ORAU TEAM

Dose Reconstruction

Project for NIOSH

Oak Ridge Associated Universities I Dade Moeller I MJW Technical Services

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DOE Review Release 03/18/2013

Document Title:

Mound Site – Occupational Medical Dose

Document Number: ORAUT-TKBS-0016-3

Revision: 02

Effective Date: 03/14/2013

Type of Document: TBD

Supersedes: Revision 01 PC-3

Subject Expert(s): Elyse M. Thomas

Approval: Signature on File Approval Date: 03/07/2013

Donald N. Stewart, Document Owner

Concurrence: Signature on File Concurrence Date: 03/05/2013

John M. Byrne, Objective 1 Manager

Concurrence: Signature on File Concurrence Date: 03/05/2013

Edward F. Maher, Objective 3 Manager

Concurrence: Vickie S. Short Signature on File for Concurrence Date: 03/06/2013

Kate Kimpan, Project Director

Approval: Signature on File Approval Date: 03/14/2013

James W. Neton, Associate Director for Science

New Total Rewrite Revision Page Change

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

REVISION AND DISCARD / DESTROY ALL COPIES OF THE PRIOR REVISION.
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 2 of 18

PUBLICATION RECORD

EFFECTIVE 

DATE

REVISION 

NUMBER DESCRIPTION

05/28/2004 00 New technical basis document for the Mound Site – Occupational 

Medical Dose. First approved issue. Initiated by Jeffrey S. Vollmer.

09/09/2004 01 Approved Issue of Revision 01. Initiated by Jeffrey S. Vollmer.

07/08/2005 01 PC-1 Approved page change revision. Page change initiated to correct 

organ dose estimates in Table 3-4 on page 7, in Section 3. No 

retraining is required. Initiated by Elyse M. Thomas.

Document Owner:

Signature on File 07/05/2005

Jeffrey S. Vollmer, TBD Team Leader

Signature on File 07/05/2005

Judson L. Kenoyer, Task 3, Manager

Signature on File 06/29/2005

Richard E. Toohey, Project Director

Signature on File 07/08/2005

James W. Neton, Associate Director for Science

03/31/2006 01 PC-2 Approved page change revision. Page change initiated to include 

boilerplate language in Section 3.1 on pages 5 and 6. Makes 

changes to Tables 3-6, 3-7 and 3-8 on pages 9 and 10 as requested 

by NIOSH. No sections were deleted. Training required: As 

determined by the Task Manager. Initiated by Paul J. Demopoulos.

Signature on File 03/17/2006

Paul J. Demopoulos, TBD Team Leader

John M. Byrne Signature on File for 03/17/2006

Judson L. Kenoyer, Task 3 Manager

Signature on File 03/17/2006

Edward F. Maher, Task 5 Manager

Signature on File 03/22/2006

Kate Kimpan, Project Director

Signature on File 03/31/2006

James W. Neton, Associate Director for Science

03/02/2009 01 PC-3 Approved page change initiated to remove information pertaining to 

Monsanto Chemical Company, the subject of a class of employees 

added to the Special Exposure Cohort. In Table 3-2 on page 7 in 

Section 3.2, a change was made in the first row to remove “Pre” from 

1949. NIOSH required language was revised on pages 5 and 6 in 

Section 3.1. References were updated on pages 6 - 8, 15 in 

Sections 3.1, 3.2, 3.3, and Reference Section. Incorporates formal 

internal review comments. No changes occurred as a result of 

formal NIOSH review. No sections were deleted. Training required: 

As determined by the Task Manager. Initiated by Donald N. Stewart.

Signature on File 02/25/2009

Donald N. Stewart, Document Owner

Signature on File for 02/26/2009 John M. Byrne, Task 3 Manager
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 3 of 18

Signature on File 02/26/2009

Edward F. Maher, Task 5 Manager

Signature on File 02/26/2009

Kate Kimpan, Project Director

Signature on File 03/02/2009

James W. Neton, Associate Director for Science

03/14/2013 02 Revision initiated to update the TBD with historical documents 

captured since the last revision, and to add skin doses for all 

procedures and periods. Incorporates formal internal review 

comments. Constitutes a total rewrite of the document. Training 

required: As determined by the Objective Manager. Initiated by 

Elyse M. Thomas.
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 4 of 18

TABLE OF CONTENTS

SECTION TITLE PAGE

Acronyms and Abbreviations ............................................................................................................... 5

3.0 Introduction .............................................................................................................................. 6

3.1 Purpose ................................................................................................................................... 7

3.2 Scope....................................................................................................................................... 7

3.3 Examination Types, Frequency, and Equipment ...................................................................... 7

3.3.1 Photofluorography ........................................................................................................ 7

3.3.2 Chest Radiography from 1947 to 1969 ......................................................................... 8

3.3.3 Chest Radiography from 1970 to 1979 ......................................................................... 8

3.3.4 Chest Radiography from 1980 to 1987 ......................................................................... 8

3.3.5 Chest Radiography from 1988 to 1997 ......................................................................... 9

3.3.6 Chest Radiography from 1998 to 2003 ......................................................................... 9

3.4 Organ Dose Calculations ....................................................................................................... 10

3.5 Uncertainty............................................................................................................................. 13

3.6 Attributions and Annotations .................................................................................................. 13

References ........................................................................................................................................ 14

Glossary ............................................................................................................................................ 16

LIST OF TABLES

TABLE TITLE PAGE

3-1 Frequency of chest X-rays for occupational health screening................................................... 7

3-2 Technique factors used for PA chest X-rays.............................................................................9

3-3 Organ dose estimates for PA chest radiographs .................................................................... 10

3-4 Organ dose estimates for LAT chest radiographs from 1988 to 2003..................................... 11

3-5 Skin dose guidance for various chest projections and periods ............................................... 11

3-6 Skin dose from various chest projections, 1947 to 2003......................................................... 12
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 5 of 18

ACRONYMS AND ABBREVIATIONS

CFR Code of Federal Regulations

cGy centigray

cm centimeter

DOE U.S. Department of Energy

DOL U.S. Department of Labor

EEOICPA Energy Employees Occupational Illness Compensation Program Act of 2000

ENSD entrance skin dose

ESE entrance skin exposure

EXSD exit skin dose

Gy gray

HVL half-value layer

ICRP International Commission on Radiological Protection

kVp peak kilovoltage

LAT lateral

mA milliampere

mAs milliampere-second

mGy milligray

mm millimeter

mR milliroentgen

mrem millirem

NCRP National Council on Radiation Protection and Measurements

NIOSH National Institute for Occupational Safety and Health

ORAU Oak Ridge Associated Universities

PFG photofluorography

POC probability of causation

PA posterior-anterior

RSD remote skin dose

s second

SRDB Ref ID Site Research Database Reference Identification (number)

SSD source-to-skin distance

TBD technical basis document

U.S.C. United States Code

§ section or sections
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 6 of 18

3.0 INTRODUCTION

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

facility encompassed by EEOICPA.

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

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

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

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

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

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

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

determined in accordance with the POC [probability of causation1

] guidelines established under 

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

guidelines (nor the dose reconstruction regulation, 42 C.F.R. Pt. 82) restrict the “performance of duty” 

referred to in 42 U S. C. § 7384n(b) to nuclear weapons work (NIOSH 2010).

The statute also includes a definition of a DOE facility that excludes “buildings, structures, premises, 

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

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

definition excludes Naval Nuclear Propulsion Facilities from being covered under the Act, the section 

of EEOICPA that deals with the compensation decision for covered employees with cancer [i.e., 42 

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

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

exposures at covered facilities in its dose reconstructions for employees at DOE facilities, including 

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

external occupational radiation exposures are considered valid for inclusion in a dose reconstruction. 

No efforts are made to determine the eligibility of any fraction of total measured exposure for inclusion 

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

occupationally derived (NIOSH 2010):

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

conventional structures

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

reasons

 1 The U.S. Department of Labor (DOL) is ultimately responsible under the EEOICPA for determining the POC.
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 7 of 18

3.1 PURPOSE

Medical X-ray procedures that were performed for occupational health screening are required to be 

considered under EEOICPA as a contributor to the occupational radiation exposure of Mound 

workers. In general, the dose from such exposures was not measured, considered, or included as 

part of the overall occupational exposure of the employee, but is required to be estimated under 

EEOICPA. This technical basis document (TBD) describes the technical aspects of dose 

reconstruction from medical X-rays administered before employment and periodically thereafter for 

occupational health screening and as a condition of employment.

3.2 SCOPE

Section 3.3 describes the types, frequencies, and equipment Mound used over the years for medical 

X-ray procedures. Section 3.4 describes the technical bases of organ doses from those procedures, 

and Section 3.5 discusses uncertainty. Attributions and annotations, indicated by bracketed callouts 

and used to identify the source, justification, or clarification of the associated information, are 

presented in Section 3.6.

3.3 EXAMINATION TYPES, FREQUENCY, AND EQUIPMENT

In the absence of individual X-ray examination data in the claim file records, dose reconstructors 

should assume the X-ray examination frequencies listed in Table 3-1. The following sections provide 

more details for the periods in Table 3-1.

Table 3-1. Frequency of chest X-rays for occupational health screening.

Period Frequency Comment

1947–1969a,b Preemployment, annual (some 

semi-annual), and termination

All employees. It is uncertain which employees might 

have had semiannual X-rays. 

1970–1979b Annually Certain employees according to job category.

Every 2 yr Certain employees according to job category.

1980–1987c Every 6 yr Employees under age 35.

Every 4 yr Employees between age 35 to 44.

Every 2 yr Employees age 45 and older.

Annually Asbestos workers.

Annually Any employee considered at risk in workplace (e.g., 

welders, etc).

1988–1997d Every 6 yr Employees under age 40.

Every 4 yr Employees between age 40 and 50.

Every 2 yr Employees age 50 and older.

Annually Smoker, any age.

1998–2003e Every 5 yr Employees under age 35.

Every 4 yr Employees between age 35 to 44.

Every 2 yr Employees age 45 and older.

Annually Smoker, any age.

a. Bradley (1948, 1949, 1950).

b. KMCN (ca. 2002, p. 1).

c. KMCN (ca. 2002, p. 4).

d. KMCN (ca. 2002, p. 7).

e. KMCN (ca. 2002, p. 87).

3.3.1 Photofluorography

No evidence has been found for photofluorography (PFG) at Mound, either in the collected historical 

documents or in the individual claim file records [1]. Therefore, dose reconstructors should not 

assume PFG X-rays for Mound workers.
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 8 of 18

3.3.2 Chest Radiography from 1947 to 1969

From 1947 through 1950, the X-rays of workers appear to have been taken on site at Mound, with a 

Picker X-ray machine in the Administration Building (Lueckerath 1948, p. 52). During this time, all 

workers appear to have received a preemployment posterior-anterior (PA) chest X-ray, an annual PA 

chest X-ray during the annual physical examination, and a termination PA chest X-ray (Bradley 1948,

1949, 1950). Some of the workers were X-rayed semiannually, although it is uncertain which workers 

these were. Dose reconstructors should include dose from the semiannual PA chest X-rays when 

they are found in the claim file records.

Not much more is known about the equipment or techniques starting in 1951. It appears that the 

workers continued to receive a preemployment PA chest X-ray, an annual PA chest X-ray during the 

annual physical examination, and a termination PA chest X-ray (KMCN ca. 2002, p. 1). The organ 

doses from this period come from ORAUT-OTIB-0006, Dose Reconstruction from Occupational 

Medical X-Ray Procedures (ORAUT-2011b).

3.3.3 Chest Radiography from 1970 to 1979

The frequency of the chest X-rays seems to have stayed the same during this period. Most 

employees probably received a preemployment, annual, and termination PA chest X-ray. It is 

possible that some workers were X-rayed every other year (KMCN ca. 2002, p. 1). Dose 

reconstructors should assume an annual frequency of PA chest X-rays unless the claim file records 

show that they were done every other year.

In 1973, the Mound newsletter published an article about the occupational health program with a 

picture of the X-ray equipment, perhaps after new equipment was purchased (Monsanto 1973, p. 9). 

The article mentions the preemployment chest X-rays. Survey measurements are available for 1974, 

on a Westinghouse machine (Moser 1974). The survey form states the total filtration in the machine 

is 3 mm Al equivalent, and that the exposure time is 1/20 of a second for chest X-rays (assuming PA 

chest X-rays). The peak kilovoltage for chests is not specified. In spite of incomplete information and 

some issues in interpreting the survey results, it is reasonable to assume that the incident air kerma 

for this period is approximately 0.013 cGy, given the measurement data of 11 mR at 183 cm, 

converting from exposure to air kerma at a skin entrance of 155 cm, and assuming 80 kVp for the PA 

chest and a half-value layer (HVL) of 2.6 mm Al (based on 3 mm Al total filtration at 80 kVp). 

3.3.4 Chest Radiography from 1980 to 1987

A formal schedule of when chest X-rays would be taken as part of the physical examination process 

was developed during this period (Reagan 1983). As part of the new frequency schedule, new 

employees might not have had preemployment X-rays if an X-ray report was available for one of the 

last 3 years. The schedule is summarized in Table 3-1.

The Westinghouse machine might still have been in use during this period, although that is not 

definitively known. A Kodak technique chart that was developed specifically for Mound and dated in 

1981 provides technique factors for PA and lateral (LAT) chests for this period (Kodak 1981). The PA 

chest technique (for a 23-cm chest) is given as 77 kVp, 10 mAs, and 106 kVp, and the LAT chest 

technique (for a 34-cm LAT chest) as 13.5 mAs. Using average air kerma rates from National Council 

on Radiological Protection and Measurements (NCRP) Report 102 (NCRP 1997), these technique 

factors result in an incident air kerma of 0.02 cGy for PA chest X-rays. 
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3.3.5 Chest Radiography from 1988 to 1997

An X-ray machine survey from 1988 shows that the X-ray equipment during this period was a 

Transworld machine (Weinel 1988). While some in house survey results are available for several 

years throughout the late 1980s and the early 1990s, no technique factors for chest X-rays are 

recorded. A U.S. Food and Drug Administration inspector surveyed the same Transworld machine in 

1995 and 1997 (Barnett 1997). At that time, the ESEs the FDA inspector measured were 16.4 mR 

and 15.9 mR, respectively. The higher of the two measurements was used to determine the incident 

air kerma, which is 0.0144 cGy for this period.

The frequency of screening seems to have changed during this period (KMCN ca. 2002, p. 7). In 

comparison with the previous period, it was recommended that workers have a chest X-ray every 

6 years up to age 40 (instead of age 35), every 4 years up to age 50 (instead of 45), and every 

2 years age 50 and older (instead of age 45 and older). These are summarized in Table 3-1.

In 1988, a LAT chest projection was required for women with known breast augmentations; the 

frequency of these examinations is not known (KMCN ca. 2002, p. 2). Dose reconstructors should 

include dose from LAT chest projections when present in the claim file records for this period. 

3.3.6 Chest Radiography from 1998 to 2003

The FDA surveyed the Transworld X-ray machine again in 2000, and measured the entrance skin 

exposure (ESE) as 14.9 mR (Bolen 2000). Because this is not a big change from the previous period

(ESE = 15.9 mR), the organ doses for this period are the same as those for the last period.

However, the screening frequency appears to have changed again (KCMN ca. 2002, p. 87). This 

slightly different examination frequency is summarized in Table 3-1 along with the other frequencies 

over the years for different groups based on information from the Mound data files. 

In the absence of claim file records, dose reconstructors should assign dose from X-rays according to 

the frequency in Table 3-1.

Table 3-2 summarizes the technical parameters and incident air kerma for PA and LAT chest 

projections.

Table 3-2. Technical factors for PA and LAT chest X-rays.

Period

Chest 

projection

Total 

filtration

(mm Al) HVL (mm Al)

Current

(mA)

Voltage

(kVp)

Exposure 

time (s)

Incident air 

kerma 

(cGy)

1947–1959a PA Unknown Unknown Unknown Unknown Unknown 0.2

1970–1979b PA 3.0 2.5 (assumed) Unknown 80 

(assumed)

1/20 0.013

1980–1987c PA Unknown 2.5 (assumed) Unknown 

(10 mAs)

77 Unknown 

(10 mAs)

0.02

1988–2003d,e PA Unknown 3.0 200 84 1/20 0.0144

LAT Unknown 3.0 200 110 1/20 0.036f

a. From ORAUT (2011b). 

b. Moser (1974, p. 33–39).

c. KMCN ca. (2002, pp. 15–16).

d. Barnett (1997, p. 84).

e. See Section 3.2.6.

f. Incident air kerma equals 2.5 times the PA incident air kerma for same period (2.5 × 0.0144 cGy = 0.036 mGy).
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 10 of 18

3.4 ORGAN DOSE CALCULATIONS

Organ doses are calculated by multiplying the incident air kerma in Tables 3-2 and 3-3 by the 

appropriate organ dose conversion factor either from Tables A.2 to A.8 in International Commission 

on Radiological Protection (ICRP) Publication 34 (ICRP 1982) or their substitutes from ORAUT-OTIB0006 (2011b). The specific organ doses are shown in Tables 3-3 and 3-4 for PA and LAT chest 

procedures for all periods. Skin dose guidance is provided in Table 3-5, and skin doses for all areas 

of skin are provided in Table 3-6.

Table 3-3. Organ dose estimates (rem) for PA chest radiographs.

Organ

Organ dose 

1947–1969

Organ dose 

1970–1979

Organ dose 

1980–1987

Organ dose 

1988–1997

Organ dose 

1998–2003

Thyroid 3.48E-02 4.16E-04 6.66E-04 6.62E-04 6.62E-04

Eye/brain 6.40E-03 4.16E-04 6.66E-04 6.62E-04 6.62E-04

Ovaries 2.50E-02 1.30E-05 2.08E-05 2.59E-05 2.59E-05

Urinary bladder/prostate 2.50E-02 1.30E-05 2.08E-05 2.59E-05 2.59E-05

Colon/rectum 2.50E-02 1.30E-05 2.08E-05 2.59E-05 2.59E-05

Testes 5.00E-03 1.30E-07 2.08E-07 1.44E-07 1.44E-07

Male lungs 8.38E-02 5.45E-03 8.72E-03 7.14E-03 7.14E-03

Female lungs 9.02E-02 5.86E-03 9.38E-03 7.70E-03 7.70E-03

Thymus 9.02E-02 5.86E-03 9.38E-03 7.70E-03 7.70E-03

Esophagus 9.02E-02 5.86E-03 9.38E-03 7.70E-03 7.70E-03

Stomach 9.02E-02 5.86E-03 9.38E-03 7.70E-03 7.70E-03

Bone surface 9.02E-02 5.86E-03 9.38E-03 7.70E-03 7.70E-03

Liver/gall bladder/spleen/pancreas 9.02E-02 5.86E-03 9.38E-03 7.70E-03 7.70E-03

Remainder organs 9.02E-02 5.86E-03 9.38E-03 7.70E-03 7.70E-03

Breast 9.80E-03 6.37E-04 1.02E-03 9.94E-04 9.94E-04

Uterus 2.50E-02 1.69E-05 2.70E-05 3.31E-05 3.31E-05

Male bone marrow 1.84E-02 1.20E-03 1.91E-03 1.68E-03 1.68E-03

Female bone marrow 1.72E-02 1.12E-03 1.79E-03 1.61E-03 1.61E-03

Entrance skina 2.70E-01 1.76E-02 2.81E-02 2.02E-02 2.02E-02

a. Entrance skin dose was determined by multiplying the incident air kerma by backscatter factors of 1.35 and 1.4, for 

HVLs of 2.5 and 3.0 mm Al, respectively, from NCRP (1997, Table B-8).
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Table 3-4. Organ dose estimates (rem) for LAT 

chest radiographs from 1988 to 2003.

Organ Organ dose

Thyroid 4.79E-03

Eye/brain 4.79E-03

Ovaries 3.24E-05

Urinary bladder/prostate 3.24E-05

Colon/rectum 3.24E-05

Testes 3.60E-06

Male lungs 8.50E-03

Female lungs 9.61E-03

Thymus 9.61E-03

Esophagus 9.61E-03

Stomach 9.61E-03

Bone surface 9.61E-03

Liver/gall bladder/spleen/pancreas 9.61E-03

Remainder organs 9.61E-03

Breast 1.03E-02

Uterus 3.24E-05

Male bone marrow 1.73E-03

Female bone marrow 1.37E-03

Entrance skina 5.04E-02

a. Entrance skin dose was determined by multiplying the 

incident air kerma by backscatter factor of 1.4 for HVL of 

3.0 mm Al, from NCRP (1997, Table B-8).

Table 3-5. Skin dose guidance for various chest projections and periods.

a

Area of skin

PA 

through 1970

LAT 

through 1970

PA 

1971-present

LAT 

1971-present

Right front shoulder EXSD ENSD EXSD ENSD

Right back shoulder ENSD ENSD ENSD ENSD

Left front shoulder EXSD EXSD EXSD EXSD

Left back shoulder ENSD EXSD ENSD EXSD

Right upper arm to elbow ENSD ENSD 10% ENSD ENSD

Left upper arm to elbow ENSD EXSD 10% ENSD EXSD

Left hand ENSD 10% ENSD 10% ENSD 10% ENSD

Right hand ENSD 10% ENSD 10% ENSD 10% ENSD

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

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

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

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

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

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

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

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

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

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

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

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

Left side of neck ENSD Eye/Brain 10% ENSD 10% ENSD

Right side of neck ENSD Eye/Brain 10% ENSD 10% ENSD

Back of head 10% ENSD Eye/Brain 10% ENSD 10% ENSD

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

Back of neck ENSD Eye/Brain 10% ENSD 10% ENSD

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

PA 

through 1970

LAT 

through 1970

PA 

1971-present

LAT 

1971-present

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

a. ENSD = entrance skin dose; EXSD = exit skin dose; RSD = remote skin dose.

Table 3-6. Skin dose (rem) from various chest projections, 1947 to 2003.

a

Area of skin

PA

1947–1969

PA

1970–1979

PA

1980–1987

PA

1988–2003

LAT

1988–2003

Right front shoulder 5.9E-03 4.E-04 6.E-04 5.E-04 5.04E-02

Right back shoulder 2.70E-01 1.76E-02 2.81E-02 2.02E-02 5.04E-02

Left front shoulder 5.9E-03 4.E-04 6.E-04 5.E-04 2.E-04

Left back shoulder 2.70E-01 1.76E-02 2.81E-02 2.02E-02 2.E-04

Right upper arm to elbow 2.70E-01 1.8E-03 2.8E-03 2.0E-03 5.04E-02

Left upper arm to elbow 2.70E-01 1.8E-03 2.8E-03 2.0E-03 2.E-04

Left hand 2.70E-01 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Right hand 2.70E-01 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Left elbow, forearm, wrist 2.70E-01 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Right elbow, forearm, wrist 2.70E-01 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Right side of head including ear and temple 2.70E-02 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Left side of head including ear and temple 2.70E-02 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Front left thigh 8.E-05 5.E-06 9.E-06 7.E-06 8.E-06

Back left thigh 8.E-05 5.E-06 9.E-06 7.E-06 8.E-06

Front right thigh 8.E-05 5.E-06 9.E-06 7.E-06 8.E-06

Back right thigh 8.E-05 5.E-06 9.E-06 7.E-06 8.E-06

Left knee and below 3.E-05 2.E-06 3.E-06 2.E-06 3.E-06

Right knee and below 3.E-05 2.E-06 3.E-06 2.E-06 3.E-06

Left side of face 6.4E-03 3.7E-03 7.E-04 7.E-04 5.0E-03

Right side of face 6.4E-03 3.7E-03 7.E-04 7.E-04 5.0E-03

Left side of neck 2.70E-01 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Right side of neck 2.70E-01 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Back of head 2.70E-02 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Front of neck 6.4E-03 3.7E-03 7.E-04 7.E-04 5.0E-03

Back of neck 2.70E-01 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Front torso: base of neck to end of sternum 5.9E-03 4.E-04 6.E-04 5.E-04 9.6E-03

Front torso: end of sternum to lowest rib 5.9E-03 4.E-04 6.E-04 5.E-04 9.6E-03

Front torso: lowest rib to iliac crest 5.9E-03 4.E-05 6.E-05 5.E-05 1.E-03

Front torso: iliac crest to pubis 6.E-04 4.E-05 6.E-05 5.E-05 1.E-03

Back torso: base of neck to mid-back 2.70E-01 1.76E-02 2.81E-02 2.02E-02 9.6E-03

Back torso: mid-back to lowest rib 2.70E-01 1.76E-02 2.81E-02 2.02E-02 9.6E-03

Back torso: lowest rib to iliac crest 2.70E-01 1.8E-03 2.8E-03 2.0E-03 1.E-03

Back torso: buttocks (Iliac crest and below) 2.70E-02 1.8E-03 2.8E-03 2.0E-03 1.E-03

Right torso: base of neck to end of sternum 2.70E-01 1.76E-02 2.81E-02 2.02E-02 5.04E-02
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 13 of 18

Area of skin

PA

1947–1969

PA

1970–1979

PA

1980–1987

PA

1988–2003

LAT

1988–2003

Right torso: end of sternum to lowest rib 2.70E-01 1.76E-02 2.81E-02 2.02E-02 5.04E-02

Right torso: lowest rib to iliac crest 2.70E-01 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Right torso: iliac crest to pubis (right hip) 2.70E-02 1.8E-03 2.8E-03 2.0E-03 5.0E-03

Left torso: base of neck to end of sternum 2.70E-01 1.76E-02 2.81E-02 2.02E-02 2.E-04

Left torso: end of sternum to lowest rib 2.70E-01 1.76E-02 2.81E-02 2.02E-02 2.E-04

Left torso: lowest rib to iliac crest 2.70E-01 1.8E-03 2.8E-03 2.0E-03 2.E-05

Left torso: iliac crest to pubis (left hip) 2.70E-02 1.8E-03 2.8E-03 2.0E-03 2.E-05

a. Values less than 1 mrem shown to one significant digit. 

3.5 UNCERTAINTY 

ORAUT-OTIB-0006 (ORAUT 2011b) lists the major sources of uncertainty in X-ray output intensity 

and subsequent effect on dose to the worker. The five sources of uncertainty are:

1. X-ray beam measurement error (±2%),

2. Variation in peak kilovoltage (±9%),

3. Variation in X-ray beam current (±5%),

4. Variation in exposure time (±25%), and

5. Variation in source-to-skin distance (SSD) as a result of worker size (±10%).

The 10% uncertainty in output intensity as a result of worker size was based on an inverse square 

correction of output intensity changes from differences from the standard chest thickness of ±7.5 cm. 

These uncertainties are assumed to be random; therefore, the combined statistical uncertainty was 

calculated as the square root of the sum of the squares of all the uncertainties, which is ±28.9%. 

Rounding this up to ±30% provides 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%.

3.6 ATTRIBUTIONS AND ANNOTATIONS

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

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

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

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

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

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

[1] Thomas, Elyse. Oak Ridge Associated Universities (ORAU) Team. Principal Medical 

Dosimetrist. January 2013.

Reviews of claims with submitted X-ray data and historical records do not indicate any 

references at all to PFG having been performed for screening.
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 14 of 18

REFERENCES

Barnett, J. E., 1997, “QA X-Ray Facility Survey - Sept. 23, 1997, Mound, Ohio - DOE Facility ID No.: 

703404303,” letter to E. Reagan (EG&G Mound Applied Technologies), U.S. Department of 

Health and Human Services, Food and Drug Administration, Cincinnati, Ohio, October 1. 

[SRDB Ref ID: 3245, p. 84]

Bolen, R. T., 2000, “QA X-Ray Facility Survey, June 13 & August 2, 2000,” letter to M. French (BWXT 

of Ohio), U.S. Department of Health and Human Services, Food and Drug Administration, 

Cincinnati, Ohio, September 11. [SRDB Ref ID: 3245, p. 98]

Bradley, J. E., 1948, Monthly Health Information Report, August 1-31, 1948, MLM-177, Monsanto 

Chemical Company, Mound Laboratory, Miamisburg, Ohio, September 23. [SRDB Ref ID: 

27282]

Bradley, J. E., 1949, Monthly Health Information Report April 1-30, 1949, MLM-327, Monsanto 

Chemical Company, Mound Laboratory, Miamisburg, Ohio, September 23. [SRDB Ref ID: 

24922]

Bradley, J. E., 1950, Monthly Health Information Report, April 1-30, 1950, MLM-459, Monsanto 

Chemical Company, Mound Laboratory, Miamisburg, Ohio. [SRDB Ref ID: 114739]

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

Diagnostic Radiology, Publication 34, Pergamon Press, Oxford, England. [SRDB Ref ID: 

32466]

KMCN (Kettering Medical Center Network), ca. 2002, “History of X-Ray Program at Mound 

Laboratory, Miamisburg, Ohio,” Kettering, Ohio. [SRDB Ref ID: 3245, p. 1]

Kodak (Eastman Kodak Company), 1981, “Adult Technic Charts,” Kodak Custom Computer Technic 

Service, October 27. [SRDB Ref ID: 3245, p. 11]

Lueckerath, E. W., 1948, Engineering Manual for Equipment and Services, Volume 1, MLM-266, 

Monsanto Chemical Company, Dayton Ohio, November. [SRDB Ref ID: 24495]

Monsanto (Monsanto Chemical Company), 1973, “Keeping Healthy,” Mound-Vue, volume XIV, 

number 3, Miamisburg, Ohio, July, p. 9. [SRDB Ref ID: 84826]

Moser, L. G., 1974, “Radiological Survey Data,” Mound Laboratory, Miamisburg, Ohio, September 26. 

[SRDB Ref ID: 48814, p. 33]

NCRP (National Council on Radiation Protection and Measurements), 1997, Medical X-Ray Electron 

Beam and Gamma-Ray Protection for Energies Up to 50 MeV (Equipment Design,

Performance and Use), Report No. 102, Bethesda, Maryland. 

NIOSH (National Institute for Occupational Safety and Health), 2010, Radiation Exposures Covered 

for Dose Reconstructions Under Part B of the Energy Employees Occupational Illness 

Compensation Program Act, DCAS-IG-003, Rev. 1, Division of Compensation Analysis and 

Support, Cincinnati, Ohio, October 5.

ORAUT (Oak Ridge Associated Universities Team), 2011a, Guidance on Assigning Occupational 

X-Ray Dose Under EEOICPA for X-Rays Administered Off Site, ORAUT-OTIB-0079, Rev. 00, 

Oak Ridge, Tennessee, January 3.
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 15 of 18

ORAUT (Oak Ridge Associated Universities Team), 2011b, Dose Reconstruction from Occupational 

Medical X-Ray Procedures, ORAUT-OTIB-0006, Rev. 04, Oak Ridge, Tennessee, June 20.

Reagan, E. J., 1983, “Schedule of X-rays - Effective Immediately,” memorandum to Staff, Monsanto 

Research Corporation, Mound Laboratory, Miamisburg, Ohio, September 30. [SRDB Ref ID: 

3245, p. 4]

Weinel, B., 1988, “Radiological Survey Data,” September 30. [SRDB Ref ID: 3245, pg. 33]
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 16 of 18

GLOSSARY

absorbed dose

Amount of energy (ergs or joules) deposited in a substance by ionizing radiation per unit mass 

(grams or kilograms) of the substance and measured in units of rads or grays.

alternating electric current

Electric current that flows alternately in one direction then the other.

ampere (A)

International System unit of electrical current equal to 1 coulomb per second.

beam quality

Empirical measure of the ability of a polyenergetic X-ray beam to penetrate matter affected by 

the kilovoltage, anode material, voltage waveform, and filtration of an X-ray tube. The halfvalue layer in millimeters of aluminum is a typical measure of X-ray beam quality for the 

energy range used in radiography. Also called beam hardness. See filtration.

dose conversion factor

Multiplier for conversion of potential dose to the personal dose equivalent to the organ of 

interest (e.g., liver or colon). In relation to radiography, ratio of dose equivalent in tissue or 

organ to entrance kerma in air at the surface of the person being radiographed.

dose equivalent

In units of rem or sievert, product of absorbed dose in tissue multiplied by a weighting factor 

and sometimes by other modifying factors to account for the potential for a biological effect 

from the absorbed dose.

electric current

Amount of charge per time passing a point in a conductor in units of amperes.

exposure

(1) In general, the act of being exposed to ionizing radiation. See acute exposure and chronic 

exposure. (2) Measure of the ionization produced by X- and gamma-ray photons in air in units 

of roentgens.

film

(1) In the context of external dosimetry, radiation-sensitive photographic film in a light-tight 

wrapping. See film dosimeter. (2) X-ray film.

filtration

The process of filtering an X-ray beam, usually with millimeter thicknesses of aluminum 

material between the X-ray source and the film that preferentially absorbs photons from the 

beam. Usually measured in equivalent millimeters of aluminum. See beam quality and halfvalue layer.

frequency

In relation to electromagnetic radiation, number of cycles per second in units of hertz.

gray (Gy)

International System unit of absorbed radiation dose, which is the amount of energy from any 

type of ionizing radiation deposited in any medium; 1 gray equals 1 joule per kilogram or 

100 rads.
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half-value layer (HVL)

Thickness of a specified substance, usually specified in equivalent millimeters of aluminum, 

which, when introduced in the path of a given beam of radiation, reduces the kerma rate by 

one-half. See filtration.

image

Pattern of differential absorption of X-rays in tissue formed on radiographic (X-ray) film from 

interaction of light from intensifying screens and the film emulsion and after photographic 

development.

image quality

Detail, sharpness, optical density, and contrast of the images of structural details in a 

radiograph.

incident air kerma

Sum of the kinetic energy of all charged particles that are liberated per unit mass of air at the 

point where an X-ray beam enters the skin surface (without backscatter). The unit is the gray; 

1 gray equals 1 joule per kilogram.

kerma

Measure in units of absorbed dose (usually grays but sometimes rads) of the energy released 

by radiation from a given amount of a substance. Kerma is the sum of the initial kinetic 

energies of all the charged ionizing particles liberated by uncharged ionizing particles 

(neutrons and photons) per unit mass of a specified material. Free-in-air kerma refers to the 

amount of radiation at a location before adjustment for any external shielding from structures 

or terrain. The word derives from kinetic energy released per unit mass.

phantom

Any structure that contains one or more tissue substitutes (any material that simulates a body 

of tissue in its interaction with ionizing radiation) and is used to simulate radiation interactions 

in the human body. Phantoms are primarily used in the calibration of in vivo counters and 

dosimeters.

photofluorography (PFG)

Historical radiographic technique to produce chest images for screening a large number of 

people in a short period of time. The X-ray image produced on a fluorescent screen was 

photographed on 4- by 5-inch film. PFG was the primary method of screening large 

populations for tuberculosis before the advent of nonradiographic screening methods. Also 

called fluorography or mass miniature radiography. Not to be confused with fluoroscopy.

rad

Traditional unit for expressing absorbed radiation dose, which is the amount of energy from 

any type of ionizing radiation deposited in any medium. A dose of 1 rad is equivalent to the 

absorption of 100 ergs per gram (0.01 joules per kilogram) of absorbing tissue. The rad has 

been replaced by the gray in the International System of Units (100 rads = 1 gray). The word 

derives from radiation absorbed dose.

radiography

The process of producing images on film (or other media) with radiation.

rem

Traditional unit of radiation dose equivalent that indicates the biological damage caused by 

radiation equivalent to that caused by 1 rad of high-penetration X-rays multiplied by a quality 
Document No. ORAUT-TKBS-0016-3 Revision No. 02 Effective Date: 03/14/2013 Page 18 of 18

factor. The sievert is the International System unit; 1 rem equals 0.01 sievert. The word 

derives from roentgen equivalent in man; rem is also the plural.

roentgen (R, sometimes r)

Unit of photon (gamma or X-ray) exposure for which the resultant ionization liberates a positive 

or negative charge equal to 2.58 × 10-4 coulombs per kilogram (or 1 electrostatic unit of 

electricity per cubic centimeter) of dry air at 0 degrees Celsius and standard atmospheric 

pressure. An exposure of 1 roentgen is approximately equivalent to an absorbed dose of 1 

rad in soft tissue for higher energy photons (generally greater than 100 kiloelectron-volts).

sievert (Sv)

International System unit for dose equivalent, which indicates the biological damage caused 

by radiation. The unit is the radiation value in gray (equal to 1 joule per kilogram) multiplied by 

a weighting factor for the type of radiation and a weighting factor for the tissue; 1 sievert 

equals 100 rem.

source-to-skin distance (SSD)

Distance from the X-ray machine target (anode) to the skin of the person being radiographed. 

This distance varies with the size of the person being radiographed.

technique

Combination of X-ray machine settings (technique factors) used to produce radiographs, which 

consists of the kilovoltage, tube current (milliamperes), and exposure time (seconds). The last 

two parameters are often multiplied to yield the electric charge that has crossed the X-ray tube 

during the exposure in units of milliampere-seconds. Any combination of time and tube 

current that produces a given product in milliampere-seconds produces the same exposure for 

a fixed peak kilovoltage. Also called technic.

volt

International System unit of potential difference and electromotive force; 1 V equals 1 joule per 

coulomb.