ORAU TEAM

Dose Reconstruction

Project for NIOSH

Oak Ridge Associated Universities I Dade Moeller I MJW Technical Services

Page 1 of 21

DOE Review Release 03/24/2014

Document Title:

Pantex Plant – Occupational Medical Dose

Document Number: ORAUT-TKBS-0013-3

Revision: 03

Effective Date: 03/20/2014

Type of Document: TBD

Supersedes: Revision 02

Subject Expert(s): Elyse M. Thomas

Approval: Signature on File Approval Date: 03/18/2014

Dale D. Thomas III, Document Owner

Concurrence: Signature on File Concurrence Date: 03/18/2014

John M. Byrne, Objective 1 Manager

Concurrence: Signature on File Concurrence Date: 03/18/2014

Edward F. Maher, Objective 3 Manager

Concurrence: Vickie S. Short Signature on File for Concurrence Date: 03/19/2014

Kate Kimpan, Project Director

Approval: Signature on File Approval Date: 03/20/2014

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-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 2 of 21

PUBLICATION RECORD

EFFECTIVE 

DATE

REVISION 

NUMBER DESCRIPTION

08/24/2004 00 New technical basis document for the Pantex Plant – Occupational 

Medical Dose. First approved issue. Initiated by Jerome B. Martin.

12/23/2005 01 Approved issue of Revision 01. Training required: As determined by 

the Task Manager. Initiated by Dillard B. Shipler.

02/01/2007 02 Approved Revision 02 for organ dose assignment based on sitespecific information. Added Section 3-5, Skin Dose Method 

Description and Section 3-8, Attributions and Annotations. 

Incorporates internal formal and NIOSH formal review comments. 

Constitutes a total rewrite of document. This revision results in an 

increase in assigned dose and a PER is required. Initiated by Robert 

C. Winslow.

03/20/2014 03 Revision to ensure organ doses are calculated according to current 

project practices and according to accumulated historical evidence, 

to add skin doses for all projections and time periods, and to add 

dose to the B-lymphocytes. Incorporates formal internal and NIOSH 

review comments. Constitutes a total rewrite of document. Training 

required: As determined by the Objective Manager. Initiated by Dale 

D. Thomas III. 
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 3 of 21

TABLE OF CONTENTS

SECTION TITLE PAGE

Acronyms and Abbreviations ............................................................................................................... 4

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

3.1.1 Purpose........................................................................................................................ 6

3.1.2 Scope........................................................................................................................... 6

3.2 Examination Types and Frequencies ....................................................................................... 6

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

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

3.3.2 General Electric Equipment, 1952 to 1971.................................................................... 7

3.3.3 Picker Equipment, 1972 to 1983................................................................................... 8

3.3.4 Universal Equipment, 1984 to 1994.............................................................................. 8

3.3.5 Continental Equipment, 1995 to 2006........................................................................... 9

3.3.6 Quantum Medical Imaging Equipment, 2007 to present................................................ 9

3.4 Organ Dose Calculations ......................................................................................................... 9

3.5 Uncertainty............................................................................................................................... 9

3.6 Attributions and Annotations .................................................................................................. 10

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

Glossary ............................................................................................................................................ 20

LIST OF TABLES

TABLE TITLE PAGE

3-1 X-ray screening examination frequency ...................................................................................7

3-2 Organ dose equivalents for PA chest X-rays, 1952 to present ............................................... 10

3-3 Skin dose guidance for PA chest projections.......................................................................... 12

3-4 Skin dose equivalents for PA chest projections, 1952 to present............................................ 13

3-5 Organ dose equivalents for AP and LAT lumbar spine radiography, 1952 to 1971................. 14

3-6 Skin dose guidance and skin dose equivalents (rem) for AP and LAT lumbar spine 

projections, 1952 to 1971....................................................................................................... 15

3-7 IREP dose distributions and corresponding statistical parameters for the dose to the Blymphocytes...........................................................................................................................16
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 4 of 21

ACRONYMS AND ABBREVIATIONS

AP anterior-posterior

CFR Code of Federal Regulations

cGy centigray

cm centimeter

DCF dose conversion factor

DHHS U.S. Department of Health and Human Services

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

GE General Electric Company

HVL half-value layer

ICRP International Commission on Radiological Protection

in. inch

kVp kilovolts-peak

LAT lateral

m meter

mA milliampere

mAs milliampere-second

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

PA posterior-anterior

PFG photofluorography

POC probability of causation

R roentgen

RSD remote skin dose

SEC Special Exposure Cohort

SRDB Ref ID Site Research Database Reference Identification (number)

TBD technical basis document

U.S.C. United States Code

§ section or sections
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 5 of 21

3.1 INTRODUCTION

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

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

documents that provide 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-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 6 of 21

3.1.1 Purpose

The purpose of this technical basis document (TBD) is to describe what is known about the Pantex 

Plant occupational medical X-ray machines and practices and to estimate organ doses from these 

machines for various radiographic examinations Pantex performed for screening. The Oak Ridge 

Associated Universities (ORAU) Team may use this information to assign occupational medical X-ray 

doses for EEOICPA claims.

3.1.2 Scope

Pantex operations have played an important role in the U.S. nuclear weapons program. Historically, 

Pantex provided several roles in the assembly, disassembly, retrofit, and modification of nuclear 

weapon systems (Mitchell 2003). Today, Pantex continues to fabricate high explosives and to 

assemble nuclear weapons. 

Pantex had an occupational health program for its workers since the beginning of its operations, 

which continues to the present. One of the objectives of the occupational health program has been to 

screen workers for disease. Any radiographic examinations for screening are eligible for inclusion in 

dose reconstruction under the EEOICPA (42 CFR Part 82). This TBD provides the technical basis for 

the estimation of organ doses that have been received by workers from medical X-ray screening 

procedures at Pantex.

3.2 EXAMINATION TYPES AND FREQUENCIES

Pantex required preemployment and routine physical examinations as part of its occupational health 

and safety program. An early but undated document mentions that Pantex will administer 

preemployment, periodic, and termination posterior-anterior (PA) chest X-rays (Author unknown, ca. 

1952, p. 8). This same document also mentions that anterior-posterior (AP) and lateral (LAT) 

preemployment lumbar spine X-rays will be taken on men only. A review of a sample of claim file 

records coincides with this pattern of primarily PA chest X-rays, with lumbar spine examinations on 

men on preemployment only. There were very few LAT chest X-rays in the sample of claim file 

records reviewed [1].

The preemployment, periodic, and termination PA chest X-rays continued through about 2004. 

However, the periodic PA chest X-rays began to be performed less frequently. Interviewees from 

Pantex stated that the asbestos and beryllium occupational health program started at Pantex around 

1970 (Robertson-DeMers 2011, p. 30). As part of this program, workers exposed to beryllium 

received X-rays every 3 years and other workers received X-rays every 5 years. The specific 

frequency for asbestos workers was not provided, but might have been more frequent than every 

5 years. Interviewees also collectively stated that the preemployment lumbar spine X-rays ended by 

about 1970.

By 2005, the preemployment PA chest X-rays were discontinued (Robertson-DeMers 2011, p. 30). 

Physicals were offered to workers until 2008 and included PA chest X-rays every 5 years. Asbestos 

and beryllium workers might have been X-rayed more frequently to comply with Occupational Health 

and Safety Administration (OSHA) regulations. Table 3-1 summarizes the types and frequency of Xray examinations for screening at Pantex.

Dose reconstructors should assign dose based on the examinations that are listed in the claim file 

records when those exist. In the absence of listed examinations in the claim file records, the dose 

reconstructor should assign dose according the frequencies in Table 3-1.
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 7 of 21

Table 3-1. X-ray screening examination frequency.

Period Examination Frequency

1952–1970 PA chest Preemployment, annual, and termination.

a

AP lumbar spine Preemployment for some categories of male workers.

a

LAT lumbar spine Preemployment for some categories of male workers.

a

1971–2004 PA chest Preemployment and every 5 years. Might have been more frequent for 

asbestos or beryllium workers.

b

2005–2008c PA chest No preemployment examinations,

c otherwise every 5 years. Might have 

been more frequent for asbestos or beryllium workers.b Annual physicals 

might have ended in 2008.

2008-

present

PA chest Asbestos and beryllium workers onlyd according to the following frequencye:

• >35 years old: every 2 or every 5 years depending on time since 

first exposure.

• 15-35 years old: every 5 years.

a. Author unknown ca. 1952, p. 8.

b. BWXT Pantex ca. 2000.

c. Robertson-DeMers 2011, p. 30.

d. Scott, 2013, p. 4-5.

e. 20 CFR 1910.1001, 2008.

3.3 EQUIPMENT AND TECHNIQUES

Enough historical information about the X-ray equipment at Pantex has been found to allow 

reasonable determination of organ doses from this site-specific information. The following paragraphs 

summarize available historical information.

3.3.1 Photofluorography

No historical information about photofluorography (PFG) at Pantex has been found, and there is no

evidence of it in claim file records.

3.3.2 General Electric Equipment, 1952 to 1971

The earliest known record of a specific X-ray machine at Pantex is a September 26, 1967, inspection 

of medical X-ray facilities by the Public Health Service (PHS 1967). The inspector identified the 

control panel manufacturer and tube head manufacturer and model as General Electric and identified 

the film as GAF Supreme with RADLIN T intensifying screens. The listed technique factors for a PA 

chest X-ray were 60 kVp and 10 mAs for a 20-cm chest. A footnote at the bottom of the technique 

chart states that the kVp should be increased 2 kVp for each additional centimeter of tissue. 

Therefore, the technique used for a 23 cm chest (ORAUT 2011) would be approximately 64 kVp and 

10 mAs. Another survey of the medical X-ray facilities at Pantex occurred in August 1970; the 

inspector recorded General Electric equipment and the same technique factors for PA chests as in 

1967 (PHS 1970). The 1970 survey mentions the total filtration in the machine as 2.5 mm Al 

equivalent (PHS 1970, p. 5).

An early General Electric (GE) technique chart (GE ca. 1941, pp. 3–4) was provided to project 

researchers in 2003 (Strom 2003). The PA chest technique factors on this chart are the same as 

those recorded during the 1967 and 1970 inspections (60 kVp and 10 mAs for a 20-cm chest). 

Therefore, it seems reasonable to assume that the GE equipment was probably used from the start of 

operations in 1952. The organ doses from the PA chest projection are based on these technique 

factors.

Using the technique factors of 64 kVp and 10 mAs for a 23-cm chest, and the average air kerma rates 

in National Council on Radiation Protection and Measurements (NCRP) Report 102 (NCRP 1997), the 
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 8 of 21

incident air kerma is 1.39 × 10-2 cGy. The half-value layer (HVL) is assumed to be approximately 

2.0 mm Al for 2.5 mm Al equivalent total filtration and 64 kVp (NCRP 1997).

The lumbar spine technique factors on the GE technique chart are 58 kVp, 100 mA, and 1 second for 

the AP lumbar spine projection (18-cm abdomen), and 74 kVp, 100 mA, and 2 seconds for the LAT 

projection (28-cm abdomen) at 40 in. source-to-image distance (GE ca. 1941, pp. 3–4). The 

technique chart suggests adding 2 kVp for each additional centimeter of tissue thickness, so the 

modified technique factors for a 24- and 34-cm abdomen for the AP and LAT lumbar projections, 

would be 70 kVp, 100 mA at 1 second and 86 kVp, 100 mA at 2 seconds, respectively. The organ 

doses from the AP and LAT lumbar spine projections are based on these modified technique factors. 

Using the modified technique factors and the average air kerma rates in National Council on Radiation 

Protection and Measurements (NCRP) Report 102 (NCRP 1997), the incident air kerma is 7.305 × 10-

1 cGy and 2.771 cGy for the AP and LAT lumbar spine projections, respectively. The half-value layer 

(HVL) is assumed to be approximately 2.0 mm Al (rounded) for 2.5 mm Al equivalent total filtration 

and 70 or 86 kVp (NCRP 1997). Poor collimation is assumed for this period.

3.3.3 Picker Equipment, 1972 to 1983

New X-ray equipment was installed at Pantex in 1972. The machine manufacturer is not identified on 

the installation documents (Alexander 1972c), but is identified on other documents from this period. 

An inspection of the Pantex equipment in 1977 identifies the machine as a Picker machine (Horton 

1977). The technique factors for PA chest X-rays are reported to be 70 kVp, 300 mA, and 

1/30 second. There are several other inspection results for this machine in 1978, 1981, and 1983 

(Horton 1978, Bolinger 1981, and Ikenberry 1983). Kodak BB-5 Blue brand film and DuPont Par 

screens were used (Ikenberry 1983). Some of these documents show enough raw data to 

demonstrate compliance with minimum filtration requirements in NCRP Report 33 (NCRP 1973) for a 

machine operating above 70 kVp, but there is not enough data to actually determine the HVL [2]. 

Timer problems with this machine persisted through its replacement in the spring of 1984 

(Ikenberry 1984).

Using the technique factors of 70 kVp and 10 mAs, the average air kerma rates in NCRP Report 102 

(NCRP 1997), the incident air kerma is 1.53 × 10-2 cGy. The HVL is assumed to be approximately 

2.5 mm Al at 70 kVp for the minimum recommended amount of filtration of 2.5 mm Al equivalent total 

filtration for a machine operating above 90 kVp (Bolinger 1981, p. 3, NCRP 1973, p. 13). Proper 

collimation is assumed for this period.

3.3.4 Universal Equipment, 1984 to 1994

A Universal X-Ray machine was first surveyed in May of 1984 (Hill 1984, p. 56). The same film-andscreen combination that was used with the Picker machine, the Kodak BB-5 Blue brand film and 

DuPont Par speed screens, was used until about 1990, when surveys report the combination as 

DuPont Cronex 7 film and Cronex Quanta III screens (Kelly 1990, p. 4). The measured HVL was 

about 3.0 mm Al at 70 kVp (Hill 1984, p. 60). The first entrance skin exposure (ESE) for PA chest 

radiography was 4.4 mR measured on September 16, 1993, for a 23-cm-thick phantom at 72 kVp, 

300 mA, and 0.016 second with no grid (Slayton 1993, p 6). The measured HVL was 3.6 mm Al at 

90 kVp (Slayton 1993, p 24), or about 3.0 mm Al at 70 kVp (NCRP 1997, p 98).

The organ doses for this period are based on the measured ESE of 4.4 mR converted to incident air 

kerma according to the equations in ORAUT-OTIB-0006, Dose Reconstruction from Occupational 

Medical X-Ray Procedures (ORAUT 2011) and an HVL of 3.0 mm Al for 70 kVp for the PA chest. 

Proper collimation is assumed for this period.
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 9 of 21

3.3.5 Continental Equipment, 1995 to 2006

A Continental X-ray machine was installed between November 1, 1993 (Slayton 1993), and 

November 6, 1995 (Huddleston 1995). Even though several measurements of X-ray exposure at 30 

in. for selected kVps between 60 and 100 in increments of 10 were performed on November 6, 1995, 

(Huddleston 1995), none of these data can be definitively linked to chest technique factors or 

measurements specific to chest X-rays. Pantex does not have more technical information to provide 

about this period (McLaurin 2013, p 10). 

The doses for this period can be bounded, however, by the existing information. Huddleston (1995 p. 

6) mentions in his survey report that the “entrance skin exposures are within limits”, and cites the 

State of Texas regulations. While he does not provide the limits in this report, he does provide them 

in a later 2012 report of a different X-ray machine. Pantex, as a federal facility, would not have been 

required to comply with state regulations, but Huddleston used them to evaluate the Pantex X-ray 

machine. The State of Texas ESE limit for a non-grid PA chest is 20 mR (Huddleston 2012, p 8). It is 

reasonable to assume that the limits were the same in the 1995-2006 period. As a matter of fact, a 

2003 document published by the Conference of Radiation Control Program Directors lists the ESE 

limit for the State of Texas as 20 mR (CRCPD 2003, p 20). This ESE limit is equal to 1.75E-02 cGy 

after conversion to incident air kerma, and will be used to determine organ doses for this period. An 

HVL of 4.0 mm Al is assumed.

3.3.6 Quantum Medical Imaging Equipment, 2007 to present

A Quantum Medical Imaging computed radiography machine was installed at Pantex in 2007 (Scott 

2013). The X-ray generator is a Quest high frequency generator (Huddleston 2013). An inspection 

report from 2012 is available for this machine that provides the necessary information for determining 

the organ doses (Huddleston 2012). The HVL is 4.0 at 80 kVp, and the measured ESE is 11.9 mR. 

The incident air kerma is 1.04 E-02 cGy after converting this exposure measurement using the 

equations in ORAU-OTIB-0006 (2011). The kVp used for chest X-rays is not recorded in the 

inspection report, so an HVL of 4.0 will be assumed for dose reconstruction. 

3.4 ORGAN DOSE CALCULATIONS

Organ and skin dose equivalents for each chest projection were calculated as described in ORAUTOTIB-0006 (ORAUT 2011a) using the site-specific information from Pantex that is described in the 

previous sections. The organ dose equivalents are listed in Tables 3-2 and 3-5, which appear after 

Section 3.6. The skin dose guidance for determining dose equivalent for the skin is found in Tables 3-

3 and 3-6, and the skin dose equivalents to all areas of skin are listed in Tables 3-4 and 3-6. The Blymphocyte cells are the tissue at risk for chronic lymphocytic leukemia. The dose equivalent to the 

B-lymphocytes was determined using the method in ORAUT-OTIB-0082, Dose Reconstruction 

Method for Chronic Lymphocytic Leukemia (ORAUT 2012), site-specific information, and International 

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

1982). The dose distributions and corresponding statistical parameters for the dose to the Blymphocytes for each projection and period is listed in Table 3-7. 

3.5 UNCERTAINTY

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

their subsequent effects 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%),
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 10 of 21

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

5. Variation in source-to-skin distance 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 of 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, a total combined standard uncertainty of ±30% can be assumed for a derived dose 

equivalent to an individual organ other than the B-lymphocytes. 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 M. Principal Medical Dosimetrist. Oak Ridge Associated Universities (ORAU)

Team. September 2013.

Review of a sample of claim file records for Pantex.

[2] Thomas, Elyse M. Principal Medical Dosimetrist. ORAU Team. September 2013.

The HVL results show enough raw data to demonstrate compliance with minimum filtration 

requirements, but there is not enough to actually determine the HVL.

Table 3-2. Organ dose equivalents (rem) for PA chest X-rays, 1952 to present.

Organ

PA chest 

1952–1971

PA chest 

1972–1983

PA chest 

1984–1994

PA chest 

1995–2006

PA chest 

2007–

present

Thyroid 2.09E-03 4.90E-04 1.77E-04 1.37E-03 8.11E-04

Eye/brain 2.09E-03 4.90E-04 1.77E-04 1.37E-03 8.11E-04

Ovaries 1.60E-03 1.53E-05 6.94E-06 9.11E-05 5.41E-05

Liver/gall 

bladder/spleen/pancreas

4.93E-03 6.90E-03 2.06E-03 1.18E-02

7.01E-03

Urinary bladder/prostate 1.60E-03 1.53E-05 6.94E-06 9.11E-05 5.41E-05

Colon/rectum 1.60E-03 1.53E-05 6.94E-06 9.11E-05 5.41E-05

Testes 7.92E-05 1.53E-07 3.86E-08 1.75E-07 1.04E-07

Lungs (male) 4.66E-03 6.41E-03 1.91E-03 1.10E-02 6.53E-03

Lungs (female) 4.93E-03 6.90E-03 2.06E-03 1.18E-02 7.01E-03

Thymus 4.93E-03 6.90E-03 2.06E-03 1.18E-02 7.01E-03

Esophagus 4.93E-03 6.90E-03 2.06E-03 1.18E-02 7.01E-03

Stomach 4.93E-03 6.90E-03 2.06E-03 1.18E-02 7.01E-03

Bone surfaces 4.93E-03 6.90E-03 2.06E-03 1.18E-02 7.01E-03

Remainder 4.93E-03 6.90E-03 2.06E-03 1.18E-02 7.01E-03

Breast 4.45E-04 7.50E-04 2.66E-04 2.03E-03 1.21E-03

Uterus 1.43E-03 1.99E-05 8.87E-06 9.11E-05 5.41E-05

Bone marrow (male) 9.59E-04 1.41E-03 4.51E-04 3.12E-03 1.85E-03

Bone marrow (female) 8.76E-04 1.32E-03 4.32E-04 3.01E-03 1.79E-03
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 11 of 21

Entrance skina 1.84E-02 2.07E-02 5.36E-03 2.45E-02 1.46E-02

a. Entrance skin dose equivalent (ENSD) is determined by multiplying the incident air kerma by the backscatter factors 

of 1.32, 1.35, 1.39, and 1.40 for HVLs of 2.0, 2.5, 3.0, and 4.0 mm Al, respectively, from NCRP Report 102 (NCRP 

1997, Table B-8). Skin doses for all areas of skin are provided in Table 3-4.
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 12 of 21

Table 3-3. Skin dose guidance for PA chest projections.

a

Area of skin

PA chest

1970 and 

before

PA chest

after 1970

Right front shoulder EXSD EXSD

Right back shoulder ENSD ENSD

Left front shoulder EXSD EXSD

Left back shoulder ENSD ENSD

Right upper arm to elbow ENSD 10% ENSD

Left upper arm to elbow ENSD 10% ENSD

Left hand ENSD 10% ENSD

Right hand ENSD 10% ENSD

Left elbow, forearm, wrist ENSD 10% ENSD

Right elbow, forearm, wrist ENSD 10% ENSD

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

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

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

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

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

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

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

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

Left side of face Eye/brain Eye/brain

Right side of face Eye/brain Eye/brain

Left side of neck ENSD 10% ENSD

Right side of neck ENSD 10% ENSD

Back of head 10% ENSD 10% ENSD

Front of neck Eye/brain Thyroid

Back of neck ENSD 10% ENSD

Front torso: base of neck to end of sternum EXSD EXSD

Front torso: end of sternum to lowest rib EXSD EXSD

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

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

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

Back torso: mid-back to lowest rib ENSD ENSD

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

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

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

Right torso: end of sternum to lowest rib ENSD ENSD

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

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

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

Left torso: end of sternum to lowest rib ENSD ENSD

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

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

a. ENSD = entrance skin dose; EXSD = exit skin dose; RSD = remote skin dose.
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 13 of 21

Table 3-4. Skin dose equivalents (rem) for PA chest projections, 1952 to present.

a

Area of skin

PA chest

1952–1971

PA chest

1972–1983

PA chest

1984–1994

PA chest

1995–2006

PA chest

2007–

present

Right front shoulder 4.E-04 5.E-04 1.E-04 8.E-04 5.E-04

Right back shoulder 1.84E-02 2.07E-02 5.4E-03 2.45E-02 1.46E-02

Left front shoulder 4.E-04 5.E-04 1.E-04 8.E-04 5.E-04

Left back shoulder 1.84E-02 2.07E-02 5.4E-03 2.45E-02 1.46E-02

Right upper arm to elbow 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Left upper arm to elbow 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Left hand 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Right hand 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Left elbow, forearm, wrist 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Right elbow, forearm, wrist 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Right side of head including ear and 

temple

1.8E-03 2.1E-03 5.E-04 2.5E-03 1.5E-03

Left side of head including ear and 

temple

1.8E-03 2.1E-03 5.E-04 2.5E-03 1.5E-03

Front left thigh 5.E-06 6.E-06 2.E-06 1.E-05 6.E-06

Back left thigh 5.E-06 6.E-06 2.E-06 1.E-05 6.E-06

Front right thigh 5.E-06 6.E-06 2.E-06 1.E-05 6.E-06

Back right thigh 5.E-06 6.E-06 2.E-06 1.E-05 6.E-06

Left knee and below 2.E-06 2.E-06 6.E-07 4.E-06 2.E-06

Right knee and below 2.E-06 2.E-06 6.E-07 4.E-06 2.E-06

Left side of face 2.1E-03 4.90E-04 2.E-04 1.4E-03 8.E-04

Right side of face 2.1E-03 4.90E-04 2.E-04 1.4E-03 8.E-04

Left side of neck 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Right side of neck 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Back of head 1.8E-03 2.1E-03 5.E-04 2.5E-03 1.5E-03

Front of neck 2.1E-03 4.90E-04 2.E-04 1.4E-03 8.E-04

Back of neck 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Front torso: base of neck to end of 

sternum

4.E-04 5.E-04 1.E-04 8.E-04 5.E-04

Front torso: end of sternum to lowest 

rib

4.E-04 5.E-04 1.E-04 8.E-04 5.E-04

Front torso: lowest rib to iliac crest 4.E-04 5.E-05 1.E-05 8.E-05 5.E-05

Front torso: iliac crest to pubis 4.E-05 5.E-05 1.E-05 8.E-05 5.E-05

Back torso: base of neck to mid-back 1.84E-02 2.07E-02 5.4E-03 2.45E-02 1.46E-02

Back torso: mid-back to lowest rib 1.84E-02 2.07E-02 5.4E-03 2.45E-02 1.46E-02

Back torso: lowest rib to iliac crest 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Back torso: buttocks (iliac crest and 

below)

1.8E-03 2.1E-03 5.E-04 2.5E-03 1.5E-03

Right torso: base of neck to end of 

sternum

1.84E-02 2.07E-02 5.4E-03 2.45E-02 1.46E-02

Right torso: end of sternum to lowest 

rib

1.84E-02 2.07E-02 5.4E-03 2.45E-02 1.46E-02

Right torso: lowest rib to iliac crest 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Right torso: iliac crest to pubis (right 

hip)

1.8E-03 2.1E-03 5.E-04 2.5E-03 1.5E-03

Left torso: base of neck to end of 

sternum

1.84E-02 2.07E-02 5.4E-03 2.45E-02 1.46E-02

Left torso: end of sternum to lowest 

rib

1.84E-02 2.07E-02 5.4E-03 2.45E-02 1.46E-02

Left torso: lowest rib to iliac crest 1.84E-02 2.1E-03 5.E-04 2.5E-03 1.5E-03

Left torso: iliac crest to pubis (left 

hip)

1.8E-03 2.1E-03 5.E-04 2.5E-03 1.5E-03

a. Values less than 0.1 mrem shown to one significant digit.
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 14 of 21

Table 3-5. Organ dose equivalents (rem) for AP and LAT lumbar spine

radiography, 1952 to 1971.

a

Organ

AP 

lumbar spine 

1952–1971

LAT 

lumbar spine 

1952–1971

Thyroid 1.46E-04 2.77E-05

Eye brain 1.46E-04 2.77E-05

Ovaries 1.17E-01 8.59E-02

Liver/gall bladder/spleen/pancreas 1.17E-01 8.59E-02

Urinary Bladder/prostate 1.17E-01 8.59E-02

Colon/Rectum 1.17E-01 8.59E-02

Testes 1.83E-03 1.39E-03

Lungs male 4.53E-02 2.77E-02

Lungs female 4.53E-02 2.77E-02

Thymus 4.53E-02 2.77E-02

Esophagus 4.53E-02 2.77E-02

Stomach 1.17E-01 8.59E-02

Bone Surfaces 1.17E-01 8.59E-02

Remainder 1.17E-01 8.59E-02

Breast 2.35E-03 5.54E-03

Uterus 1.59E-01 5.54E-02

Bone Marrow male 1.75E-02 4.16E-02

Bone Marrow female 1.75E-02 4.16E-02

Skin 9.642E-01 3.66E+00

a. Entrance skin dose equivalent (ENSD) is determined by multiplying the incident air

kerma by the backscatter factors of 1.32, 1.35, 1.39, and 1.40 for HVLs of 2.0, 2.5, 

3.0, and 4.0 mm Al, respectively, from NCRP Report 102 (NCRP 1997, Table B-8). 

Skin doses for all areas of skin from the lumbar spine projections are provided in

Table 3-6.
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 15 of 21

Table 3-6. Skin dose guidance and skin dose equivalents (rem) for AP and LAT lumbar spine 

projections, 1952 to 1971.

a,b

Area of skin

AP 

lumbar spine

1970 and 

before

AP

lumbar spine

1952–1971

LAT 

lumbar spine

1970 and 

before

LAT 

lumbar spine

1952–1971

Right front shoulder 10% ENSD 9.64E-02 10% ENSD 3.66E-01

Right back shoulder 10% EXSD 1.8E-03 10% ENSD 3.66E-01

Left front shoulder 10% ENSD 9.64E-02 10% EXSD 1.4E-03

Left back shoulder 10% EXSD 1.8E-03 10% EXSD 1.4E-03

Right upper arm to elbow 10% ENSD 9.64E-02 10% ENSD 3.66E-01

Left upper arm to elbow 10% ENSD 9.64E-02 10% EXSD 1.4E-03

Left hand ENSD 9.64E-01 10% EXSD 1.4E-03

Right hand ENSD 9.64E-01 10% ENSD 3.66E-01

Left elbow, forearm, wrist ENSD 9.64E-01 10% EXSD 1.4E-03

Right elbow, forearm, wrist ENSD 9.64E-01 10% ENSD 3.66E-01

Right side of head including ear and temple Eye/Brain 1.E-04 Eye/Brain 3.E-05

Left side of head including ear and temple Eye/Brain 1.E-04 Eye/Brain 3.E-05

Front left thigh 10% ENSD 9.64E-02 10% EXSD 1.4E-03

Back left thigh 10% EXSD 1.8E-03 10% EXSD 1.4E-03

Front right thigh 10% ENSD 9.64E-02 10% ENSD 3.66E-01

Back right thigh 10% EXSD 1.8E-03 10% ENSD 3.66E-01

Left knee and below RSD (0.60 m) 2.E-04 RSD (0.60 m) 3.E-04

Right knee and below RSD (0.60 m) 2.E-04 RSD (0.60 m) 3.E-04

Left side of face Eye/Brain 1.E-04 Eye/Brain 3.E-05

Right side of face Eye/Brain 1.E-04 Eye/Brain 3.E-05

Left side of neck Eye/Brain 1.E-04 Eye/Brain 3.E-05

Right side of neck Eye/Brain 1.E-04 Eye/Brain 3.E-05

Back of head Eye/Brain 1.E-04 Eye/Brain 3.E-05

Front of neck Eye/Brain 1.E-04 Eye/Brain 3.E-05

Back of neck Eye/Brain 1.E-04 Eye/Brain 3.E-05

Front torso: base of neck to end of sternum 10% ENSD 9.64E-02 Lung 2.77E-02

Front torso: end of sternum to lowest rib ENSD 9.64E-01 Lung 2.77E-02

Front torso: lowest rib to iliac crest ENSD 9.64E-01 Lung 2.77E-02

Front torso: iliac crest to pubis ENSD 9.64E-01 Lung 2.77E-02

Back torso: base of neck to mid-back 10% EXSD 1.8E-03 Lung 2.77E-02

Back torso: mid-back to lowest rib EXSD 1.85E-02 Lung 2.77E-02

Back torso: lowest rib to iliac crest EXSD 1.85E-02 Lung 2.77E-02

Back torso: buttocks (iliac crest and below) EXSD 1.85E-02 Lung 2.77E-02

Right torso: base of neck to end of sternum 10% ENSD 9.64E-02 10% ENSD 3.66E-01

Right torso: end of sternum to lowest rib ENSD 9.64E-01 ENSD 3.66E+00

Right torso: lowest rib to iliac crest ENSD 9.64E-01 ENSD 3.66E+00

Right torso: iliac crest to pubis (right hip) ENSD 9.64E-01 ENSD 3.66E+00

Left torso: base of neck to end of sternum 10% ENSD 9.64E-02 10% EXSD 1.4E-03

Left torso: end of sternum to lowest rib ENSD 9.64E-01 EXSD 1.39E-02

Left torso: lowest rib to iliac crest ENSD 9.64E-01 EXSD 1.39E-02

Left torso: iliac crest to pubis (left hip) ENSD 9.64E-01 EXSD 1.39E-02

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

b. Values less than 0.1 mrem shown to one significant digit.
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 16 of 21

 Table 3-7. IREP dose distributions and corresponding statistical parameters for the dose to the B-

 lymphocytes.

Projection and Period IREP Distribution Parameter 1 Parameter 2 Parameter 3

PA Chest 1952-1971 Weibull 3 2.823142 0.002904 9.83936E-06

PA Chest 1972-1983 Weibull 3 2.060253 0.002911 6.74303E-06

PA Chest 1984-1994 Weibull 3 2.054837 8.77845E-04 3.93136E-06

PA Chest 1995-2006 Weibull 3 2.101617 0.005112 4.74997E-05

PA Chest 2007-present Weibull 3 2.125324 0.003069 1.58803E-06

AP Lumbar Spine 1952-1971 Weibull 3 3.233980 0.103640 -6.64010E-04

LAT Lumbar Spine 1952-1971 Normal 0.073585 0.022848 -
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 17 of 21

REFERENCES

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Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 20 of 21

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

anterior-posterior (AP)

Physical orientation of the body relative to a penetrating directional radiation field such that the 

radiation passes through the body from the front to the back.

entrance skin exposure (ESE)

Exposure in air, measured in units of roentgens, at the point of entry into the body (without 

backscatter).

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.

half-value layer (HVL)

Thickness of a specified substance, usually specified in millimeters of aluminum, which, when 

introduced in the path of a given beam of radiation, reduces the kerma rate by one-half. See 

filtration.

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. See entrance skin exposure.

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.

lateral (LAT)

Orientation of the body during an X-ray procedure in which the X-rays pass from one side of 

the body to the other. See exposure geometry.

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.

posterior-anterior (PA)

Physical orientation of the body relative to a penetrating directional radiation field such that the 

radiation passes through the body from the back to the front.
Document No. ORAUT-TKBS-0013-3 Revision No. 03 Effective Date: 03/20/2014 Page 21 of 21

radiograph

Static images produced on radiographic film by gamma rays or X-rays after passing through 

matter. In the context of EEOICPA, radiographs are X-ray images of the various parts of the 

body used to screen for disease.

radiography

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

roentgen (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 R is approximately equivalent to an absorbed dose of 1 rad in soft 

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

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 

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.

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.

X-ray radiation

Electromagnetic radiation (photons) produced by bombardment of atoms by accelerated 

particles. X-rays are produced by various mechanisms including bremsstrahlung and electron 

shell transitions within atoms (characteristic X-rays). Once formed, there is no difference 

between X-rays and gamma rays, but gamma photons originate inside the nucleus of an atom.