified machine produces 120 pulses 

of X-rays per second. In 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 inaccurate; accuracy improved significantly with the 

introduction of electronic timers. The assumed uncertainty in beam output attributable to timers is 

±25%. 

The final factor likely to affect worker dose relates to distance from the source of the X-rays, which is 

an important determinant of the incident air kerma. For a given procedure using a standard SID, the 

SSD will be determined largely by the body thickness of the worker and the accuracy of the 

positioning. Information on worker thickness is rarely available, even in the medical literature. The 

estimated variation in SSD is no more than a few centimeters, with an upper limit of perhaps 7.5 cm 

for typical workers. Using the inverse square law, this indicates an uncertainty of ±10% from this 

source.

There are two approaches to determine the combined uncertainty from these five 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 2 + 9 +5 + 25 + 10 = 

±51%. However, a more reasonable approach would be to assume that the uncertainties are in fact 

random, and therefore to compute the combined statistical uncertainty as the square root of the sum 

of the squares of all the uncertainties, which is ±28.9%. Rounding this up to ±30% would seem to 

provide an adequate and suitably conservative indication of uncertainty. Therefore, for a derived dose 

equivalent to an individual organ, a total combined standard uncertainty of ±30% can be assumed. 

Dose reconstructors should, therefore, input the organ dose equivalent as the mean of a normal 

distribution, with a standard uncertainty of ±30%. 

Entrance skin dose measurements were made on nine workers of varying chest thicknesses (builds)

at the Savannah River Plant, (Cooley 1967). While Cooley does not report the measured chest 

thicknesses for these nine workers, the entrance skin doses are reported and reflect the increase in 

exposure needed to radiograph thicker body parts, in this case, chests. The measured entrance skin 

doses in this small study would already include the uncertainty in the technical factors (kVp, mA, and 

time) used to make the exposures, and can therefore be used a reasonable check of the uncertainty 

calculated above. The standard uncertainty of the range of measurements reported in Cooley is 5.6, 

or 21%. This would seem to indicate that the 30% standard uncertainty calculated above is a 
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 34 of 61

reasonable estimate of uncertainty to use in dose reconstruction of organ dose from medical X-ray 

procedures.

9.0

All information requiring identification was addressed via references in the reference section of this 

document.

ATTRIBUTIONS AND ANNOTATIONS
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 35 of 61

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Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 40 of 61

LIST OF TABLES

TABLE TITLE

A-1 Skin dose guidance for chest projections for the poor collimation period 

through 1970..........................................................................................................................

PAGE

41

A-2 Skin dose guidance for lumbar spine and pelvis projections for the poor 

collimation period through 1970 ............................................................................................. 42

A-3 Skin dose guidance for thoracic spine projections for the poor collimation 

period through 1970...............................................................................................................44

A-4 Skin dose guidance for cervical spine projections for the poor collimation 

period through 1970...............................................................................................................45

A-5 Skin dose guidance for chest projections for the good collimation period after 

1970.......................................................................................................................................46

A-6 Skin dose guidance for lumbar spine projections for the good collimation 

period after 1970....................................................................................................................47

A-7 Organ dose equivalents for chest projections for all periods................................................... 49

A-8 Skin dose equivalents from chest projections through 1970................................................... 51

A-9 Skin dose equivalents from various chest projections post-1970............................................ 52

A-10 Organ dose equivalents for lumbar spine and pelvis projections for all periods ...................... 54

A-11 Skin dose equivalent from lumbar spine and pelvis projections for all periods........................ 56

A-12 Organ dose equivalents for thoracic and cervical spine projections through 

1960.......................................................................................................................................57

A-13 Skin dose equivalent from thoracic and cervical spine projections through 

1960.......................................................................................................................................58

A-14 DCFs used in determining dose equivalents .......................................................................... 60

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 1 of 22
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 41 of 61

Table A-1. Skin dose guidance for chest projections for the poor collimation period through 1970. 

Area of skin

Basis

for PFG

Basis for 

PA chest 

through

1970a

Basis for 

LAT chest 

through

1970 

Basis for 

AP lordotic 

chest 

through

1970

Basis for 

RAO chest 

through

1970

Basis for 

LAO chest

through

1970

Basis for 

chest 

fluoroscopy 

through

1970a

R front shoulder EXSD EXSD ENSD ENSD EXSD EXSD EXSD

R back shoulder ENSD ENSD ENSD EXSD ENSD ENSD ENSD

L front shoulder EXSD EXSD EXSD ENSD EXSD EXSD EXSD

L back shoulder ENSD ENSD EXSD EXSD ENSD ENSD ENSD

R upper arm to elbow 10% ENSD ENSD ENSD ENSD ENSD ENSD ENSD

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

L hand ENSD ENSD 10% ENSD 10% ENSD 10% ENSD 10% ENSD ENSD

R hand ENSD ENSD 10% ENSD 10% ENSD 10% ENSD 10% ENSD ENSD

L elbow, forearm, 

wrist

10% ENSD ENSD 10% ENSD ENSD 10% ENSD 10% ENSD ENSD 

R elbow, forearm, 

wrist

10% ENSD ENSD 10% ENSD ENSD 10% ENSD 10% ENSD ENSD

R side of head 

(including temple and 

ear)

10% ENSD 10% ENSD Eye/brain 10% ENSD 10% EXSD 10% ENSD 10% ENSD

L side of head 

(including temple and 

ear)

10% ENSD 10% ENSD Eye/brain 10% ENSD 10% ENSD 10% EXSD 10% ENSD

Front L thigh RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD (0.52m)

Back L thigh RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD (0.52m)

Front R thigh RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD (0.52m)

Back R thigh RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD 

(0.52m)

RSD (0.52m)

L knee and below RSD 

(0.86m)

RSD 

(0.86m)

RSD 

(0.86m)

RSD 

(0.86m)

RSD 

(0.86m)

RSD 

(0.86m)

RSD (0.86m)

R knee and below RSD 

(0.86m)

RSD 

(0.86m)

RSD 

(0.86m)

RSD 

(0.86m)

RSD 

(0.86m)

RSD 

(0.86m)

RSD (0.86m)

L side of face Eye/brain Eye/brain Eye/brain ENSD ENSD EXSD Eye/brain

R side of face Eye/brain Eye/brain Eye/brain ENSD EXSD ENSD Eye/brain

L side of neck 10% ENSD ENSD Eye/brain ENSD ENSD EXSD ENSD

R side of neck 10% ENSD ENSD Eye/brain ENSD EXSD ENSD ENSD

Back of head 10% ENSD 10% ENSD Eye/brain EXSD 10% ENSD 10% ENSD 10% ENSD

Front of neck Eye/brain Eye/brain Eye/brain ENSD Eye/brain Eye/brain Eye/brain

Back of neck 10% ENSD ENSD Eye/brain EXSD ENSD ENSD ENSD

Front torso: base of 

neck to end of 

sternum

EXSD EXSD Lungb ENSD EXSD EXSD EXSD

Front torso: end of 

sternum to lowest rib

EXSD EXSD Lungb ENSD EXSD EXSD EXSD 

Front torso: lowest 

rib to iliac crest

EXSD EXSD Lungb ENSD EXSD EXSD EXSD

Front torso: iliac 

crest to pubis

10% EXSD 10% EXSD 10% Lungb 10% ENSD 10% EXSD 10% EXSD 10% EXSD

Back torso: base of 

neck to mid-back

ENSD ENSD Lungb EXSD ENSD ENSD ENSD

Back torso: mid-back 

to lowest rib

ENSD ENSD Lungb EXSD ENSD ENSD ENSD 

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 2 of 22
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 42 of 61

Area of skin

Basis

for PFG

Basis for 

PA chest 

through

1970a

Basis for 

LAT chest 

through

1970 

Basis for 

AP lordotic 

chest 

through

1970

Basis for 

RAO chest 

through

1970

Basis for 

LAO chest

through

1970

Basis for 

chest 

fluoroscopy 

through

1970a

Back torso: lowest 

rib to iliac crest

ENSD ENSD Lungb EXSD ENSD ENSD ENSD

Back torso: buttocks 

(Iliac crest and 

below)

10% ENSD 10% ENSD 10% Lungb 10% EXSD 10% ENSD 10% ENSD 10% ENSD

Right torso: base of 

neck to end of 

sternum

ENSD ENSD ENSD ENSD EXSD ENSD ENSD 

Right torso: end of 

sternum to lowest rib

ENSD ENSD ENSD ENSD EXSD ENSD ENSD

Right torso: lowest 

rib to iliac crest

ENSD ENSD ENSD ENSD EXSD ENSD ENSD

Right torso: iliac 

crest to pubis (R hip)

10% ENSD 10% ENSD 10% ENSD 10% ENSD 10% EXSD 10% ENSD 10% ENSD

Left torso: base of 

neck to end of 

sternum

ENSD ENSD EXSD ENSD ENSD EXSD ENSD 

Left torso: end of 

sternum to lowest rib

ENSD ENSD EXSD ENSD ENSD EXSD ENSD

Left torso: lowest rib 

to iliac crest

ENSD ENSD EXSD ENSD ENSD EXSD ENSD

Left torso: iliac crest 

to pubis (L hip)

10% ENSD 10% ENSD 10% EXSD 10% ENSD 10% ENSD 10% EXSD 10% ENSD

a. Skin dose guidance for chest fluoroscopy is the same as the guidance for the PA chest through 1970.

b. The higher of the male or female lung dose value should be used for both genders. 

Table A-2. Skin dose guidance for lumbar spine and pelvis projections for the poor collimation period

through 1970. 

Area of skin

Basis for AP 

and AP spot 

lumbar spine

through 1970 

Basis for LAT 

and LAT spot 

lumbar spine

through 1970 

Basis for LPO 

lumbar spine

through 1970 

Basis for 

RPO lumbar 

spine

through 1970 

Basis for AP 

pelvis 

through 1970

R front shoulder 10% ENSD 10% ENSD 10% ENSD 10% ENSD 10% ENSD

R back shoulder 10% EXSD 10% ENSD 10% ENSD 10% EXSD 10% EXSD

L front shoulder 10% ENSD 10% EXSD 10% EXSD 10% ENSD 10% ENSD

L back shoulder 10% EXSD 10% EXSD 10% EXSD 10% EXSD 10% EXSD

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

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

L hand ENSD 10% EXSD 10% EXSD 10% ENSD ENSD

R hand ENSD 10% ENSD 10% ENSD 10% EXSD ENSD

L elbow, forearm, wrist ENSD 10% EXSD 10% EXSD 10% ENSD ENSD

R elbow, forearm, wrist ENSD 10% ENSD 10% ENSD 10% EXSD ENSD

R side of head (including 

temple and ear)

Eye/brain Eye/brain Eye/brain Eye/brain Eye/brain

L side of head (including 

temple and ear)

Eye/brain Eye/brain Eye/brain Eye/brain Eye/brain

Front L thigh 10% ENSD 10% EXSD 10% ENSD 10% ENSD 10% ENSD

Back L thigh 10% EXSD 10% EXSD 10% EXSD 10% EXSD 10% EXSD

Front R thigh 10% ENSD 10% ENSD 10% ENSD 10% ENSD 10% ENSD

Back R thigh 10% EXSD 10% ENSD 10% EXSD 10% EXSD 10% EXSD

L knee and below RSD (0.60m) RSD (0.60m) RSD (0.60m) RSD (0.60m) RSD (0.60m)

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Area of skin

Basis for AP 

and AP spot 

lumbar spine

through 1970 

Basis for LAT 

and LAT spot 

lumbar spine

through 1970 

Basis for LPO 

lumbar spine

through 1970 

Basis for 

RPO lumbar 

spine

through 1970 

Basis for AP 

pelvis 

through 1970

R knee and below RSD (0.60m) RSD (0.60m) RSD (0.60m) RSD (0.60m) RSD (0.60m)

L side of face Eye/brain Eye/brain Eye/brain Eye/brain Eye/brain

R side of face Eye/brain Eye/brain Eye/brain Eye/brain Eye/brain

L side of neck Eye/brain Eye/brain Eye/brain Eye/brain Eye/brain

R side of neck Eye/brain Eye/brain Eye/brain Eye/brain Eye/brain

Back of head Eye/brain Eye/brain Eye/brain Eye/brain Eye/brain

Front of neck Eye/brain Eye/brain Eye/brain Eye/brain Eye/brain

Back of neck Eye/brain Eye/brain Eye/brain Eye/brain Eye/brain

Front torso: base of neck to 

end of sternum

10% ENSD Lunga 10% ENSD 10% ENSD 10% ENSD

Front torso: end of sternum 

to lowest rib

ENSD Lunga ENSD ENSD ENSD 

Front torso: lowest rib to 

iliac crest

ENSD Lunga ENSD ENSD ENSD 

Front torso: iliac crest to 

pubis

ENSD Lunga ENSD ENSD ENSD

Back torso: base of neck to 

mid-back

10% EXSD Lunga 10% EXSD 10% EXSD 10% EXSD

Back torso: mid-back to 

lowest rib

EXSD Lunga EXSD EXSD EXSD

Back torso: lowest rib to 

iliac crest

EXSD Lunga EXSD EXSD EXSD

Back torso: buttocks (Iliac 

crest and below)

EXSD Lunga EXSD EXSD EXSD 

Right torso: base of neck to 

end of sternum

10% ENSD 10% ENSD 10% ENSD 10% EXSD 10% ENSD

Right torso: end of sternum 

to lowest rib

ENSD ENSD ENSD EXSD ENSD

Right torso: lowest rib to 

iliac crest

ENSD ENSD ENSD EXSD ENSD

Right torso: iliac crest to 

pubis (R hip)

ENSD ENSD ENSD EXSD ENSD 

Left torso: base of neck to 

end of sternum

10% ENSD 10% EXSD 10% EXSD 10% ENSD 10% ENSD

Left torso: end of sternum to 

lowest rib

ENSD EXSD EXSD ENSD ENSD

Left torso: lowest rib to iliac 

crest

ENSD EXSD EXSD ENSD ENSD

Left torso: iliac crest to 

pubis (L hip)

ENSD EXSD EXSD ENSD ENSD

a. The higher of the male or female lung dose value should be used for both genders.

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Table A-3. Skin dose guidance for thoracic spine projections for the poor collimation period through 

1970. 

Area of skin

Basis for AP 

thoracic 

spine

through 1970

Basis for LAT 

thoracic spine

through 1970

Basis for 

RPO thoracic 

spine

through 1970

Basis for LPO 

thoracic spine

through 1970

R front shoulder ENSD ENSD ENSD ENSD

R back shoulder EXSD ENSD EXSD EXSD

L front shoulder ENSD EXSD ENSD ENSD

L back shoulder EXSD EXSD EXSD EXSD

R upper arm to elbow ENSD ENSD ENSD ENSD

L upper arm to elbow ENSD EXSD ENSD ENSD

L hand 10% ENSD 10% ENSD 10% ENSD 10% ENSD

R hand 10% ENSD 10% ENSD 10% ENSD 10% ENSD

L elbow, forearm, wrist ENSD 10% ENSD 10% ENSD 10% ENSD

R elbow, forearm, wrist ENSD 10% ENSD 10% ENSD 10% ENSD

R Side of head (including temple and ear) 10% ENSD 10% ENSD 10% EXSD 10% ENSD

L Side of head (including temple and ear) 10% ENSD 10% ENSD 10% ENSD 10% EXSD

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

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

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

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

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

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

L side of face 10% ENSD Eye/brain 10% ENSD 10% EXSD

R side of face 10% ENSD Eye/brain 10% EXSD 10% ENSD

L side of neck ENSD Eye/brain ENSD EXSD

R side of neck ENSD Eye/brain EXSD ENSD

Back of head 10% EXSD Eye/brain 10% ENSD 10% ENSD

Front of neck ENSD Eye/brain Thyroid Thyroid

Back of neck EXSD Eye/brain EXSD EXSD

Front torso: base of neck to end of 

sternum

ENSD Lunga ENSD ENSD

Front torso: end of sternum to lowest rib ENSD Lunga ENSD ENSD

Front torso: lowest rib to iliac crest ENSD Lunga ENSD ENSD

Front torso: iliac crest to pubis 10% ENSD 10% lunga 10% ENSD 10% ENSD

Back torso: base of neck to mid-back EXSD Lunga EXSD EXSD

Back torso: mid-back to lowest rib EXSD Lunga EXSD EXSD

Back torso: lowest rib to iliac crest EXSD Lunga EXSD EXSD

Back torso: buttocks (Iliac crest and 

below)

10% EXSD 10% lunga 10% EXSD 10% EXSD

Right torso: base of neck to end of 

sternum

ENSD ENSD EXSD ENSD

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

Right torso: lowest rib to iliac crest ENSD ENSD EXSD ENSD

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

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

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

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

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

a. The higher of the male or female lung dose value should be used for both genders.

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Table A-4. Skin dose guidance for cervical spine projections for the poor collimation period through 

1970. 

Area of skin

Basis for AP 

cervical spine

through 1970

Basis for LAT 

cervical spine

through 1970

Basis for RPO 

cervical spine

through 1970

Basis for LPO 

cervical spine

through 1970

R front shoulder 10% ENSD ENSD 10% ENSD 10% ENSD

R back shoulder 10% EXSD ENSD 10% EXSD 10% EXSD

L front shoulder 10% ENSD EXSD 10% ENSD 10% ENSD

L back shoulder 10% EXSD EXSD 10% EXSD 10% EXSD

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

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

L hand RSD (0.40m) RSD (0.40m) RSD (0.40m) RSD (0.40m)

R hand RSD (0.40m) RSD (0.40m) RSD (0.40m) RSD (0.40m)

L elbow, forearm, wrist RSD (0.40m) RSD (0.40m) RSD (0.40m) RSD (0.40m)

R elbow, forearm, wrist RSD (0.40m) RSD (0.40m) RSD (0.40m) RSD (0.40m)

R side of head (including temple and 

ear)

ENSD ENSD EXSD2a ENSD

L side of head (including temple and 

ear)

ENSD EXSD2a ENSD EXSD2a 

Front left thigh RSD (0.70m) RSD (0.70m) RSD (0.70m) RSD (0.70m)

Back left thigh RSD (0.70m) RSD (0.70m) RSD (0.70m) RSD (0.70m)

Front right thigh RSD (0.70m) RSD (0.70m) RSD (0.70m) RSD (0.70m)

Back right thigh RSD (0.70m) RSD (0.70m) RSD (0.70m) RSD (0.70m)

L knee and below RSD (1.00m) RSD (1.00m) RSD (1.00m) RSD (1.00m)

R knee and below RSD (1.00m) RSD (1.00m) RSD (1.00m) RSD (1.00m)

L side of face ENSD EXSD2a ENSD EXSD2a

R side of face ENSD ENSD EXSD2a ENSD

L side of neck ENSD EXSD2a ENSD EXSD2a

R side of neck ENSD ENSD EXSD2a ENSD

Back of head EXSD ENSD ENSD ENSD

Front of neck ENSD ENSD ENSD ENSD

Back of neck EXSD2a EXSD2a EXSD2a EXSD2a

Front torso: base of neck to end of 

sternum

ENSD 10% ENSD ENSD ENSD

Front torso: end of sternum to lowest 

rib

RSD (0.30m) RSD (0.30m) RSD (0.30m) RSD (0.30m)

Front torso: lowest rib to iliac crest RSD (0.30m) RSD (0.30m) RSD (0.30m) RSD (0.30m)

Front torso: iliac crest to pubis RSD (0.50m) RSD (0.50m) RSD (0.50m) RSD (0.50m)

Back torso: base of neck to midbackEXSD 10% ENSD EXSD EXSD

Back torso: mid-back to lowest rib RSD (0.30m) RSD (0.30m) RSD (0.30m) RSD (0.30m)

Back torso: lowest rib to iliac crest RSD (0.30m) RSD (0.30m) RSD (0.30m) RSD (0.30m)

Back torso: buttocks (Iliac crest and 

below)

RSD (0.50m) RSD (0.50m) RSD (0.50m) RSD (0.50m)

Right torso: base of neck to end of 

sternum

10% ENSD ENSD 10% ENSD 10% ENSD

Right torso: end of sternum to lowest 

rib

RSD (0.30m) RSD (0.30m) RSD (0.30m) RSD (0.30m)

Right torso: lowest Rib to iliac crest RSD (0.30m) RSD (0.30m) RSD (0.30m) RSD (0.30m)

Right torso: iliac crest to pubis (R 

hip)

RSD (0.50m) RSD (0.50m) RSD (0.50m) RSD (0.50m)

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

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Area of skin

Basis for AP 

cervical spine

through 1970

Basis for LAT 

cervical spine

through 1970

Basis for RPO 

cervical spine

through 1970

Basis for LPO 

cervical spine

through 1970

Left torso: base of neck to end of 

sternum

10% ENSD EXSD 10% ENSD 10% ENSD

Left torso: end of sternum to lowest 

rib

RSD (0.30m) RSD (0.30m) RSD (0.30m) RSD (0.30m)

Left torso: lowest rib to iliac crest RSD (0.30m) RSD (0.30m) RSD (0.30m) RSD (0.30m)

Left torso: iliac crest to pubis (L hip) RSD (0.50m) RSD (0.50m) RSD (0.50m) RSD (0.50m)

a. EXSD2 is the EXSD calculated at 15 cm (thickness of the neck) as opposed to 24 or 34 cm (the thickness of the chest).

Table A-5. Skin dose guidance for chest projections for the good collimation period after 1970. 

Area of skin

Basis for PA 

chest

after 1970

Basis for 

LAT chest

after 1970

Basis for 

AP lordotic 

chest 

after 1970

Basis for 

RAO chest

after 1970

Basis for 

LAO chest

after 1970

R front shoulder EXSD ENSD ENSD EXSD EXSD

R back shoulder ENSD ENSD EXSD ENSD ENSD

L front shoulder EXSD EXSD ENSD EXSD EXSD

L back shoulder ENSD EXSD EXSD ENSD ENSD

R upper arm to elbow 10% ENSD ENSD ENSD 10% ENSD 10% ENSD

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

L hand 10% ENSD 10% ENSD 10% ENSD 10% ENSD 10% ENSD

R hand 10% ENSD 10% ENSD 10% ENSD 10% ENSD 10% ENSD

L elbow, forearm, wrist 10% ENSD 10% ENSD ENSD 10% ENSD 10% ENSD

R elbow, forearm, wrist 10% ENSD 10% ENSD ENSD 10% ENSD 10% ENSD

R side of head (including temple 

and ear)

10% ENSD 10% ENSD 10% ENSD 10% EXSD 10% ENSD

L side of head (including temple 

and ear)

10% ENSD 10% ENSD 10% ENSD 10% ENSD 10% EXSD

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

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

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

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

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

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

L side of face Eye/brain 10% ENSD ENSD 10% ENSD 10% EXSD

R side of face Eye/brain 10% ENSD ENSD 10% EXSD 10% ENSD

L side of neck 10% ENSD 10% ENSD ENSD 10% ENSD 10% EXSD

R side of neck 10% ENSD 10% ENSD ENSD 10% EXSD 10% ENSD

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

Front of neck Thyroid 10% ENSD ENSD Thyroid Thyroid

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

Front torso: base of neck to 

end of sternum

EXSD Lunga ENSD EXSD EXSD

Front torso: end of sternum to 

lowest rib

EXSD Lunga ENSD EXSD EXSD

Front torso: lowest rib to iliac 

crest

10% EXSD 10% lunga ENSD 10% EXSD 10% EXSD

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

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Area of skin

Basis for PA 

chest

after 1970

Basis for 

LAT chest

after 1970

Basis for 

AP lordotic 

chest 

after 1970

Basis for 

RAO chest

after 1970

Basis for 

LAO chest

after 1970

Front torso: iliac crest to pubis 10% EXSD 10% lunga 10% ENSD 10% EXSD 10% EXSD

Back torso: base of neck to 

mid-back

ENSD Lunga EXSD ENSD ENSD

Back torso: mid-back to lowest 

rib

ENSD Lunga EXSD ENSD ENSD

Back torso: lowest rib to iliac 

crest

10% ENSD 10% Lunga EXSD 10% ENSD 10% ENSD

Back torso: buttocks (Iliac crest 

and below)

10% ENSD 10% Lunga 10% EXSD 10% ENSD 10% ENSD

Right torso: base of neck to 

end of sternum

ENSD ENSD ENSD EXSD ENSD

Right torso: end of sternum to 

lowest rib

ENSD ENSD ENSD EXSD ENSD

Right torso: lowest rib to iliac 

crest

10% ENSD 10% ENSD ENSD 10% EXSD 10% ENSD

Right torso: iliac crest to pubis 

(R hip)

10% ENSD 10% ENSD 10% ENSD 10% EXSD 10% ENSD

Left torso: base of neck to end 

of sternum

ENSD EXSD ENSD ENSD EXSD

Left torso: end of sternum to 

lowest rib

ENSD EXSD ENSD ENSD EXSD

Left torso: lowest rib to iliac 

crest

10% ENSD 10% EXSD ENSD 10% ENSD 10% EXSD

Left torso: iliac crest to pubis (L 

hip)

10% ENSD 10% EXSD 10% ENSD 10% ENSD 10% EXSD

a. The higher of the male or female lung dose value should be used for both genders.

Table A-6. Skin dose guidance for lumbar spine projections for the good collimation period after 

1970.

a

Area of skin

Basis for AP 

and AP spot 

lumbar spine

after 1970

Basis for LAT 

and LAT spot 

lumbar spine

after 1970

Basis for LPO 

lumbar spine

after 1970

Basis for RPO 

lumbar spine

after 1970

R front shoulder 10% ENSD 10% ENSD 10% ENSD 10% ENSD

R back shoulder 10% EXSD 10% ENSD 10% ENSD 10% EXSD

L front shoulder 10% ENSD 10% EXSD 10% EXSD 10% ENSD

L back shoulder 10% EXSD 10% EXSD 10% EXSD 10% EXSD

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

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

L hand 10% ENSD 10% EXSD 10% EXSD 10% ENSD

R hand 10% ENSD 10% ENSD 10% ENSD 10% EXSD

L elbow, forearm, wrist 10% ENSD 10% EXSD 10% EXSD 10% ENSD

R elbow, forearm, wrist 10% ENSD 10% ENSD 10% ENSD 10% EXSD

R side of head (including temple and 

ear)

Eye/brain Eye/brain Eye/brain Eye/brain

L side of head (including temple and ear) Eye/brain Eye/brain Eye/brain Eye/brain

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Area of skin

Basis for AP 

and AP spot 

lumbar spine 

after 1970

Basis for LAT 

and LAT spot 

lumbar spine 

after 1970

Basis for LPO 

lumbar spine 

after 1970

Basis for RPO 

lumbar spine 

after 1970

Front L thigh 10% ENSD 10% EXSD 10% ENSD 10% ENSD

Back L thigh 10% EXSD 10% EXSD 10% EXSD 10% EXSD

Front R thigh 10% ENSD 10% ENSD 10% ENSD 10% ENSD

Back R thigh 10% EXSD 10% ENSD 10% EXSD 10% EXSD

L knee and below RSD (0.60m) RSD (0.60m) RSD (0.60m) RSD (0.60m)

R knee and below RSD (0.60m) RSD (0.60m) RSD (0.60m) RSD (0.60m)

L side of face Eye/brain Eye/brain Eye/brain Eye/brain

R side of face Eye/brain Eye/brain Eye/brain Eye/brain

L side of neck Eye/brain Eye/brain Eye/brain Eye/brain

R side of neck Eye/brain Eye/brain Eye/brain Eye/brain

Back of head Eye/brain Eye/brain Eye/brain Eye/brain

Front of neck Eye/brain Eye/brain Eye/brain Eye/brain

Back of neck Eye/brain Eye/brain Eye/brain Eye/brain

Front torso: base of neck to end of 

sternum

10% ENSD Lungb 10% ENSD 10% ENSD

Front torso: end of sternum to lowest rib ENSD Lungb ENSD ENSD

Front torso: lowest rib to iliac crest ENSD Lungb ENSD ENSD

Front torso: iliac crest to pubis ENSD Lungb ENSD ENSD

Back torso: base of neck to mid-back 10% EXSD Lungb 10% EXSD 10% EXSD

Back torso: mid-back to lowest rib EXSD Lungb EXSD EXSD

Back torso: lowest rib to iliac crest EXSD Lungb EXSD EXSD

Back torso: buttocks (Iliac crest and 

below)

EXSD Lungb EXSD EXSD

Right torso: base of neck to end of 

sternum

10% ENSD 10% ENSD 10% ENSD 10% EXSD

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

Right torso: lowest rib to iliac crest ENSD ENSD ENSD EXSD

Right torso: iliac crest to pubis (R hip) ENSD ENSD ENSD EXSD

Left torso: base of neck to end of 

sternum

10% ENSD 10% EXSD 10% EXSD 10% ENSD

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

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

Left torso: iliac crest to pubis (L hip) ENSD EXSD EXSD ENSD

a. The pelvis, thoracic spine, and cervical spine would not have been performed for screening after 1970.

b. The higher of the male or female lung dose value should be used for both genders.

ATTACHMENT A

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Table A-7 Organ dose equivalents (rem) for chest projections for all periods.

a,b

Organ Projection

Through 

1970 1971–1985 Post-1985

Thyroid PFGc 3.94E-01 ---d ---d

PA 3.48E-02 3.20E-03 3.90E-03

LAT/OBL 6.85E-02 2.88E-02 2.13E-02

AP lordotic 1.74E-01 3.17E-02 ---d

Fluoroe 3.75E-01 ---d ---d

Eye/brain PFGc 7.25E-02 ---d ---d

PA 6.40E-03 3.20E-03 3.90E-03

LAT/OBL 6.85E-02 2.88E-02 2.13E-02

AP lordotic 1.74E-01 3.17E-02 ---d

Fluoroe 5.25E-02 ---d ---d

Ovariesa PFGc 2.50E-02a ---d ---d

PA 2.50E-02a 1.00E-04 2.60E-04

LAT/OBL 1.30E-02a 1.50E-04 3.25E-04

AP lordotic 4.66E-02 2.00E-04 ---d

Fluoroe 1.50E-03 ---d ---d

Urinary/bladder/prostatea PFGc 2.50E-02a ---d ---d

PA 2.50E-02a 1.00E-04 2.60E-04

LAT/OBL 1.30E-02a 1.50E-04 3.25E-04

AP lordotic 4.66E-02 2.00E-04 ---d

Fluoroe 1.50E-03 ---d ---d

Colon/rectuma PFGc 2.50E-02a ---d ---d

PA 2.50E-02a 1.00E-04 2.60E-04

LAT/OBL 1.30E-02a 1.50E-04 3.25E-04

AP lordotic 4.66E-02 2.00E-04 ---d

Fluoroe 1.50E-03 ---d ---d

Testesa PFGc 5.00E-03a ---d ---d

PA 5.00E-03a 1.00E-06 5.00E-07

LAT/OBL 2.50E-03 2.50E-05 1.30E-05

AP lordotic 3.60E-03 1.00E-06 ---d

Fluoroe 2.50E-05 ---d ---d

Lungs (male) PFGc 9.50E-01 ---d ---d

PA 8.38E-02 4.19E-02 3.14E-02

LAT/OBL 9.65E-02 4.83E-02 4.07E-02

AP lordotic 9.46E-02 4.73E-02 ---d

Fluoroe 8.38E-01 ---d ---d

Lungs (female) PFGc 1.02E-00 ---d ---d

PA 9.02E-02 4.51E-02 3.37E-02

LAT/OBL 1.10E-01 5.50E-02 4.56E-02

AP lordotic 7.06E-02 3.53E-02 ---d

Fluoroe 8.88E-01 ---d ---d

Thymus PFGc 1.02E-00 ---d ---d

PA 9.02E-02 4.51E-02 3.37E-02

LAT/OBL 1.10E-01 5.50E-02 4.56E-02

AP lordotic 9.46E-02 4.73E-02 ---d

Fluoroe 8.88E-01 ---d ---d

ATTACHMENT A

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Organ Projection

Through 

1970 1971–1985 Post-1985

Esophagus PFGc 1.02E-00 ---d ---d

PA 9.02E-02 4.51E-02 3.37E-02

LAT/OBL 1.10E-01 5.50E-02 4.56E-02

AP lordotic 9.46E-02 4.73E-02 ---d

Fluoroe 8.88E-01 ---d ---d

Stomach PFGc 1.02E-00 ---d ---d

PA 9.02E-02 4.51E-02 3.37E-02

LAT/OBL 1.10E-01 5.50E-02 4.56E-02

AP lordotic 9.46E-02 4.73E-02 ---d

Fluoroe 8.88E-01 ---d ---d

Bone surface PFGc 1.02E-00 ---d ---d

PA 9.02E-02 4.51E-02 3.37E-02

LAT/OBL 1.10E-01 5.50E-02 4.56E-02

AP lordotic 9.46E-02 ---d

Fluoroe 8.88E-01 ---d ---d

Liver/gall bladder/spleen PFGc 1.02E-00 ---d ---d

PA 9.02E-02 4.51E-02 3.37E-02

LAT/OBL 1.10E-01 5.50E-02 4.56E-02

AP lordotic 9.46E-02 4.73E-02 ---d

Fluoroe 8.88E-01 ---d ---d

Remainder organs PFGc 1.02E-00 ---d ---d

PA 9.02E-02 4.51E-02 3.37E-02

LAT/OBL 1.10E-01 5.50E-02 4.56E-02

AP lordotic 9.46E-02 4.73E-02 ---d

Fluoroe 8.88E-01 ---d ---d

Breast PFGc 1.11E-01 ---d ---d

PA 9.80E-03 4.90E-03 5.80E-03

LAT/OBL 1.28E-01 6.38E-02 4.46E-02

AP lordotic 1.67E-01 8.36E-02 ---d

Fluoroe 8.00E-02 ---d ---d

Uterusa PFGc 2.50E-02a ---d ---d

PA 2.50E-02a 1.30E-04 2.60E-04

LAT/OBL 1.30E-02a 1.50E-04 2.73E-04

AP lordotic 6.10E-02 1.50E-04 ---d

Fluoroe 1.75E-03 ---d ---d

Bone marrow (male) PFGc 2.09E-01 ---d ---d

PA 1.84E-02 9.20E-03 8.90E-03

LAT/OBL 1.85E-02 9.25E-03 9.88E-03

AP lordotic 9.60E-03 4.80E-03 ---d

Fluoroe 1.73E-01 ---d ---d

Bone marrow (female) PFGc 1.95E-01 ---d ---d

PA 1.72E-02 8.60E-03 8.60E-03

LAT/OBL 1.45E-02 7.25E-03 7.67E-03

AP lordotic 9.60E-03 4.80E-03 ---d

Fluoroe 1.58E-01 ---d ---d

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 11 of 22
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Organ Projection Through 

1970

1971–1985 Post-1985

Entrance skinf PFGc 3.06E+00 ---d ---d

PA 2.70E-01 1.35E-01 7.00E-02

LAT/OBL 6.75E-01 3.38E-01 1.82E-01

AP lordotic 2.70E-01 1.35E-01 ---d

Fluoroe 3.30E+00 ---d ---d

a. Dose equivalents through 1970 are based on measured values (Rising and Soldat 1959; 

Webster and Merrill 1957) for testes, ovaries, uterus, and analogues.

b. Rounded to nearest tenth of a millirem.

c. PFG dose equivalents are for stereo projections (two exposures). If only one projection was 

taken, these dose equivalents should be halved.

d. Procedure not performed for screening in this period.

e. Fluoro dose equivalents based on 5 R/min for 30 seconds, with an HVL of 2.0 mm Al eq.

f. Entrance skin dose equivalents determined by multiplying the incident air kerma by the 

backscatter factors of 1.35 and 1.42 for HVL of 2.5 mm Al and 4.0 mm Al, respectively, from 

NCRP Report 102 (NRCP 1997, Table B-8). Skin dose equivalents for all areas of skin are 

provided in Tables A-8 and A-9.

Table A-8. Skin dose equivalents (rem) from chest projections through 1970.

a

Area of skin

PFG 

1943–

1962

Chest 

fluoro

PA chest 

through

1970

LAT 

chest 

through

1970

AP 

lordotic 

chest 

through

1970

RAO 

chest 

through

1970

LAO 

chest 

through

1970

Right front shoulder 6.67E-02 6.32E-02 5.9E-03 6.75E-01 2.70E-01 3.0E-03 3.0E-03

Right back shoulder 3.06E+00 3.30E+00 2.70E-01 6.75E-01 5.9E-03 6.75E-01 6.75E-01

Left front shoulder 6.67E-02 6.32E-02 5.9E-03 3.0E-03 2.70E-01 3.0E-03 3.0E-03

Left back shoulder 3.06E+00 3.30E+00 2.70E-01 3.0E-03 5.9E-03 6.75E-01 6.75E-01

Right upper arm to elbow 3.06E-01 3.30E+00 2.70E-01 6.75E-01 2.70E-01 6.75E-01 6.75E-01

Left upper arm to elbow 3.06E-01 3.30E+00 2.70E-01 3.0E-03 2.70E-01 6.75E-01 6.75E-01

Left hand 3.06E+00 3.30E+00 2.70E-01 6.75E-02 2.70E-02 6.75E-02 6.75E-02

Right hand 3.06E+00 3.30E+00 2.70E-01 6.75E-02 2.70E-02 6.75E-02 6.75E-02

Left elbow, forearm, wrist 3.06E-01 3.30E+00 2.70E-01 6.75E-02 2.70E-01 6.75E-02 6.75E-02

Right elbow, forearm, wrist 3.06E-01 3.30E+00 2.70E-01 6.75E-02 2.70E-01 6.75E-02 6.75E-02

Right side of head including 

temple and ear

3.06E-01 3.30E-01 2.70E-02 6.85E-02 2.70E-02 3.E-04 6.75E-02

Left side of head including 

temple and ear

3.06E-01 3.30E-01 2.70E-02 6.85E-02 2.70E-02 6.75E-02 3.E-04

Front left thigh 9.E-04 8.E-04 8.E-05 1.E-04 8.E-05 1.E-04 1.E-04

Back left thigh 9.E-04 8.E-04 8.E-05 1.E-04 8.E-05 1.E-04 1.E-04

Front right thigh 9.E-04 8.E-04 8.E-05 1.E-04 8.E-05 1.E-04 1.E-04

Back right thigh 9.E-04 8.E-04 8.E-05 1.E-04 8.E-05 1.E-04 1.E-04

Left knee and below 3.E-04 3.E-04 3.E-05 4.E-05 3.E-05 4.E-05 4.E-05

Right knee and below 3.E-04 3.E-04 3.E-05 4.E-05 3.E-05 4.E-05 4.E-05

Left side of face 7.25E-02 5.25E-02 6.4E-03 6.85E-02 2.70E-01 6.75E-01 3.0E-03

Right side of face 7.25E-02 5.25E-02 6.4E-03 6.85E-02 2.70E-01 3.0E-03 6.75E-01

Left side of neck 3.06E-01 3.30E+00 2.70E-01 6.85E-02 2.70E-01 6.75E-01 3.0E-03

Right side of neck 3.06E-01 3.30E+00 2.70E-01 6.85E-02 2.70E-01 3.0E-03 6.75E-01

Back of head 3.06E-01 3.30E-01 2.70E-02 6.85E-02 5.9E-03 6.75E-02 6.75E-02

Front of neck 7.25E-02 5.25E-02 6.4E-03 6.85E-02 2.70E-01 6.85E-02 6.85E-02

Back of neck 3.06E-01 3.30E+00 2.70E-01 6.85E-02 5.9E-03 6.75E-01 6.75E-01

Front torso: base of neck to 

end of sternum

6.67E-02 6.32E-02 5.9E-03 1.10E-01 2.70E-01 3.0E-03 3.0E-03

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 12 of 22
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Area of skin

PFG 

1943–

1962

Chest 

fluoro

PA chest 

through

1970

LAT 

chest 

through

1970

AP 

lordotic 

chest 

through

1970

RAO 

chest 

through

1970

LAO 

chest 

through

1970

Front torso: end of sternum to 

lowest rib

6.67E-02 6.32E-02 5.9E-03 1.10E-01 2.70E-01 3.0E-03 3.0E-03

Front torso: lowest rib to iliac 

crest

6.67E-02 6.32E-02 5.9E-03 1.10E-01 2.70E-01 3.0E-03 3.0E-03

Front torso: iliac crest to 

pubis

6.7E-03 6.3E-03 6.E-04 1.10E-02 2.70E-02 3.E-04 3.E-04

Back torso: base of neck to 

mid-back

3.06E+00 3.30E+00 2.70E-01 1.10E-01 5.9E-03 6.75E-01 6.75E-01

Back torso: mid-back to 

lowest rib

3.06E+00 3.30E+00 2.70E-01 1.10E-01 5.9E-03 6.75E-01 6.75E-01

Back torso: lowest rib to iliac 

crest

3.06E+00 3.30E+00 2.70E-01 1.10E-01 5.9E-03 6.75E-01 6.75E-01

Back torso: buttocks (Iliac 

crest and below)

3.06E-01 3.30E-01 2.70E-02 1.10E-02 6.E-04 6.75E-02 6.75E-02

Right torso: base of neck to 

end of sternum

3.06E+00 3.30E+00 2.70E-01 6.75E-01 2.70E-01 3.0E-03 6.75E-01

Right torso: end of sternum to 

lowest rib

3.06E+00 3.30E+00 2.70E-01 6.75E-01 2.70E-01 3.0E-03 6.75E-01

Right torso: lowest rib to iliac 

crest

3.06E+00 3.30E+00 2.70E-01 6.75E-01 2.70E-01 3.0E-03 6.75E-01

Right torso: iliac crest to 

pubis (right hip)

3.06E-01 3.30E-01 2.70E-02 6.75E-02 2.70E-02 3.E-04 6.75E-02

Left torso: base of neck to 

end of sternum

3.06E+00 3.30E+00 2.70E-01 3.0E-03 2.70E-01 6.75E-01 3.0E-03

Left torso: end of sternum to 

lowest rib

3.06E+00 3.30E+00 2.70E-01 3.0E-03 2.70E-01 6.75E-01 3.0E-03

Left torso: lowest rib to iliac 

crest

3.06E+00 3.30E+00 2.70E-01 3.0E-03 2.70E-01 6.75E-01 3.0E-03

Left torso: iliac crest to pubis 

(Left hip)

3.06E-01 3.30E-01 2.70E-02 3.E-04 2.70E-02 6.75E-02 3.E-04

a. Values less than 0.1 mrem shown to one significant digit. 

Table A-9. Skin dose equivalents (rem) from various chest projections post-1970.

a

Area of skin

PA 

chest 

1971–

1985

LAT 

chest 

1971–

1985

AP 

lordotic 

chest 

1971–

1985

RAO 

chest 

1971–

1985

LAO 

chest 

1971–

1985

PA 

chest 

post1985

LAT 

chest 

post1985

RAO 

chest 

post1985

LAO 

chest 

post1985

Right front shoulder 2.9E-03 3.38E-01 1.35E-01 1.5E-03 1.5E-03 2.4E-03 1.82E-01 1.4E-03 1.4E-03

Right back shoulder 1.35E-01 3.38E-01 2.9E-03 3.38E-01 3.38E-01 7.00E-02 1.82E-01 1.82E-01 1.82E-01

Left front shoulder 2.9E-03 1.5E-03 1.35E-01 1.5E-03 1.5E-03 2.4E-03 1.4E-03 1.4E-03 1.4E-03

Left back shoulder 1.35E-01 1.5E-03 2.9E-03 3.38E-01 3.38E-01 7.00E-02 1.4E-03 1.82E-01 1.82E-01

Right upper arm to 

elbow

1.35E-02 3.38E-01 1.35E-01 3.38E-02 3.38E-02 7.0E-03 1.82E-01 1.82E-02 1.82E-02

Left upper arm to 

elbow

1.35E-02 1.5E-03 1.35E-01 3.38E-02 3.38E-02 7.0E-03 1.4E-03 1.82E-02 1.82E-02

Left hand 1.35E-02 3.38E-02 1.35E-02 3.38E-02 3.38E-02 7.0E-03 1.82E-02 1.82E-02 1.82E-02

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 13 of 22
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Area of skin

PA 

chest 

1971–

1985

LAT 

chest 

1971–

1985

AP 

lordotic 

chest 

1971–

1985

RAO 

chest 

1971–

1985

LAO 

chest 

1971–

1985

PA 

chest 

post1985

LAT 

chest 

post1985

RAO 

chest 

post1985

LAO 

chest 

post1985

Right hand 1.35E-02 3.38E-02 1.35E-02 3.38E-02 3.38E-02 7.0E-03 1.82E-02 1.82E-02 1.82E-02

Left elbow, forearm, 

wrist

1.35E-02 3.38E-02 1.35E-01 3.38E-02 3.38E-02 7.0E-03 1.82E-02 1.82E-02 1.82E-02

Right elbow, 

forearm, wrist

1.35E-02 3.38E-02 1.35E-01 3.38E-02 3.38E-02 7.0E-03 1.82E-02 1.82E-02 1.82E-02

Right side of head 

including temple and 

ear

1.35E-02 3.38E-02 1.35E-02 1.E-04 3.38E-02 7.0E-03 1.82E-02 1.E-04 1.82E-02

Left side of head 

including temple and 

ear

1.35E-02 3.38E-02 1.35E-02 3.38E-02 1.E-04 7.0E-03 1.82E-02 1.82E-02 1.E-04

Front left thigh 4.E-05 5.E-05 4.E-05 5.E-05 5.E-05 3.E-05 4.E-05 4.E-05 4.E-05

Back left thigh 4.E-05 5.E-05 4.E-05 5.E-05 5.E-05 3.E-05 4.E-05 4.E-05 4.E-05

Front right thigh 4.E-05 5.E-05 4.E-05 5.E-05 5.E-05 3.E-05 4.E-05 4.E-05 4.E-05

Back right thigh 4.E-05 5.E-05 4.E-05 5.E-05 5.E-05 3.E-05 4.E-05 4.E-05 4.E-05

Left knee and below 1.E-05 2.E-05 1.E-05 2.E-05 2.E-05 1.E-05 1.E-05 1.E-05 1.E-05

Right knee and 

below

1.E-05 2.E-05 1.E-05 2.E-05 2.E-05 1.E-05 1.E-05 1.E-05 1.E-05

Left side of face 3.2E-03 3.38E-02 1.35E-01 3.38E-02 1.E-04 3.9E-03 1.82E-02 1.82E-02 1.E-04

Right side of face 3.2E-03 3.38E-02 1.35E-01 1.E-04 3.38E-02 3.9E-03 1.82E-02 1.E-04 1.82E-02

Left side of neck 1.35E-02 3.38E-02 1.35E-01 3.38E-02 1.E-04 7.0E-03 1.82E-02 1.82E-02 1.E-04

Right side of neck 1.35E-02 3.38E-02 1.35E-01 1.E-04 3.38E-02 7.0E-03 1.82E-02 1.E-04 1.82E-02

Back of head 1.35E-02 3.38E-02 2.9E-03 3.38E-02 3.38E-02 7.0E-03 1.82E-02 1.82E-02 1.82E-02

Front of neck 3.2E-03 3.38E-02 1.35E-01 2.88E-02 2.88E-02 3.9E-03 1.82E-02 2.13E-02 2.13E-02

Back of neck 1.35E-02 3.38E-02 2.9E-03 3.38E-02 3.38E-02 7.0E-03 1.82E-02 1.82E-02 1.82E-02

Front torso: base of 

neck to end of 

sternum

2.9E-03 5.50E-02 1.35E-01 1.5E-03 1.5E-03 2.4E-03 4.56E-02 1.4E-03 1.4E-03

Front torso: end of 

sternum to lowest rib

2.9E-03 5.50E-02 1.35E-01 1.5E-03 1.5E-03 2.4E-03 4.56E-02 1.4E-03 1.4E-03

Front torso: lowest 

rib to iliac crest

3.E-04 5.5E-03 1.35E-01 1.E-04 1.E-04 2.E-04 4.6E-03 1.E-04 1.E-04

Front torso: iliac 

crest to pubis

3.E-04 5.5E-03 1.35E-02 1.E-04 1.E-04 2.E-04 4.6E-03 1.E-04 1.E-04

Back torso: base of 

neck to mid-back

1.35E-01 5.50E-02 2.9E-03 3.38E-01 3.38E-01 7.00E-02 4.56E-02 1.82E-01 1.82E-01

Back torso: midback to lowest rib1.35E-01 5.50E-02 2.9E-03 3.38E-01 3.38E-01 7.00E-02 4.56E-02 1.82E-01 1.82E-01

Back torso: lowest 

rib to iliac crest

1.35E-02 5.5E-03 2.9E-03 3.38E-02 3.38E-02 7.0E-03 4.6E-03 1.82E-02 1.82E-02

Back torso: 

buttocks (Iliac crest 

and below)

1.35E-02 5.5E-03 3.E-04 3.38E-02 3.38E-02 7.0E-03 4.6E-03 1.82E-02 1.82E-02

Right torso: base of 

neck to end of

sternum

1.35E-01 3.38E-01 1.35E-01 1.5E-03 3.38E-01 7.00E-02 1.82E-01 1.4E-03 1.82E-01

Right torso: end of 

sternum to lowest rib

1.35E-01 3.38E-01 1.35E-01 1.5E-03 3.38E-01 7.00E-02 1.82E-01 1.4E-03 1.82E-01

Right torso: lowest 

rib to iliac crest

1.35E-02 3.38E-02 1.35E-01 1.E-04 3.38E-02 7.0E-03 1.82E-02 1.E-04 1.82E-02

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 14 of 22
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Area of skin

PA 

chest 

1971–

1985

LAT 

chest 

1971–

1985

AP 

lordotic 

chest 

1971–

1985

RAO 

chest 

1971–

1985

LAO 

chest 

1971–

1985

PA 

chest 

post1985

LAT 

chest 

post1985

RAO 

chest 

post1985

LAO 

chest 

post1985

Right torso: iliac 

crest to pubis (right 

hip)

1.35E-02 3.38E-02 1.35E-02 1.E-04 3.38E-02 7.0E-03 1.82E-02 1.E-04 1.82E-02

Left torso: base of 

neck to end of 

sternum

1.35E-01 1.5E-03 1.35E-01 3.38E-01 1.5E-03 7.00E-02 1.4E-03 1.82E-01 1.4E-03

Left torso: end of 

sternum to lowest rib

1.35E-01 1.5E-03 1.35E-01 3.38E-01 1.5E-03 7.00E-02 1.4E-03 1.82E-01 1.4E-03

Left torso: lowest rib 

to iliac crest

1.35E-02 1.E-04 1.35E-01 3.38E-02 1.E-04 7.0E-03 1.E-04 1.82E-02 1.E-04

Left torso: iliac crest 

to pubis (Left hip)

1.35E-02 1.E-04 1.35E-02 3.38E-02 1.E-04 7.0E-03 1.E-04 1.82E-02 1.E-04

a. Values less than 0.1 mrem shown to one significant digit.

Table A-10. Organ dose equivalents (rem) for lumbar spine and pelvis 

projections for all periods.

a

Organ Projection

Through 

1970 Post-1970

Thyroid AP or AP spot lumbar spineb 2.88E-04 2.73E-04

LAT or LAT spot lumbar spinec 3.79E-05 3.48E-05

AP pelvis 1.52E-05 ---g

Eye/brain AP or AP spot lumbar spineb 2.88E-04 2.73E-04

LAT or LAT spot lumbar spinec 3.79E-05 3.48E-05

AP pelvis 1.52E-05 ---g

Ovariesa AP or AP spot lumbar spineb 5.60E-01 1.97E-01

LAT or LAT spot lumbar spinec 7.10E-01 1.64E-01

AP pelvis 6.50E-01 ---g

Urinary/bladder/prostated AP or AP spot lumbar spineb 2.30E-01 1.97E-01

LAT or LAT spot lumbar spinec 1.17E-01 1.64E-01

AP pelvis 2.64E-01 ---g

Colon/rectumd AP or AP spot lumbar spineb 2.30E-01 1.97E-01

LAT or LAT spot lumbar spinec 1.17E-01 1.64E-01

AP pelvis 2.64E-01 ---g

Testesa AP or AP spot lumbar spineb 2.70E-02 3.82E-03

LAT or LAT spot lumbar spinec 5.60E-02 2.78E-03

AP pelvis 6.40E-01 ---g

Lungs (male) AP or AP spot lumbar spineb 8.93E-02 7.19E-02

LAT or LAT spot lumbar spinec 3.79E-02 4.87E-02

AP pelvis 1.52E-03 ---g

Lungs (female) AP or AP spot lumbar spineb 8.93E-02 7.19E-02

LAT or LAT spot lumbar spinec 3.79E-02 4.87E-02

AP pelvis 1.52E-03 ---g

Thymus AP or AP spot lumbar spineb 8.93E-02 7.19E-02

LAT or LAT spot lumbar spinec 3.79E-02 4.87E-02

AP pelvis 1.52E-03 ---g

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 15 of 22
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Organ Projection

Through 

1970 Post-1970

Esophagus AP or AP spot lumbar spineb 8.93E-02 7.19E-02

LAT or LAT spot lumbar spinec 3.79E-02 4.87E-02

AP pelvis 1.52E-03 ---g

Stomachd AP or AP spot lumbar spineb 2.30E-01 1.97E-01

LAT or LAT spot lumbar spinec 1.17E-01 1.64E-01

AP pelvis 2.64E-01 ---g

Bone surfaced AP or AP spot lumbar spineb 2.30E-01 1.97E-01

LAT or LAT spot lumbar spinec 1.17E-01 1.64E-01

AP pelvis 2.64E-01 ---g

Liver/gall bladder/spleend AP or AP spot lumbar spineb 2.30E-01 1.97E-01

LAT or LAT spot lumbar spinec 1.17E-01 1.64E-01

AP pelvis 2.64E-01 ---g

Remainder organsd AP or AP spot lumbar spineb 2.30E-01 1.97E-01

LAT or LAT spot lumbar spinec 1.17E-01 1.64E-01

AP pelvis 2.64E-01 ---g

Breaste AP or AP spot lumbar spineb 4.78E-03 9.56E-04

LAT or LAT spot lumbar spinec 7.58E-03 2.07E-03

AP pelvis 7.79E-03 ---g

Uterus AP or AP spot lumbar spineb 3.12E-01 2.61E-01

LAT or LAT spot lumbar spinec 7.58E-02 1.08E-01

AP pelvis 3.71E-01 ---g

Bone marrow (male) AP or AP spot lumbar spineb 3.46E-02 3.37E-02

LAT or LAT spot lumbar spinec 5.69E-02 7.66E-02

AP pelvis 3.50E-02 ---g

Bone marrow (female) AP or AP spot lumbar spineb 3.46E-02 3.37E-02

LAT or LAT spot lumbar spinec 5.69E-02 7.66E-02

AP pelvis 3.50E-02 ---g

Entrance skinf AP or AP spot lumbar spineb 1.900E+00a 1.200E+00

LAT or LAT spot lumbar spinec 5.00E+00a 4.59E+00

AP pelvis 2.000E+00a ---g

a. Doses through 1970 are based on measured values (Lincoln and Gupton 1958) for skin, 

testes, and ovaries.

b. Dose equivalents are for one projection. If both AP and AP spot are being included as the 

default frequency, the listed dose equivalents should be doubled.

c. Dose equivalents are for one projection. If both LAT and LAT spot are being included as the 

default frequency, the listed dose equivalents should be doubled.

d. The DCF for the ovary is used to determine organ dose equivalents for the Remainder organs 

and other organs in the primary beam for projections of the lumbar spine and pelvis.

e. Breast dose equivalents determined by using the method described by Huda and Bissessur, 

1990.

f. Skin dose equivalents for all areas of skin are provided in Tables A-11.

g. Not performed for screening in this period.

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 16 of 22
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 56 of 61

Table A-11. Skin dose equivalent (rem) from lumbar spine and pelvis projections for all periods.

a

Area of skin

AP or AP 

spot 

lumbar 

spine

through

1970

LAT or 

LAT spot 

lumbar 

spine 

through

1970

Pelvis

through

1970

AP or AP 

spot 

lumbar 

spine

post 1970

LAT or 

LAT spot 

lumbar 

spine 

post 1970

Right front shoulder 1.90E-01 5.00E-01 2.00E-01 1.20E-01 4.59E-01

Right back shoulder 3.6E-03 5.00E-01 3.8E-03 2.6E-03 4.59E-01

Left front shoulder 1.90E-01 1.90E-03 2.00E-01 1.20E-01 2.0E-03

Left back shoulder 3.6E-03 1.90E-03 3.8E-03 2.6E-03 2.0E-03

Right upper arm to elbow 1.90E-01 5.00E-01 2.00E-01 1.20E-01 4.59E-01

Left upper arm to elbow 1.90E-01 1.90E-03 2.00E-01 1.20E-01 2.0E-03

Left hand 1.90E+00 1.90E-03 2.00E+00 1.20E-01 2.0E-03

Right hand 1.90E+00 5.00E-01 2.00E+00 1.20E-01 4.59E-01

Left elbow, forearm, wrist 1.90E+00 1.90E-03 2.00E+00 1.20E-01 2.0E-03

Right elbow, forearm, wrist 1.90E+00 5.00E-01 2.00E+00 1.20E-01 4.59E-01

Right side of head including temple and ear 3.E-04 3.E-05 1.E-05 3.E-04 3.E-05

Left side of head including temple and ear 3.E-04 3.E-05 1.E-05 3.E-04 3.E-05

Front left thigh 1.90E-01 1.90E-03 2.00E-01 1.20E-01 2.0E-03

Back left thigh 3.6E-03 1.90E-03 3.8E-03 2.6E-03 2.0E-03

Front right thigh 1.90E-01 5.00E-01 2.00E-01 1.20E-01 4.59E-01

Back right thigh 3.6E-03 5.00E-01 3.8E-03 2.6E-03 4.59E-01

Left knee and below 4.E-04 5.E-04 4.E-04 3.E-04 5.E-04

Right knee and below 4.E-04 5.E-04 4.E-04 3.E-04 5.E-04

Left side of face 3.E-04 3.E-05 1.E-05 3.E-04 3.E-05

Right side of face 3.E-04 3.E-05 1.E-05 3.E-04 3.E-05

Left side of neck 3.E-04 3.E-05 1.E-05 3.E-04 3.E-05

Right side of neck 3.E-04 3.E-05 1.E-05 3.E-04 3.E-05

Back of head 3.E-04 3.E-05 1.E-05 3.E-04 3.E-05

Front of neck 3.E-04 3.E-05 1.E-05 3.E-04 3.E-05

Back of neck 3.E-04 3.E-05 1.E-05 3.E-04 3.E-05

Front torso: base of neck to end of sternum 1.90E-01 3.32E-02 2.00E-01 1.20E-01 4.87E-02

Front torso: end of sternum to lowest rib 1.90E+00 3.32E-02 2.00E+00 1.20E+00 4.87E-02

Front torso: lowest rib to iliac crest 1.90E+00 3.32E-02 2.00E+00 1.20E+00 4.87E-02

Front torso: iliac crest to pubis 1.90E+00 3.32E-02 2.00E+00 1.20E+00 4.87E-02

Back torso: base of neck to mid-back 3.6E-03 3.32E-02 3.8E-03 2.6E-03 4.87E-02

Back torso: mid-back to lowest rib 3.64E-02 3.32E-02 3.83E-02 2.61E-02 4.87E-02

Back torso: lowest rib to iliac crest 3.64E-02 3.32E-02 3.83E-02 2.61E-02 4.87E-02

Back torso: buttocks (Iliac crest and below) 3.64E-02 3.32E 3.83E-02 2.61E-02 4.87E-02

Right torso: base of neck to end of sternum 1.90E-01 5.00E-01 2.00E-01 1.20E-01 4.59E-01

Right torso: end of sternum to lowest rib 1.90E+00 5.00E+00 2.00E+00 1.20E+00 4.59E+00

Right torso: lowest rib to iliac crest 1.90E+00 5.00E+00 2.00E+00 1.20E+00 4.59E+00

Right torso: iliac crest to pubis (right hip) 1.90E+00 5.00E+00 2.00E+00 1.20E+00 4.59E+00

Left torso: base of neck to end of sternum 1.90E-01 1.90E-03 2.00E-01 1.20E-01 2.0E-03

Left torso: end of sternum to lowest rib 1.90E+00 1.90E-02 2.00E+00 1.20E+00 2.02E-02

Left torso: lowest rib to iliac crest 1.90E+00 1.90E-02 2.00E+00 1.20E+00 2.02E-02

Left torso: iliac crest to pubis (left hip) 1.90E+00 1.90E-02 2.00E+00 1.20E+00 2.02E-02

a. Values less than 0.1 mrem shown to one significant digit. 

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 17 of 22
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Table A-12. Organ dose equivalents (rem) for thoracic and cervical spine 

projections through 1960.

Organ

Thoracic 

spine 

projection

Through 

1960

Cervical 

spine 

projection

Through 

1960

Thyroid AP 9.26E-02 AP 3.25E-01

LAT 1.23E-01 LAT 1.46E-02

RPO 1.23E-01 RPO 3.25E-01

LPO 1.23E-01 LPO 3.25E-01

Eye/brain AP 9.26E-03 AP 3.25E-01

LAT 8.80E-03 LAT 1.46E-02

RPO 8.80E-03 RPO 3.25E-01

LPO 8.80E-03 LPO 3.25E-01

Ovaries AP 2.80E-02a AP 6.00E-05a

LAT 4.60E-02a LAT 2.00E-04a

RPO 4.60E-02 RPO 6.00E-05

LPO 4.60E-02 LPO 6.00E-05

Urinary/bladder/prostate AP 6.90E-04c AP 6.00E-05

LAT 2.20E-04c LAT 2.00E-04

RPO 2.20E-04 RPO 6.00E-05

LPO 2.20E-04 LPO 6.00E-05

Colon/rectum AP 6.90E-04c AP 6.00E-05

LAT 2.20E-04c LAT 2.00E-04

RPO 2.20E-04 RPO 6.00E-05

LPO 2.20E-04 LPO 6.00E-05

Testes AP 1.00E-03a AP 2.70E-04a

LAT 2.00E-03a LAT 9.20E-04a

RPO 2.00E-03 RPO 2.70E-04

LPO 2.00E-03 LPO 2.70E-04

Lungs (male) AP 3.27E-01b AP 6.48E-03

LAT 2.35E-01b LAT 5.98E-03

RPO 2.35E-01 RPO 6.48E-03

LPO 2.35E-01 LPO 6.48E-03

Lungs (female) AP 2.33E-01b AP 6.48E-03

LAT 2.82E-01b LAT 5.98E-03

RPO 2.82E-01 RPO 6.48E-03

LPO 2.82E-01 LPO 6.48E-03

Thymus AP 3.27E-01b AP 6.48E-03

LAT 2.82E-01b LAT 5.98E-03

RPO 2.82E-01 RPO 6.48E-03

LPO 2.82E-01 LPO 6.48E-03

Esophagus AP 3.27E-01b AP 6.48E-03

LAT 2.82E-01b LAT 5.98E-03

RPO 2.82E-01 RPO 6.48E-03

LPO 2.82E-01 LPO 6.48E-03

Stomach AP 3.27E-01b AP 6.48E-03

LAT 2.82E-01b LAT 5.98E-03

RPO 2.82E-01 RPO 6.48E-03

LPO 2.82E-01 LPO 6.48E-03

Bone surface AP 3.27E-01b AP 6.48E-03

LAT 2.82E-01b LAT 5.98E-03

RPO 2.82E-01 RPO 6.48E-03

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 18 of 22
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 58 of 61

LPO 2.82E-01 LPO 6.48E-03

Liver/gall bladder/spleen AP 3.27E-01b AP 6.48E-03

LAT 2.82E-01b LAT 5.98E-03

RPO 2.82E-01 RPO 6.48E-03

LPO 2.82E-01 LPO 6.48E-03

Remainder organs AP 3.27E-01b AP 6.48E-03

LAT 2.82E-01b LAT 5.98E-03

RPO 2.82E-01 RPO 6.48E-03

LPO 2.82E-01 LPO 6.48E-03

Breast AP 3.61E-01 AP 6.48E-03

LAT 1.23E-02 LAT 5.98E-03

RPO 1.23E-02 RPO 6.48E-03

LPO 1.23E-02 LPO 6.48E-03

Uterus AP 4.93E-04 AP 6.00E-05a

LAT 2.20E-04 LAT 2.00E-04a

RPO 2.20E-04 RPO 6.00E-05

LPO 2.20E-04 LPO 6.00E-05

Bone marrow (male) AP 2.86E-02 AP 4.75E-03

LAT 3.96E-02 LAT 4.42E-03

RPO 3.96E-02 RPO 4.75E-03

LPO 3.96E-02 LPO 4.75E-03

Bone marrow (female) AP 2.27E-02 AP 4.75E-03

LAT 3.08E-02 LAT 4.42E-03

RPO 3.08E-02 RPO 4.75E-03

LPO 3.08E-02 LPO 4.75E-03

Entrance skind AP 1.30E+00a AP 5.70E-01

LAT 2.90E+00a LAT 3.43E-01

RPO 2.90E+00 RPO 5.70E-01

LPO 2.90E+00 LPO 5.70E-01

a. Dose equivalents through 1970 are based on measured values (Lincoln and Gupton 

1958) for skin, testes, and ovaries for the thoracic spine, and measured values 

(Braestrup and Wycoff 1958) for testes, ovaries, and uterus for the cervical spine.

b. The higher of the two lung DCFs is used to determine organ dose equivalents for the 

Remainder organs and other organs in the primary beam for projections of the thoracic 

spine.

c. The DCF for the ovary is used to determine organ dose equivalents for the urinary 

bladder, prostate, colon, and rectum for projections of the thoracic spine.

d. Skin dose equivalents for all areas of skin are provided in Tables A-13.

Table A-13. Skin dose equivalent (rem) from thoracic and cervical spine projections through 1960.a

Area of skin

AP 

thoracic 

spine

LAT 

thoracic 

spine

RPO 

thoracic 

spine

RPO 

thoracic 

spine

AP 

cervical 

spine

LAT 

cervical 

spine

RPO 

cervical 

spine

LPO 

cervical 

spine

Right front shoulder 1.30E+00 2.90E+00 2.90E+00 2.90E+00 5.70E-02 3.43E-01 5.70E-02 5.70E-02

Right back shoulder 2.49E-02 2.90E+00 1.10E-02 1.10E-02 1.1E-03 3.43E-01 1.1E-03 1.1E-03

Left front shoulder 1.30E+00 1.10E-02 2.90E+00 2.90E+00 5.70E-02 1.3E-03 5.70E-02 5.70E-02

Left back shoulder 2.49E-02 1.10E-02 1.10E-02 1.10E-02 1.1E-03 1.3E-03 1.1E-03 1.1E-03

Right upper arm to elbow 1.30E+00 2.90E+00 2.90E+00 2.90E+00 5.70E-02 3.43E-02 1.1E-03 5.70E-02

Left upper arm to elbow 1.30E+00 1.10E-02 2.90E+00 2.90E+00 5.70E-02 1.E-04 5.70E-02 5.70E-02

Left hand 1.30E-01 2.90E-01 2.90E-01 2.90E-01 4.E-04 3.E-04 4.E-04 4.E-04

Right hand 1.30E-01 2.90E-01 2.90E-01 2.90E-01 4.E-04 3.E-04 4.E-04 4.E-04

Left elbow, forearm, wrist 1.30E+00 2.90E-01 2.90E-01 2.90E-01 4.E-04 3.E-04 4.E-04 4.E-04

Right elbow, forearm, 

wrist

1.30E+00 2.90E-01 2.90E-01 2.90E-01 4.E-04 3.E-04 4.E-04 4.E-04

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 19 of 22
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 59 of 61

Area of skin

AP 

thoracic 

spine

LAT 

thoracic 

spine

RPO 

thoracic 

spine

RPO 

thoracic 

spine

AP 

cervical 

spine

LAT 

cervical 

spine

RPO 

cervical 

spine

LPO 

cervical 

spine

Right side of head 

including temple and ear

1.30E-01 2.90E-01 1.1E-03 2.90E-01 5.70E-01 3.43E-01 4.76E-02 5.70E-01

Left side of head 

including temple and ear

1.30E-01 2.90E-01 2.90E-01 1.1E-03 5.70E-01 2.87E-02 5.70E-01 4.76E-02

Front left thigh 3.E-04 4.E-04 4.E-04 4.E-04 1.E-04 9.E-05 1.E-04 1.E-04

Back left thigh 3.E-04 4.E-04 4.E-04 4.E-04 1.E-04 9.E-05 1.E-04 1.E-04

Front right thigh 3.E-04 4.E-04 4.E-04 4.E-04 1.E-04 9.E-05 1.E-04 1.E-04

Back right thigh 3.E-04 4.E-04 4.E-04 4.E-04 1.E-04 9.E-05 1.E-04 1.E-04

Left knee and below 1.E-04 1.E-04 1.E-04 1.E-04 7.E-05 4.E-05 7.E-05 7.E-05

Right knee and below 1.E-04 1.E-04 1.E-04 1.E-04 7.E-05 4.E-05 7.E-05 7.E-05

Left side of face 1.30E-01 7.7E-03 2.90E-01 1.1E-03 5.70E-01 2.87E-02 5.70E-01 4.76E-02

Right side of face 1.30E-01 7.7E-03 1.1E-03 2.90E-01 5.70E-01 3.43E-01 4.76E-02 5.70E-01

Left side of neck 1.30E+00 7.7E-03 2.90E+00 1.10E-02 5.70E-01 2.87E-02 5.70E-01 4.76E-02

Right side of neck 1.30E+00 7.7E-03 1.10E-02 2.90E+00 5.70E-01 3.43E-01 4.76E-02 5.70E-01

Back of head 2.5E-03 7.7E-03 2.90E-01 2.90E-01 1.09E-02 3.43E-01 5.70E-01 5.70E-01

Front of neck 1.30E+00 7.7E-03 1.08E-01 1.08E-01 5.70E-01 3.43E-01 5.70E-01 5.70E-01

Back of neck 2.49E-02 7.7E-03 1.10E-02 1.10E-02 4.76E-02 2.87E-02 4.76E-02 4.76E-02

Front torso: base of 

neck to end of sternum

1.30E+00 2.46E-01 2.90E+00 2.90E+00 5.70E-01 3.43E-02 5.70E-01 5.70E-01

Front torso: end of 

sternum to lowest rib

1.30E+00 2.46E-01 2.90E+00 2.90E+00 8.E-04 5.E-04 8.E-04 8.E-04

Front torso: lowest rib to 

iliac crest

1.30E+00 2.46E-01 2.90E+00 2.90E+00 8.E-04 5.E-04 8.E-04 8.E-04

Front torso: iliac crest to 

pubis

1.30E-01 2.46E-02 2.90E-01 2.90E-01 3.E-04 2.E-04 3.E-04 3.E-04

Back torso: base of neck 

to mid-back

2.49E-02 2.46E-01 1.10E-02 1.10E-02 1.09E-02 3.43E-02 1.09E-02 1.09E-02

Back torso: mid-back to 

lowest rib

2.49E-02 2.46E-01 1.10E-02 1.10E-02 8.E-04 5.E-04 8.E-04 8.E-04

Back torso: lowest rib to 

iliac crest

2.49E-02 2.46E-01 1.10E-02 1.10E-02 8.E-04 5.E-04 8.E-04 8.E-04

Back torso: buttocks 

(Iliac crest and below)

2.5E-03 2.46E-02 1.1E-03 1.1E-03 3.E-04 2.E-04 3.E-04 3.E-04

Right torso: base of 

neck to end of sternum

1.30E+00 2.90E+00 1.10E-02 2.90E+00 5.70E-02 3.43E-01 5.70E-02 5.70E-02

Right torso: end of 

sternum to lowest rib

1.30E+00 2.90E+00 1.10E-02 2.90E+00 8.E-04 5.E-04 8.E-04 8.E-04

Right torso: lowest rib to 

iliac crest

1.30E+00 2.90E+00 1.10E-02 2.90E+00 8.E-04 5.E-04 8.E-04 8.E-04

Right torso: iliac crest to 

pubis (right hip)

1.30E-01 2.90E-01 1.1E-03 2.90E-01 3.E-04 2.E-04 3.E-04 3.E-04

Left torso: base of neck 

to end of sternum

1.30E+00 1.10E-02 2.90E+00 1.10E-02 5.70E-02 1.3E-03 5.70E-02 5.70E-02

Left torso: end of 

sternum to lowest rib

1.30E+00 1.10E-02 2.90E+00 1.10E-02 8.E-04 5.E-04 8.E-04 8.E-04

Left torso: lowest rib to 

iliac crest

1.30E+00 1.10E-02 2.90E+00 1.10E-02 8.E-04 5.E-04 8.E-04 8.E-04

Left torso: iliac crest to 

pubis (Left hip)

1.30E-01 1.1E-03 2.90E-01 1.1E-03 3.E-04 2.E-04 3.E-04 3.E-04

a. Values less than 0.1 mrem shown to one significant digit. 

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 20 of 22
Document No. ORAUT-OTIB-0006 Revision No. 04 Effective Date: 06/20/2011 Page 60 of 61

Table A-14. DCFs used in determining dose equivalents (mGy/Gy × 1E-3rem-Gy/cGy-mGy).

Organ

Through 1970 1971-1985

HVL = 2.5 

mm Al

HVL = 2.0 

mm Al

HVL = 2.5 

mm Al

HVL = 2.5 

mm Al

HVL = 2.5 

mm Al

HVL = 2.5 

mm Al

HVL = 2.5 

mm Al

HVL = 2.5 

mm Al

PFG

Chest 

fluoro PA chest

LAT/OBL 

chest

AP lordotic 

chest PA chest

LAT/OBL 

chest

AP lordotic 

chest

Thyroid 1.74E-01 1.50E-01 1.74E-01 1.37E-01 8.68E-01 3.20E-02 1.15E-01

Eye brain 3.20E-02 2.10E-02 3.20E-02 1.37E-01 8.68E-01 3.20E-02 1.15E-01 3.17E-01

Ovaries N/A 6.00E-04 N/A N/A 2.33E-01 1.00E-03 6.00E-04 3.17E-01

Liver/gall 

bladder/spleen

4.51E-01 3.55E-01 4.51E-01 2.20E-01 4.73E-01 4.51E-01 2.20E-01 2.00E-03

Urinary 

bladder/prostate 

N/A 6.00E-04 N/A N/A 2.33E-01 1.00E-03 6.00E-04 4.73E-01

Colon rectum N/A 6.00E-04 N/A N/A 2.33E-01 1.00E-03 6.00E-04 2.00E-03

Testes N/A 1.00E-05 N/A N/A 1.80E-02 1.00E-05 1.00E-04 2.00E-03

Lungs male 4.19E-01 3.35E-01 4.19E-01 1.93E-01 4.73E-01 4.19E-01 1.93E-01 1.00E-05

Lungs female 4.51E-01 3.55E-01 4.51E-01 2.20E-01 3.53E-01 4.51E-01 2.20E-01 4.73E-01

Thymus 4.51E-01 3.55E-01 4.51E-01 2.20E-01 4.73E-01 4.51E-01 2.20E-01 3.53E-01

Esophagus 4.51E-01 3.55E-01 4.51E-01 2.20E-01 4.73E-01 4.51E-01 2.20E-01 4.73E-01

Stomach 4.51E-01 3.55E-01 4.51E-01 2.20E-01 4.73E-01 4.51E-01 2.20E-01 4.73E-01

Bone surfaces 4.51E-01 3.55E-01 4.51E-01 2.20E-01 4.73E-01 4.51E-01 2.20E-01 4.73E-01

Remainder 4.51E-01 3.55E-01 4.51E-01 2.20E-01 4.73E-01 4.51E-01 2.20E-01 4.73E-01

Breast 4.90E-02 3.20E-02 4.90E-02 2.55E-01 8.36E-01 4.90E-02 2.55E-01 4.73E-01

Uterus N/A 7.00E-04 N/A N/A 3.05E-01 1.30E-03 6.00E-04 8.36E-01

Bone marrow 

male

9.20E-02 6.90E-02 9.20E-02 3.70E-02 4.80E-02 9.20E-02 3.70E-02 1.50E-03

Bone marrow 

female

8.60E-02 6.30E-02 8.60E-02 2.90E-02 4.80E-02 8.60E-02 2.90E-02 4.80E-02

Table A-14. DCFs used in determining dose equivalents (mGy/Gy × 1E-3rem-Gy/cGy-mGy) (cont’d.).

Organ

1986 and later Through 1970 1971 and later

Through 

1970

HVL = 4.0 

mm Al

HVL = 4.0

mm Al

HVL = 2.0 

mm Al

HVL = 2.0 

mm Al

HVL = 2.5 

mm Al

HVL = 2.5 

mm Al

HVL = 2.0 

mm Al

PA chest

LAT/OBL 

chest

AP lumbar 

spine

LAT lumbar 

spine

AP lumbar 

spine

LAT lumbar 

spine AP pelvis

Thyroid 7.80E-02 1.64E-01 2.00E-04 1.00E-05 3.00E-04 1.00E-05 1.00E-05

Eye brain 7.80E-02 1.64E-01 2.00E-04 1.00E-05 3.00E-04 1.00E-05 1.00E-05

Ovaries 5.20E-03 2.50E-03 N/A N/A 2.16E-01 4.70E-02 N/A

Liver/gall bladder/spleen 6.74E-01 3.51E-01 1.60E-01 3.10E-02 2.16E-01 4.70E-02 1.74E-01

Urinary bladder/prostate 5.20E-03 2.50E-03 1.60E-01 3.10E-02 2.16E-01 4.70E-02 1.74E-01

Colon rectum 5.20E-03 2.50E-03 1.60E-01 3.10E-02 2.16E-01 4.70E-02 1.74E-01

Testes 1.00E-05 1.00E-04 N/A N/A 4.20E-03 8.00E-04 N/A

Lungs male 6.28E-01 3.13E-01 6.20E-02 1.00E-02 7.90E-02 1.40E-02 1.00E-03

Lungs female 6.74E-01 3.51E-01 6.20E-02 1.00E-02 7.90E-02 1.40E-02 1.00E-03

Thymus 6.74E-01 3.51E-01 6.20E-02 1.00E-02 7.90E-02 1.40E-02 1.00E-03

Esophagus 6.74E-01 3.51E-01 6.20E-02 1.00E-02 7.90E-02 1.40E-02 1.00E-03

Stomach 6.74E-01 3.51E-01 1.60E-01 3.10E-02 2.16E-01 4.70E-02 1.74E-01

Bone surfaces 6.74E-01 3.51E-01 1.60E-01 3.10E-02 2.16E-01 4.70E-02 1.74E-01

Remainder 6.74E-01 3.51E-01 1.60E-01 3.10E-02 2.16E-01 4.70E-02 1.74E-01

Breast 1.16E-01 3.43E-01 N/A N/A N/A N/A N/A

Uterus 5.20E-03 2.10E-03 2.17E-01 2.00E-02 2.87E-01 3.10E-02 2.44E-01

Bone marrow male 1.78E-01 7.60E-02 2.40E-02 1.50E-02 3.70E-02 2.20E-02 2.30E-02

Bone marrow female 1.72E-01 5.90E-02 2.40E-02 1.50E-02 3.70E-02 2.20E-02 2.30E-02

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

Page 21 of 22
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Table A-14. DCFs used in determining dose equivalents (mGy/Gy × 1E-3rem-Gy/cGy-mGy) 

(cont’d).

Organ

Through 1960 Through 1960

HVL = 2.0 mm Al

AP thoracic 

spine

HVL = 2.0 mm Al

LAT/OBL 

thoracic spine

HVL = 2.0 mm Al

AP/OBL cervical 

spine

HVL = 2.0 mm Al

LAT cervical 

spine

Thyroid 9.40E-02 5.60E-02 7.53E-01 5.60E-02

Eye brain 9.40E-03 4.00E-03 7.53E-01 5.60E-02

Ovaries N/A N/A N/A N/A

Liver/gall bladder/spleen 3.32E-01 1.28E-01 1.50E-02 2.30E-02

Urinary bladder/prostate 7.00E-04 1.00E-04 N/A N/A

Colon rectum 7.00E-04 1.00E-04 N/A N/A

Testes N/A N/A N/A N/A

Lungs male 3.32E-01 1.07E-01 1.50E-02 2.30E-02

Lungs female 2.37E-01 1.28E-01 1.50E-02 2.30E-02

Thymus 3.32E-01 1.28E-01 1.50E-02 2.30E-02

Esophagus 3.32E-01 1.28E-01 1.50E-02 2.30E-02

Stomach 3.32E-01 1.28E-01 1.50E-02 2.30E-02

Bone surfaces 3.32E-01 1.28E-01 1.50E-02 2.30E-02

Remainder 3.32E-01 1.28E-01 1.50E-02 2.30E-02

Breast 3.67E-01 5.60E-03 1.50E-02 2.30E-02

Uterus 5.00E-04 1.00E-04 N/A N/A

Bone marrow male 2.90E-02 1.80E-02 1.10E-02 1.70E-02

Bone marrow female 2.30E-02 1.40E-02 1.10E-02 1.70E-02

ATTACHMENT A

ORGAN DOSE EQUIVALENT TABLES

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