ORAU TEAM

Dose Reconstruction

Project for NIOSH

Oak Ridge Associated Universities I Dade Moeller & Associates I MJW Corporation

Page 1 of 25

Document Title:

Area IV of the Santa Susana Field Laboratory, 

the Canoga Avenue Facility (Vanowen Building), 

the Downey Facility, and the De Soto Avenue 

Facility (sometimes referred to as Energy 

Technology Engineering Center [ETEC] or 

Atomics International) – Occupational Medical 

Dose

Document Number: ORAUT-TKBS-0038-3 

Revision: 02

Effective Date: 10/31/2008

Type of Document TBD

Supersedes: Revision 01

Subject Expert(s): Robert L. Morris

Site Expert(s): N/A

Approval: Signature on File Approval Date: 10/20/2008

Melton H. Chew, Document Owner

Concurrence: Signature on File Concurrence Date: 10/20/2008

John M. Byrne, Task 3 Manager

Concurrence: Signature on File Concurrence Date: 10/30/2008

Edward F. Maher, Task 5 Manager

Concurrence: Signature on File Concurrence Date: 10/30/2008

Kate Kimpan, Project Director

Approval: Signature on File Approval Date: 10/31/2008

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-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 2 of 25

PUBLICATION RECORD

EFFECTIVE 

DATE

REVISION 

NUMBER DESCRIPTION

02/03/2006 00 New technical basis document for the Energy Technical Center -

Occupational Medical Dose. First approved issue. Initiated by 

Melton H. Chew.

09/08/2006 01 Revision to change the site name to Atomics International throughout 

the document in keeping with DOE site naming conventions. 

Updated required language in Section 3.1. Purpose section (Section 

3.2) and Scope section (Section 3.3) were added. Approved 

Revision 01. No further changes occurred as a result of formal 

internal review. Incorporates NIOSH formal review comments. 

Training required: As determined by the Task Manager. Initiated by 

Melton H. Chew.

10/31/2008 02 Revision to change the site name to Area IV of the Santa Susana 

Field Laboratory, the Canoga Avenue Facility, the Downey Facility, 

and the De Soto Avenue Facility (sometimes referred to as Energy 

Technology Engineering Center [ETEC] or Atomics International) to 

match the new DOE site naming conventions. Added Attributions 

and Annotations section. Organ doses are revised as follows: 

• AP lumbar spine, before 1971, uterine dose is decreased by a 

factor of 10; correcting an error,

• AP and LAT lumbar spine, after 1997, except for breast and 

remainder, all organ doses are marginally decreased due to a 

change in beam quality assumption,

• AP and LAT lumbar spine, all years, remainder organ dose is 

increased by a factor ranging from 2 to 15 due to a change in 

the reference organ used to define the remainder. 

Doses to skin at additional locations to the primary beam entrance 

are added in accordance with Revision 01 of ORAUT-PROC-0031. 

All skin doses at newly tabulated locations are lower than the skin 

dose at the primary beam entrance location. Maximum organ dose 

tables for PA and LAT chest, and AP and LAT lumbar spine, are 

deleted in accordance with Revision 01 of ORAUT-PROC-0031. A 

discrepancy between the dose tables and the text is corrected. The 

corrected frequency is lower to ensure any misunderstanding due to 

the discrepancy that would result in a favorable to claimant dose 

assessment. Text in Section 3.5.1.2 about examination frequency is 

relocated to Section 3.4 where it logically belongs. 

Breast doses from AP lumbar spine projections for periods after 1971 

are increased by a factor 2.2 to 2.6. For the LAT lumbar spine 

projections the breast dose increases range from no change, up to a 

factor of 1.1. The increase results from a change in the assumed 

dose conversion factors recommended by the Principal Medical 

Dosimetrist.

The term "view" is globally replaced with the more modern term 

"projection" and the term Entrance Skin Exposure (ESE) is replaced 

by the more modern term "entrance air kerma." The term "routine" 

when describing examination frequency is replaced by the more 

descriptive word "periodic." The terms "entrance" and "exit" in 

Tables 3-2 through 3-5 are replaced with "pre-employment" and 
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 3 of 25

"termination."

Additional information on eye/brain organ doses prior to 1971 is 

added to Tables 3-2 and 3-3. The column showing entrance skin 

exposure in Table 3-2 through 3-5 is eliminated as this is not needed 

for dose reconstruction.

The possibility that photon energy could be less than 30 keV is 

eliminated as this is applicable only to mammography.

Testes dose in Table 3-5 associated with LAT lumbar spine 

exposures after 1997 decreases by 60% as a data error in the DCF 

is corrected.

The description of skin doses has been modified to match that in 

newly issued guidance, and skin dose tables have been separated 

into two each for clarity in describing doses under poorly collimated 

versus well collimated exposure conditions. 

Incorporates formal NIOSH review comments. Constitutes a total 

rewrite of the document. Training required: As determined by the 

Task Manager. Initiated by Melton H. Chew. 
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 4 of 25

TABLE OF CONTENTS

SECTION TITLE

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

PAGE

6

3.1 Introduction ..............................................................................................................................8

3.2 Purpose ...................................................................................................................................9

3.3 Scope.......................................................................................................................................9

3.4 Examination Frequency ......................................................................................................... 10

3.4.1 Preemployment Examination......................................................................................10

3.4.1.1 Before 1971 ................................................................................................. 10

3.4.1.2 1972 Through 1997...................................................................................... 11

3.4.1.3 After 1997 .................................................................................................... 11

3.4.2 Periodic Examination..................................................................................................11

3.4.2.1 Before 1971 ................................................................................................. 11

3.4.2.2 1971 Through 1997...................................................................................... 12

3.4.2.3 After 1997 .................................................................................................... 12

3.5 Equipment and Techniques.................................................................................................... 12

3.5.1 Before 1971................................................................................................................12

3.5.1.1 Chest Projections......................................................................................... 12

3.5.1.2 Lumbar Spine Projections ............................................................................ 12

3.5.2 1971 Through 1997 ....................................................................................................12

3.5.2.1 Chest Projections......................................................................................... 13

3.5.2.2 Lumbar Spine Projections ............................................................................ 13

3.5.3 After 1997...................................................................................................................13

3.5.3.1 Chest Projections......................................................................................... 13

3.5.3.2 Lumbar Spine Projections ............................................................................ 14

3.6 Organ Dose Calculations ....................................................................................................... 14

3.7 Dose Reconstruction..............................................................................................................15

3.8 Uncertainty.............................................................................................................................16

3.9 AttributionS and Annotations.................................................................................................. 16

References ........................................................................................................................................24

Glossary ............................................................................................................................................25
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LIST OF TABLES

TABLE TITLE

3-1 Analogues for IREP organs not included in ICRP (1982) for use with properly collimated 

chest X-rays...........................................................................................................................

PAGE

14

3-2 Parameters and organ doses (rem) per exposure for 14- by 17-in. PA chest radiography...... 18

3-3 Parameters and organ doses (rem) per exposure for 14- by 17-in. LAT chest 

radiography............................................................................................................................18

3-4 Parameters and organ doses (rem) for a single-exposure AP lumbar spine radiograph ......... 19

3-5 Parameters and organ doses (rem) for a single-exposure LAT lumbar spine radiograph ....... 19

3-6 Skin doses per exposure for poorly collimated PA chest radiography .................................... 20

3-7 Skin doses per exposure for well collimated PA chest radiography ........................................ 21

3-8 Skin doses per exposure for poorly collimated LAT chest radiography................................... 21

3-9 Skin doses per exposure for well collimated LAT chest radiography ...................................... 22

3-10 Skin doses per exposure for single-exposure poorly collimated AP lumbar spine 

radiography. ..........................................................................................................................22

3-11 Skin doses per exposure for single-exposure well collimated AP lumbar spine 

radiography. ...........................................................................................................................23

3-12 Skin doses per exposure for single-exposure poorly collimated LAT lumbar spine 

radiography. ...........................................................................................................................23

3-13 Skin doses per exposure for single-exposure well collimated LAT lumbar spine 

radiography............................................................................................................................23
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ACRONYMS AND ABBREVIATIONS

AEC U.S. Atomic Energy Commission

AP anterior-posterior

AI Atomics International

cGy centigray

cm centimeter

DCF dose conversion factor

DOE U.S. Department of Energy

EEOICPA Energy Employees Occupational Illness Compensation Program Act of 2000

ESE entrance skin exposure

ETEC Energy Technology Engineering Center

FDA Food and Drug Administration

Gy gray

ICRP International Commission on Radiological Protection

in. inch

IREP Interactive RadioEpidemiological Program

keV kiloelectron-volt (1,000 electron-volts)

kVp kilovolts-peak

LAT lateral

mA milliampere

mAs milliampere-second

mGy milligray

mm millimeter

mR milliroentgen

NAA North American Aviation

NIOSH National Institute for Occupational Safety and Health

PA posterior-anterior

POC probability of causation

R roentgen

s second

SID source-to-image distance

SSD source-to-skin distance

SRDB Ref ID Site Research Database reference identification (number)

SSFL Area IV Santa Susana Field Laboratory (See Section 3.3 for a discussion of the 

naming conventions used in this document.)

U.S.C. United States Code

yr year
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§ section or sections
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3.1 INTRODUCTION

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

facility encompassed by EEOICPA.

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

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

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

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

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

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

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

determined in accordance with the POC [probability of causation1

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

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

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

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

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

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

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

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

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

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

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

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

occupationally derived (NIOSH 2007):

] guidelines established under 

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

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

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

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

conventional structures

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

reasons

 

1 The U.S. Department of Labor (DOL) is ultimately responsible under the EEOICPA for determining the POC. 
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3.2 PURPOSE

The purpose of this document is to provide a technical basis for evaluation of the occupational 

medical dose for EEOICPA claimants who were employed at Area IV of the Santa Susana Field 

Laboratory, the Canoga Avenue Facility (Vanowen Building), the Downey Facility, and the De Soto 

Avenue Facility (sometimes referred to as Energy Technology Engineering Center [ETEC] or Atomics 

International [AI]) described below.

3.3 SCOPE

The scope of this document is technical data in relation to medical X-rays provided to workers as a 

condition of employment. 

The facility, which includes four locations, has been identified in various ways over time. The name 

Santa Susana Field Laboratory (SSFL) is used to represent all of them unless more specific location 

information is warranted. In that context, SSFL includes Area IV of the Santa Susana Field 

Laboratory, which has also been known as the Nuclear Development Field Laboratory, Liquid Metal 

Engineering Center, and Energy Technology Engineering Center; portions of the Downey facility; the 

Vanowen Building at the Canoga facility; and the De Soto facility. 

U.S. Atomic Energy Commission (AEC)-funded work at SSFL facility began in 1948. North American 

Aviation (NAA) entered into a contract with AEC to conduct nuclear research operations at Area IV 

and the Downey, Canoga, and De Soto sites. At that time, AI, an internal division of NAA, was the 

company’s designated nuclear research and development division. In addition to the employees of 

the AI division, other employees of NAA who worked at any of the above sites during the AEC 

contract period are potentially eligible for EEOICPA benefits. While no evidence of the screening 

protocols have been found, it is clear from a review of actual X-rays and records in claim files that 

screening likely included chest and lumbar spine examinations. These examinations caused 

exposure of the lungs, spine, and other tissues of the body. Exposure came from the primary X-ray 

beam and from scattered radiation. 

A review of randomly selected X-ray films that date back to 1956 provides insight into the 

occupational medical program (Morris 2005a). Individual SSFL medical charts do not contain X-ray 

films. If an old film is to be reviewed, the separate X-ray record must be retrieved. Three boxes of 

archived radiographs for approximately 300 individuals were reviewed. The boxes contained an 

envelope for each individual; each envelope contained films that spanned many years for that person. 

The outside of each file storage envelope describes the contents, so it is possible to determine the 

number and kind of radiograph and if the radiograph represents a preemployment examination, 

periodic reexamination, or a workup after an industrial injury. Radiographs that were associated with 

an industrial injury are typically identified as “IND”; they are not pertinent to dose reconstruction. Due 

to corporate reorganizations, the medical records of employees of the AI division of NAA are 

intermingled with records of Rocketdyne, another internal division of NAA. Employees of Rocketdyne 

(or any other employee of NAA) are potentially within the scope of EEOICPA if they worked at Area IV 

or the Downey, Canoga, or De Soto locations during the period when the AEC contract work was 

performed. In a few cases, a file was annotated “AI” indicating that the person was an AI employee, 

but in the majority of cases the employment status is not clear. The review of records suggests that:

• About half of the preemployment examinations included both posterior-anterior (PA) and 

lateral (LAT) chest projections and one or two projections (PA and LAT) of the lumbar spine. 

The remainder included only one PA chest projection.

• It was rare for an employee to have annual chest radiographs. Most individuals were never 

subjected to periodic radiographic reexamination.
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• Of those who were reexamined, the typical periodic examination frequency was every 3 to 

5 years. About half of those reexamined had one PA chest projection. Others had a PA chest 

and some form of lumbar spine examination.

• There was no evidence of collimation on the radiographs.

• There was no evidence to suggest the use of photofluorography.

• There was no evidence to suggest the use of fluoroscopy.

• There was no evidence to suggest the use of stereo chest films (same projection on two films, 

slightly displaced).

• All projections – PA chest, LAT chest, AP lumbar spine, and LAT lumbar spine – that were 

commonly found in the records were of the same size: 14 by 17 in.

• In a few cases, AP spot and LAT spot lumbar spine projections were observed, and in these 

cases a smaller film size, 10 by 12 in., was common.

• There was no evidence of the use of gonadal shielding in the lumbar spine radiographs.

Interviews (Chew 2005; Morris 2005a) with medical clinic personnel provided information on the 

equipment and techniques that were used between 1971 and 1997. By 1998, all radiographic 

examinations were subcontracted to West Hills Hospital in West Hills, California. 

Neutron exposures were not used in occupational medical evaluations and are not part of the 

occupational medical dose. Similarly, there is no electron dose in the occupational medical dose.

3.4 EXAMINATION FREQUENCY 

Existing programmatic documents do not furnish a complete record of the screening protocol that was 

used since 1948 to determine which workers were required to have X-ray examinations or the 

frequencies of the examinations for occupational health screening. Instead the screening protocol 

was inferred from the information described above (Morris 2005a). In addition, the claimant records 

provided by DOE are likely to provide information on the radiographs that were administered to the 

Energy Employee (EE). This is discussed in Section 3.5. The assumptions that are provided in this 

section should be used when the claimant record proves to be inadequate or unavailable. 

3.4.1

3.4.1.1 Before 1971

Preemployment Examination

Radiation safety standards dating back to 1966 (Garcia and Alexander 1970) required “pre-exposure 

examinations” for radiation workers. This examination was to include a chest X-ray. It is reasonable 

to assume that this practice has been in effect for radiation workers since the origination of SSFL [1]. 

For dose reconstruction this should be interpreted as a preemployment physical requirement.

SSFL employees who were not radiation workers would not have been covered by the radiation safety 

standard. Therefore, some employees might not have received routine preemployment radiographic 

examinations. A review of SSFL X-ray film historical records (Morris 2005b) indicated that some 

employees had preemployment chest and lumbar spine radiographic examinations. Criteria for the 

selection of these employees have not been found. 
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 11 of 25

A reasonable assumption [2] that gives the benefit of the doubt to claimants is that before 1971 all 

employees had a preemployment examination consisting of: 

• PA chest film,

• LAT chest film,

• AP lumbar spine film,

• AP lumbar spine spot film, 

• LAT lumbar spine film, and

• LAT lumbar spine spot film. 

3.4.1.2 1972 Through 1997

In an interview, the nurse who took many of the radiographs, beginning in 1971, stated that 

preemployment physicals were routinely required of all SSFL personnel (Chew 2005). Such physicals 

included a PA chest radiograph. Lumbar spine radiographs were sometimes required, depending on 

the job description. No photofluorography was performed. This or a similar examination policy was 

probably in place before 1966 and continued well into the 1990s. A reasonable assumption [3] that 

gives the benefit of the doubt to claimants is that all employees had a preemployment examination 

consisting of: 

• PA chest film,

• LAT chest film,

• AP lumbar spine film,

• AP lumbar spine spot film, 

• LAT lumbar spine film, and

• LAT lumbar spine spot film. 

3.4.1.3 After 1997

A 2005 interview with the medical director found that the policy on chest X-rays that is described in 

Section 3.4.1.2 was in place when he assumed his position in 1995 (Morris 2005a). By 1997, he was 

actively discouraging chest X-rays. Preemployment lumbar spine and chest radiography has not 

occurred as a condition of employment since 1997.

3.4.2

3.4.2.1 Before 1971

Periodic Examination

Radiation safety standards that date back to 1966 (Garcia and Alexander 1970) required periodic 

examinations at a minimum frequency of 1 yr for radiation workers. The standards also required 

termination examinations. The periodic examination included a chest X-ray. The standard does not 

require lumber spine examination. This or a similar examination policy was probably in place before 

1966 and continued well into the 1990s. Dose reconstructors may assume each radiation worker had 

a PA and LAT radiographic chest examination every year and one AP and LAT lumbar spine with an 

AP and LAT lumbar spine spot film examination every 3 years [4].

For personnel who were not radiation workers, no information is available about the periodic 

radiographic examination schedule. A review of SSFL X-ray film historical records (Morris 2005b) 

suggests that some workers did undergo periodic surveillance. No clear frequency pattern was 

discernable, but annual examinations were rare. Among those who received periodic surveillance, 3 

to 5 years (and often more) elapsed between radiographic examinations. Dose reconstructors may 

assume each person who was not a radiation worker had one PA and LAT radiographic chest 
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 12 of 25

examination every 3 years and one AP and LAT lumbar spine with an AP and LAT lumbar spine spot 

film examination every 3 years [5].

3.4.2.2 1971 Through 1997

The examination frequency and assumptions that are described for years before 1971 applies for the 

period from 1971 through 1997 [6].

3.4.2.3 After 1997

A 2005 interview with the medical director found that the policy on chest X-rays was in place when he 

assumed his position in 1995 (Morris 2005a). By 1997, he was actively discouraging routine chest 

X-ray screening. Lumbar spine and chest radiography have not been performed for screening since 

1997.

Tables 3-2 through 3-5 include information on the frequency of chest radiography for periods 

throughout the SSFL operating history.

3.5 EQUIPMENT AND TECHNIQUES

3.5.1

No specific information is available on medical X-ray equipment and techniques that were used at 

SSFL before 1971. An interview with the current SSFL physician (Morris 2005a), who is familiar with 

the content of the historical medical files, and an inspection of randomly selected radiographs from 

this period (Morris 2005b) revealed no evidence that photofluorography, fluoroscopy, or stereo 

radiography was used at SSFL.

Before 1971

3.5.1.1 Chest Projections

The pre-1971 parameters for PA and LAT chest radiography are assumed values based on data for 

the “Pre-1970 Period” in Table 3-4 of ORAUT (2005). Therefore, 0.20 cGy is the assumed entrance 

kerma in the PA projection, and 0.50 cGy in LAT projection.

3.5.1.2 Lumbar Spine Projections

The pre-1971 default values for AP and LAT lumbar spine radiography are based on data for the 

technique that is described in Tables 7-7 through 7-9 of ORAUT (2005). Table 7-7 lists the AP and 

AP spot projection techniques as 80 kVp, 2.0 mm of Al HVL, 40 mA, for 4 s at a source-to-image 

distance (SID) of 99 cm with a 20-cm cone. Two AP projections are assumed: the AP and the AP 

spot. Table 7-7 lists LAT and LAT spot projection techniques as 86 kVp, 2.0 mm of Al HVL, 40 mA, 

for 8 s at SID of 99 cm with a 20-cm cone. Two LAT projections are assumed: the LAT and the LAT 

spot. Table 7-8 from ORAUT (2005) defines the entrance skin exposure (ESE) for both AP lumbar 

spine projections combined as 4.0 rem (1 rem is typically assumed for dosimetry purposes to be 

numerically the same as 1 cGy, so the entrance air kerma is interpreted to be 4 cGy) (ORAUT 2005, 

Section 3.1). The entrance air kerma for the combined LAT lumbar spine projections is 10 rem (10 

cGy). If it can be shown that only one AP or LAT lumbar spine projection was made, it is reasonable 

to assume these values can be divided by 2 [7]. 

3.5.2

An interview with the nurse/technician who operated the X-ray machine revealed that before or during 

1971 a Picker X-ray system, Model 754971, was installed in the SSFL clinic (Chew 2005). The 

1971 Through 1997
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reported maximum settings on the unit were 125 kVp and 600 mA. The equipment was used for PA 

chest and lumbar spine projections. The normal technique for chest X-rays was to use 80- to 90-kVp 

tube potential and 1/60 s exposure time, which according to the notes in this interview resulted in an 

exposure of 200 mAs at a standard SID of 72 in. 

The reported value of 200 mAs (Chew 2005) is unreasonably high, and is judged to be wrong (Morris 

2008). If the Picker X-ray machine delivered a 200 mAs exposure to an X-ray film and cassette 

assembly, the resultant film would be overexposed and have no value as a diagnostic tool. The 

reviewing physician would have required the technique be changed to a lower exposure. For chest 

examinations PA projections, a value closer to 10 mAs is more likely (CRCPD 1994) and 20 mAs is a 

high estimate. Therefore, the value of 20 mAs is assumed. ORAUT (2005) suggests a conservative 

estimate for the entrance air kerma for the LAT projection of 2.5 times the PA entrance air kerma. 

Using this estimate, the analysis assumed the exposure for the LAT projection is 50 mAs. This TBD 

assumes these values for calculation of entrance air kerma and organ dose for chest X-rays.

3.5.2.1 Ches t Projections

For simplicity, this TBD assumes the performance of all chest radiographs at 90 kVp because this 

produces a higher average air kerma rate than 80 kVp and is, therefore, favorable to claimants [8]. 

The machine filtration is not known so, consistent with the recommendation of ORAUT (2005) for 

machines before 1980, this TBD analysis assumed it to be 2.5 mm Al. Based on Table B.3 in NCRP 

(1989), a single-phase machine with an SID of 183 cm (72 in.) and operating at 90 kVp produces an 

average air kerma rate of 0.18 cGy/100 mAs. For a 20-mAs exposure in the AP projection, this 

equates to average air kerma of 0.036 cGy. For 50 mAs in the LAT projection, this equates to an 

average air kerma of 0.09 cGy. Correcting for a source to skin distance (SSD) of 154 cm, the 

entrance air kerma (numerically the same as the ESE) is 0.050 cGy for the PA projection and 0.130 

cGy for the LAT projection. These entrance air kerma values are used to calculate organ doses, as 

discussed in Section 3.1 of ORAUT (2005).

3.5.2.2 Lumbar Spine Projections

No specific information is available on the lumbar spine technique that was used at SSFL in this 

period; the default data in ORAUT (2005) for lumbar spine projections is derived from 1953 data and 

unlikely to reflect the practice 2 decades later. The lumbar spine technique was probably a modern 

one [9], similar to that which was described in 1995 by the Conference of Radiation Control Program 

Directors (CRCPD 2001). As a consequence, this analysis assumes the technique to be 78 kVp, 

294 mAs, half-value layer of 3.1 mm Al, with an average entrance air kerma of 0.370 cGy.

3.5.3

In 1997, the Picker system was retired and radiographic examinations were performed on a 

subcontract basis at West Hills Hospital. That arrangement continued at least through 2006. 

Considering the wide assortment of X-ray equipment at a modern medical center such as West Hills, 

it is not possible to identify the specific equipment and techniques that were used. However, it is 

reasonable to assume the use of modern well-maintained equipment for exposures [10]. 

After 1997

3.5.3.1 Ches t Projections

This TBD bases its assumption of the post-1997 default values for PA and LAT chest on data for the 

“Post-1985 Period” in Table 3-4 of ORAUT (2005). The entrance kerma for the PA projection is 

0.05 cGy. For the LAT projection, the entrance kerma is 0.13 cGy.
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3.5.3.2 Lumbar Spine Projections

No specific information is available on the lumbar spine technique that was used at SSFL during this 

period; the default data in ORAUT (2005) for lumbar spine projections is derived from 1953 data and 

unlikely to reflect the practice 2 decades later. The lumbar spine technique was probably a modern 

one, similar to that which was described in 1995 by the Conference of Radiation Control Program 

Directors (CRCPD 2001) [11]. The TBD analysis assumes that the technique is 78 kVp, 294 mAs, 

with an average entrance air kerma of 0.370 cGy.

3.6 ORGAN DOSE CALCULATIONS

With the exception of measured values taken from tables, and dose to the skin, estimates of the mean 

dose equivalents to individual organs from a given X-ray exposure are the product of the entrance air 

kerma and a dose conversion factor (DCF) from ICRP (1982) or some other source (ORAUT 2005). 

Skin doses calculations are described in Morris (2008). 

For well-collimated chest and lumbar spine radiographs of differing beam quality, ICRP (1982) 

contains tables of DCFs for as many as seven organs and the total (whole) body based on an adult 

anthropomorphic phantom. For an organ that is not listed in these tables but is needed for the 

Interactive RadioEpidemiological Program (IREP), the DCF is usually that for the anatomically closest 

organ in the ICRP tables. Table 3-1 lists ICRP reference organs for IREP analogues (ORAUT 2005), 

assuming a properly collimated chest X-rays. ICRP (1982) lists different DCFs for males and females 

for the lung, bone marrow, and total (whole) body. The larger of the two values is assigned for the 

dose equivalent to the IREP organ analogues. 

Table 3-1. Analogues for IREP organs not included in ICRP

(1982) for use with properly collimated chest X-rays .

Anatomical 

location 

ICRP (1982) 

reference organ IREP organ analogue

Thorax Lung Thymus 

Esophagus 

Stomach 

Bone surface

Liver/gall bladder/spleen

Remainder organs 

Abdomen Ovaries Urinary/bladder 

Colon/rectum 

Head and neck Thyroid Eye/brain 

Source: ORAUT (2005, Table 3-2). 

The ICRP tables were developed under the assumption that the primary X-ray beam is collimated to 

the image receptor size, which is reasonable subsequent to 1971. Earlier techniques were probably 

not well collimated (ORAUT 2005 A2.4.2). Because no information about the collimation practices 

before 1971 was discovered, the application of these DCF tables to the early X-ray machines must 

occur in a way that compensates for the possible lack of collimation. ORAUT (2005) assessed 

allowance for this circumstance during different periods in the past based on ICRP (1982). 

The ICRP DCFs give the average dose equivalent in a given organ in milligray for different beam 

qualities when the entrance kerma (air kerma in air without backscatter) is 1 Gy. ORAUT (2005) 

approximated that an ESE of 1 R produces a skin entrance kerma of 1 rad. In addition to simplifying 

the computations, this assumption is well within relatively large uncertainties from other sources and 

is favorable to claimants.

This TBD analysis used the following guidelines to develop Tables 3-2 through 3-9.
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 15 of 25

When an organ dose equivalent difference between male and female organs exists, the higher value 

is listed in Tables 3-2 through 3-5. 

ICRP (1982) does not tabulate dose conversion factors for lumbar spine projections for the female 

breast, but the table includes the comment “Not computed but small compared to the projections 

listed above.” The basis for the DCFs used in the calculations is in Morris (2008). 

Default assumptions in ORAUT (2005) are used unless specific data or documented assumptions to 

the contrary are cited. If specific claimant files indicate the use of photofluorography, dose 

reconstructors should apply the default parameters and organ dose factor values in ORAUT (2005). 

Table 3-2 is a summary of parameters and organ doses for 14- by 17-in. PA chest radiography for 

periods during which each X-ray system was in use. Table 3-3 is a summary of parameters and 

organ doses for LAT chest radiography. The calculations are detailed in Morris (2008). Lung dose is 

used as a surrogate for remainder organ dose [12].

Tables 3-4 and 3-5 summarize parameters and organ doses for AP and LAT lumbar spine 

radiography, respectively. The calculations are detailed in Morris (2008). Lumbar spine films are 

sometimes done in pairs: a large 14- by 17-in. radiograph and a smaller spot film of the same 

projection. If the claimant medical records indicate the use of both a large format and spot film of the 

same projection, dose reconstructors should double the doses in Tables 3-4 and 3-5 to represent the 

dose for that pair of exposures [13]. Ovary dose is used as a surrogate for remainder organ dose 

[14].

Tables 3-6 through 3-13 lists doses for regions of the skin on the entrance and exit side of the primary 

beam. Tables 3-6 and 3-7 provide data associated with the PA chest projection, and Tables 3-8 and 

3-9 provide data associated with the LAT chest projection. Tables 3-10 and 3-11 provide data 

associated with the AP lumbar spine projection, and Tables 3-12 and 3-13 provide data associated 

with the LAT lumbar spine projection. 

3.7 DOSE RECONSTRUCTION

The records DOE provided are likely to include adequate information to define the date, type, and 

count of X-ray examinations that were administered to the Energy Employee for screening and as a 

condition of employment. The default periodic examination frequency will provide a maximizing dose 

estimate. 

To perform a best estimate dose the dose reconstructors should consider requesting that the notes on 

the exterior of the envelope(s) that contain the Energy Employee’s X-ray films be transcribed and 

provided. These notes should give insight to the reason that the exposures were made, for example 

pre-employment examination, periodic screening, or diagnosis of injury. Dose reconstructors should 

assume that any radiograph that was not

The photon energy associated with occupational medical X-ray dose is in the 30-to-250-keV energy 

group. Assignment of all SSFL occupational medical doses to the 30-to-250-keV energy group is 

favorable to claimants and recommended (ORAUT 2005). 

a PA chest, LAT chest, AP lumbar spine, or LAT lumbar 

spine projection was diagnostic, not to be included in dose reconstruction under EEOICPA. If the 

X-ray envelope notes associate the annotation “IND” or “industrial” with a particular exposure, that 

means the radiograph was a diagnostic exposure (i.e., associated with a workplace injury). “IND” 

radiographs are not included in dose reconstruction. 
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 16 of 25

For purposes of skin dose calculations note that standard radiographic imagining procedures require 

the subject to be positioned in a particular orientation. Consequently the entrance skin dose side for 

lateral projections is well known. This orientation information is reflected in Tables 3-6 through 3-16. 

3.8 UNCERTAINTY

ORAUT (2005) analyzed uncertainties in the required occupational medical X-ray organ doses. The 

document considered several major sources of uncertainty: measurement errors; variations in applied 

voltage (peak voltage), beam current and exposure time; and uncertainties due to worker size and 

placement. ORAUT (2005) assesses the relative error in an individual entrance air kerma or organ 

dose to be ±30% at 1 standard deviation. The actual doses could have been as much as 30% larger 

than those listed in Tables 3-2 through 3-13. 

3.9 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.

[1] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007.

Data that are cited in Morris (2005b) support the assumption that radiographic examinations 

performed for screening were at no time more frequent than annual. These data also shows 

that spot films of any kind were rare. The default assumptions for radiographic frequency are 

based on professional judgment and are likely to be biased to be favorable to the claimant.

[2] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007.

Data that are cited in Morris (2005b) are applicable to all workers at SSFL because the 

records of radiation workers are intermingled with those of nonradiation workers.

[3] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

Professional judgment that is informed by the data that is cited in Morris (2005b).

[4] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

Professional judgment that is informed by the data that is cited in Morris (2005b).

[5] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

Professional judgment that is informed by the data that is cited in Morris (2005b).

[6] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

Professional judgment that is informed by the data that is cited in Morris (2005b).

[7] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

The default values in Tables 7-8 and 7-10 of ORAUT (2005) are based on a single exposure 

that has been doubled to account for the possibility that a spot film was taken at the same 

time. The data are separated here to accommodate the more likely situation that a spot film 

was not taken. No exposure or dose data exists separately for spot films, so following the 

precedent in ORAUT (2005) the assumption is made that the entrance air kerma is the same 

for both the normal exposure and the spot film.
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 17 of 25

[8] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

An X-ray tube that is operated at a fixed current produces an entrance air kerma directly 

proportional to the operating potential. See the discussion in Section 2.1 of ORAUT (2005).

[9] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

The equipment was similar to the kind that is found at any contemporary private clinic in the 

United States and therefore is well represented by the survey results that are presented in the 

CRCPD report.

[10] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

Hospital accreditation practices in the United States ensure that reasonably modern 

equipment is available as a standard of care.

[11] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

Hospital accreditation practices in the United States ensure that reasonably modern 

equipment is available as a standard of care.

[12] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

Either the lung or the breast is the organ with the highest dose in chest exposures. Use of the 

lung dose overestimates the value for any other organ except the breast, which is tabulated 

separately.

[13] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

The default values in Tables 7-8 and 7-10 of ORAUT (2005) are based on a single exposure 

that has been doubled to account for the possibility that a spot film was taken at the same 

time. The data are separated here to accommodate the more likely situation that a spot film 

was not taken. No exposure or dose data exists separately for spot films, so following the 

precedent in ORAUT (2005) the assumption is made that the entrance air kerma is the same 

for both the normal exposure and the spot film.

[14] Robert L. Morris. Principal Health Physicist. M. H. Chew & Associates. November 2007. 

Either the ovary or uterus is the organ with the highest dose in lumbar spine exposures. Use 

of the ovary dose overestimates the value for any other organ except the uterus, which is 

tabulated separately.
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 18 of 25

Table 3-2. Parameters and organ doses (rem) per exposure for 14- by 17-in. PA chest radiography. 

Period Frequency Applicability Eye/brain Thyroida Ovariesa Testesa Lungsa, c Breasta

Uterus 

(embryo)a

Bone 

marrowa, c Remainderb

Pre-1971 Pre-employment: likely

Periodic annual: likely

Termination: likely

All radiation 

workers

6.40E-03 3.48E-02 2.5E-02 5.0E-03 9.02E-02 9.80E-03 2.5E-02 1.84E-02 9.02E-02 (b)

Pre-1971 Pre-employment: likely

Periodic assumed to be at 

3-yr intervals

Termination: not likely

Nonradiation 

workers

6.40E-03 3.48E-02 2.5E-02 5.0E-03 9.02E-02 9.80E-03 2.5E-02 1.84E-02 9.02E-02 (b)

1971 to 

1997

Pre-employment: likely

Periodic annual: likely

Termination: likely

All radiation 

workers

1.60E-03 1.60E-03 5.00E-05 5.00E-07 2.26E-02 2.45E-03 6.50E-05 4.60E-03 2.26E-02

1971 to 

1997

Pre-employment: likely

Periodic: assumed to be 

at 3-yr intervals 

Termination: not likely

Nonradiation 

workers

1.60E-03 1.60E-03 5.00E-05 5.00E-07 2.26E-02 2.45E-03 6.50E-05 4.60E-03 2.26E-02

1998 to 

present

Highly unlikely All workers 3.90E-03 3.90E-03 2.60E-04 5.00E-07 3.37E-02 5.80E-03 2.60E-04 8.90E-03 3.37E-02

a. Organs identified in ICRP (1982).

b. Female lung is the reference organ for “Remainder.”

c. Male bone marrow data and female lung data are reported as these produce the highest values.

Table 3-3. Parameters and organ doses (rem) per exposure for 14- by 17-in. LAT chest radiography. 

Period Frequency Applicability Eye/brain Thyroida Ovariesa Testesa Lungsa, c Breasta 

Uterus 

(embryo)a 

Bone 

marrowa, c Remainderb 

Pre-1971

Pre-employment: likely

Periodic annual: likely

Termination: likely

All radiation 

workers

6.85E-2 6.85E-02 1.3E-02 2.5E-03 1.10E-01 1.28E-01 1.3E-02 1.85E-02 1.10E-01

Pre-1971 Pre-employment: likely

Periodic assumed to be at 

3-yr intervals

Termination: not likely

Nonradiation 

workers

6.85E-02 6.85E-02 1.3E-02 2.5E-03 1.10E-01 1.28E-01 1.3E-02 1.85E-02 1.10E-01 

1971 to 

1997

Pre-employment: likely

Periodic annual: likely

Termination: likely

All radiation 

workers

1.50E-02 1.50E-02 7.80E-05 1.30E-05 :

2.86E-02

3.32E-02 7.80E-05 4.81E-03 2.86E-02

1971 to 

1997

Pre-employment: likely

Periodic: assumed to be 

at 3-yr intervals 

Termination: not likely

Nonradiation 

workers

1.50E-02 1.50E-02 7.80E-05 1.30E-05 2.86E-02 3.32E-02 7.80E-05 4.81E-03 2.86E-02

1998 to 

present

Highly unlikely All workers 2.13E-02 2.13E-02 3.25E-04 1.30E-05 4.56E-02 4.46E-02 2.73E-04 9.88E-03 4.56E-02

a. Organs identified in ICRP (1982). 

b. Female lung is the reference organ for “Remainder.”

c. Male bone marrow and female lung data are reported as these produce the highest values.
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 19 of 25

Table 3-4. Parameters and organ doses (rem) for a single-exposure AP lumbar spine radiographb. 

Period Frequency Applicability Thyroida Ovariesa Testesa Lungsa Breasta 

Uterus 

(embryo)a 

Bone 

marrowa Remainderc

Pre-1971

Pre-employment: likely

Periodic annual: assumed 

to be at 3-yr intervals

Termination: not likely

All workers 4.00E-04 5.60E-01 2.70E-02 1.24E-01 3.60E-02 4.34E-01 4.80E-02 5.6E-01

1971 to 

1997

Pre-employment: likely

Periodic: assumed to be at 

3-yr intervals

Termination: not likely

All workers 1.11E-04 7.99E-02 1.55E-03 2.92E-02 4.85E-03 1.06E-01 1.37E-02 7.99E-02

1998 to 

present

Highly unlikely All workers 2.22E-04 1.01E-01 2.37E-03 3.52E-02 5.92E-03 1.31E-01 1.96E-02 1.01E-01

a. Organs identified in ICRP (1982).

b. ESE and organ doses are presented for a single AP or spot AP lumbar spine projection. If both AP and spot AP lumbar spine projections were imaged, double the entrance air kerma and

 organ doses in this row.

c. Ovary is the reference organ for “Remainder”. 

Table 3-5. Parameters and organ doses (rem) for a single-exposure LAT lumbar spine radiographb. 

Period Frequency Applicability Thyroida Ovariesa Testesa Lungsa Breasta 

Uterus 

(Embryo)a 

Bone 

marrowa Remainderc 

Pre-1971

Pre-employment: likely

Periodic: assumed to be 

at 3-yr intervals

Termination: not likely

All workers 5.00E-05 7.60E-01 5.6E-02 5.00E-02 4.75E-02 1.00E-01 7.50E-02 7.60E-01

1971 to 

1997

Pre-employment: likely

Periodic: assumed to be 

at 3-yr intervals

Termination: not likely

All workers 3.70E-06 1.74E-02 2.96E-04 5.18E-03 1.85E-03 1.15E-02 8.14E-03 1.74E-02

1998 to 

present

Highly unlikely All workers 3.70E-06 2.48E-02 4.44E-04 6.29E-03 2.59E-03 1.67E-02 1.15E-02 2.48E-02

a. Organs identified in ICRP (1982).

b. ESE and organ doses are listed for a single LAT or spot LAT lumbar spine projection. If both LAT and spot LAT lumbar spine projections were imaged, double the entrance air kerma and

 organ doses in this row.

c. Ovary is the reference organ for “Remainder”. 
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 20 of 25

Table 3-6. Skin doses per exposure for poorly collimated PA chest radiography. 

Poorly Collimated PA Chest Skin Dose Pre-1971

Region of the Skin 

Entrance (Posterior) Side of the Body

Inside primary beam: back and sides of chest to iliac crest, back of 

shoulders, back of neck, upper arms, elbows, forearms, and palms of 

hands. 2.78E-01

Outside but near primary beam: back of head, ears, and buttocks

2.78E-02

Exit (Anterior) side of the body

Inside primary beam: front of chest, front of shoulders, front of upper 

abdomen (to iliac crest), front of neck. 6.30E-03

Backs of hands 

2.41E-01

Outside but near primary beam: face, front lower abdomen from iliac 

crest to pubis 6.30E-04

All skin covering the following

Thighs to top of knees

9.05E-05

Knees and below

3.31E-05

Table 3-7. Skin doses per exposure for well collimated PA chest radiography. 

Well Collimated PA Chest Skin Dose 1972 to 

1997 

1998 to 

present

Region of the Skin 

Entrance (Posterior) Side of the Body

Inside primary beam: back and sides of chest from 

base of neck to lowest rib, and back of shoulders 6.95E-02 7.10E-02

Outside but near primary beam: back of head, neck, ears, 

buttocks, arms, and hands 6.95E-03 7.10E-03

Exit (Anterior) side of the body

Inside primary beam: front of chest from base of neck 

to lowest rib, and front of shoulders. 1.58E-03 2.16E-03

Outside but near primary beam: face 1.60E-03 3.90E-03

Outside but near primary beam: front lower abdomen 

from iliac crest to pubis 1.58E-04 2.16E-04

All skin covering the following

Thighs to top of knees 2.26E-05 2.79E-05

Knees and below 8.27E-06 1.02E-05
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 21 of 25

Table 3-8. Skin doses per exposure for poorly collimated LAT chest radiography. 

Poorly Collimated LAT Chest Skin Dose Pre-1971

Region of the Skin 

Entrance (Right) Side of the Body

Inside primary beam: right side of torso from base of neck to iliac 

crest, including right shoulder, and upper right arm to elbow. 

6.95E-01

Outside but near primary beam: head, face, ears, right side of hip, 

elbows, forearms, and hands 6.95E-02

Exit (Anterior) side of the body

Inside primary beam: left side of torso from base of neck to iliac 

crest, including left shoulder, and upper left arm to elbow.

3.22E-03

Outside but near primary beam: left side of hip 3.22E-04

Front and Back (Anterior and Posterior)

Inside primary beam: front and back of torso from base of neck to 

iliac crest (lung) 1.10E-01

Outside but near primary beam: buttocks and front of lower abdomen 

(10% lung) 1.10E-02

All skin covering the following

Thighs to top of knees 2.26E-04

Knees and below 8.27E-05

Table 3-9. Skin doses per exposure for well collimated LAT chest radiography. 

Well Collimated LAT Chest Skin Dose 1972 to 

1997 

1998 to 

present

Region of the Skin 

Entrance (Right) Side of the Body

Inside primary beam: right side of torso from base of 

neck to lowest rib, including right shoulder, and upper 

right arm to elbow 1.81E-01 1.85E-01

Outside but near primary beam: head, face, ears, right 

side of hip, right elbow, right forearm, and right hand 1.81E-02 1.85E-02

Exit (Left) side of the body

Inside primary beam: left side of torso from base of 

neck to lowest rib, including left shoulder, and upper left 

arm to elbow. 8.37E-04 1.24E-03

Outside but near primary beam: left side of hip, left 

elbow, left forearm, and left hand 8.37E-05 1.24E-04

Front and Back (Anterior and Posterior)

Inside primary beam: front and back of torso from base 

of neck to lowest rib (Lund dose) 2.86E-02 4.56E-02

Outside but near primary beam: buttocks and front of 

abdomen (10% lung) 2.86E-03 4.56E-03

All skin covering the following

Thighs to top of knees 5.88E-05 7.25E-05

Knees and below 2.15E-05 2.65E-05
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 22 of 25

Table 3-10. Skin doses per exposure for single-exposure poorly collimated AP lumbar 

spine radiographya

. 

Poorly Collimated AP Lumbar Spine Skin Dose Pre-1971

Region of the Skin 

Entrance (Anterior) Side of the Body

Inside primary beam: front of abdomen and chest from the armpits to 

below pubis, hand, forearms, and elbows. 

2.64E+00

Outside but near primary beam: upper arms, front of shoulders, and 

front of thighs 2.64E-01

Exit (Posterior) side of the body

Inside primary beam: back of abdomen and chest from the armpits to 

the buttocks.. 9.94E-02

Outside but near primary beam: upper back, back of shoulders, back 

of thighs. 9.94E-03

All skin covering the following

Neck face and ears 1.52E-03

Knees and below 6.74E-04

a. Double these values if an AP lumbar spine spot film was taken.

Table 3-11. Skin doses per exposure for single-exposure well collimated AP lumbar 

spine radiographya

. 

Well Collimated AP Lumbar Spine Skin Dose 1972 to 

1997 

1998 to 

present

Region of the Skin 

Entrance (Anterior) Side of the Body

Inside primary beam: front of abdomen from the end of 

the sternum to the pubis. 5.14E-01 5.14E-01

Outside but near primary beam: front of chest, upper 

arms, front of shoulders, elbows, forearms, hands, and 

front of thighs. 5.14E-02 5.14E-02

Exit (Posterior) side of the body

Inside primary beam: back from the mid rib cage to the 

buttocks.. 2.60E-02 2.60E-02

Outside but near primary beam: upper back, back of 

shoulders, back of thighs. 2.60E-03 2.60E-03

All skin covering the following

Neck face and ears 3.84E-04 3.84E-04

Knees and below 1.71E-04 1.71E-04

a. Double these values if an AP lumbar spine spot film was taken.
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 23 of 25

Table 3-12. Skin doses per exposure for single-exposure poorly collimated LAT lumbar 

spine radiographya

. 

Poorly Collimated LAT Lumbar Spine Skin Dose Pre-1971

Region of the Skin 

Entrance (Right) Side of the Body

Inside primary beam: right side of torso from the 

armpits to side of right thigh 6.60E+00

Outside but near primary beam: right shoulder, right 

arm, right hand, right thigh 6.60E-01

Exit (Left) side of the body

Inside primary beam: left side of torso from armpits to 

left side of thigh. 1.12E-01

Outside but near primary beam: left shoulder, left arm, 

left hand, left thigh 1.12E-02

Front and Back (Anterior and Posterior)

front and back of chest and abdomen from base of neck 

to pubis/buttocks 5.00E-02

All skin covering the following

Neck face and ears 3.79E-03

Knees and below 1.68E-03

a. Double these values if a LAT lumbar spine spot film was taken.

Table 3-13. Skin doses per exposure for single-exposure well collimated LAT lumbar

spine radiographya

. 

Well Collimated LAT Lumbar Spine Skin Dose 1972 to 

1997

1998 to 

present

Region of the Skin 

Entrance (Right) Side of the Body

Inside primary beam: right side of torso from level of 

the base of the sternum to right hip 5.14E-01 5.14E-01

Outside but near primary beam: right shoulder, right 

arm, right hand, right thigh 5.14E-02 5.14E-02

Exit (Left) side of the body

Inside primary beam: left side of torso from level of the 

base of the sternum to left hip 1.17E-02 1.17E-02

Outside but near primary beam: left shoulder, left arm, 

left hand, left thigh 1.17E-03 1.17E-03

Front and Back (Anterior and Posterior)

Front and back of chest and abdomen from base of 

neck to pubis/buttocks: (lung dose) 5.18E-03 6.29E-03

All skin covering the following

Neck face and ears 3.84E-04 3.84E-04

Knees and below 1.71E-04 1.71E-04

a. Double these values if a LAT lumbar spine spot film was taken.
Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 24 of 25

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Document No. ORAUT-TKBS-0038-3 Revision No. 02 Effective Date: 10/31/2008 Page 25 of 25

GLOSSARY

absorbed dose

Energy absorbed per unit mass; units are rad and gray.

backscatter

Radiation scattered backwards, enhancing skin dose in areas where an X-ray beam enters the 

body.

dose equivalent

Product of absorbed dose and a quality factor or radiation weighting factor. With absorbed 

dose in rad, unit is rem.

exposure

Amount of electric charge produced per unit mass of air by electromagnetic radiation.

gray (Gy)

Unit of absorbed dose, defined as 1 joule per kilogram. It is equal to 100 rad.

kerma

Sum of initial kinetic energies of all charged particles (including Auger electrons) liberated by 

uncharged radiation per unit mass. Units are rad and gray. The word derives from the phrase 

Kinetic Energy Released in Matter. 

lumbar spine 

The vertebrae of the lower back.

rad

Unit of absorbed dose, defined as 100 ergs per gram. It is equal to 0.01 Gy.

rem

Unit of dose equivalent.

roentgen (R)

Unit of exposure.

X-ray

(1) Electromagnetic radiation emitted by fast electrons slowing down in matter or in certain 

electronic transitions in atoms. (2) A radiograph produced by X-rays.