Draft

ADVISORY BOARD ON 

RADIATION AND WORKER HEALTH

National Institute for Occupational Safety and Health

SC&A’S EVALUATION OF ORAUT-OTIB-0006, REVISION 05, 

“DOSE RECONSTRUCTION FROM OCCUPATIONAL 

MEDICAL X-RAY PROCEDURES”

Contract No. 211-2014-58081 

SCA-TR-2019-PR002, Revision 0 

Prepared by 

Ron Buchanan, PhD, CHP 

SC&A, Inc.

2200 Wilson Boulevard, Suite 300 

Arlington, VA 22201-3324 

Saliant, Inc.

5579 Catholic Church Road

Jefferson, Maryland 21755 

January 14, 2019 

DISCLAIMER 

This is a working document provided by the Centers for Disease Control and Prevention (CDC) technical 

support contractor, SC&A for use in discussions with the National Institute for Occupational Safety and 

Health (NIOSH) and the Advisory Board on Radiation and Worker Health (ABRWH), including its 

Working Groups or Subcommittees. Documents produced by SC&A, such as memorandum, white paper, 

draft or working documents are not final NIOSH or ABRWH products or positions, unless specifically 

marked as such. This document prepared by SC&A represents its preliminary evaluation on technical 

issues.

NOTICE: This document has been reviewed to identify and redact any information that is protected by 

the Privacy Act 5 U.S.C. § 552a and has been cleared for distribution. 
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SC&A, INC.: Technical Support for the Advisory Board on Radiation and 

Worker Health Review of NIOSH Dose Reconstruction Program

DOCUMENT TITLE: SC&A’s Evaluation of ORAUT-OTIB-0006, Revision 05, “Dose 

Reconstruction from Occupational Medical X-Ray Procedures”

DOCUMENT NUMBER/

DESCRIPTION:

SCA-TR-2019-PR002 

REVISION NO.: 0 (Draft)

SUPERSEDES: N/A

EFFECTIVE DATE: January 14, 2019

TASK MANAGER Kathy Behling [signature on file]

PROJECT MANAGER: John Stiver, MS, CHP [signature on file]

DOCUMENT 

REVIEWER(S):

Kathy Behling [signature on file]

John Stiver, MS, CHP [signature on file]

Record of Revisions

Revision 

Number

Effective 

Date

Description of Revision

0 (Draft) 1/14/2019 Initial issue
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TABLE OF CONTENTS

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

1.0 Introduction and Background ................................................................................................. 5

2.0 Overview of ORAUT-OTIB-0006 .......................................................................................... 5

3.0 SC&A’s Evaluation of ORAUT-OTIB-0006 ......................................................................... 7

3.1 Evaluation of the Technical Approach Used in ORAUT-OTIB-0006 ........................... 7

3.1.1 Equations and Units .................................................................................................... 7

3.1.2 Terminology ................................................................................................................ 7

3.1.3 Technical Information ................................................................................................. 8

3.2 Evaluation of Documentation Used in ORAUT-OTIB-0006 ....................................... 10

4.0 Summary and Conclusions ................................................................................................... 12

5.0 References ............................................................................................................................. 13
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ABBREVIATIONS AND ACRONYMS

ABRWH Advisory Board on Radiation and Worker Health

AP anterior-posterior

cGy centigray

DCF dose conversion factor

DOE U.S. Department of Energy

ENSD entrance skin dose

EXSD exit skin dose

Gy gray

ICD-9 International Classification of Diseases, Ninth Edition

ICRP International Commission on Radiological Protection

kerma kinetic energy released per unit mass

LAT lateral

Lum. Vert. lumbar vertical

mGy milligray

NIOSH National Institute for Occupational Safety and Health

ORAUT Oak Ridge Associated Universities Team

OTIB ORAUT technical information bulletin

PA posterior-anterior

PFG photofluorography

RSD remote skin dose

SID source-to-image distance

SRDB Site Research Database
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1.0 INTRODUCTION AND BACKGROUND

As a result of tasking on December 3, 2018, after the Subcommittee for Procedure Reviews 

meeting of October 31, 2018, SC&A has performed a technical review of ORAUT-OTIB-0006, 

Revision 05, Dose Reconstruction from Occupational Medical X-Ray Procedures (NIOSH 2018, 

referred to as “OTIB-0006”). 

This report presents SC&A’s evaluation of the technical approach and documentation in 

OTIB-0006. 

2.0 OVERVIEW OF ORAUT-OTIB-0006

The following is a brief outline of OTIB-0006. 

• Purpose – According to page 9 of OTIB-0006, the purpose of the document “is to 

describe medical X-ray dose reconstruction in general, and to provide organ dose 

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

not available.” 

• Technical Factors that Affect Medical X-Ray Dose – Section 3.0 provides a brief 

discussion of the technical factors that affect medical x-ray dose, which are: 

- Kilovoltage, filtration, and type of high-voltage generator 

- Current and exposure time 

- Distance

- Collimation

- Screens, grids, and other factors 

• Determining Incident Air Kerma – Section 4.0 provides a brief discussion of the 

methods used to determine incident air kinetic energy released per unit mass (kerma), 

which are: 

- Using beam measurements

- Using technical factors

- Using published values from medical literature 

Table 4-1 provides a lists of incident air kerma used in OTIB-0006. 

• Determining Dose Equivalent to Organs Other than Skin – Section 5.0 discusses the 

basic concept of deriving the main objective of OTIB-0006 for organ dose reconstruction: 

the organ dose equivalent, which is the incident air kerma multiplied by the organ dose 

conversion factor (DCF), as shown in Equation 5-1 on page 18 of OTIB-0006. 

Section 5.0 also addresses poorly collimated beam issues (through 1970) and summarizes 

the recommended organ DCFs as a function of the x-ray procedure performed using 

poorly collimated x-ray beams. Attachment B of OTIB-0006 provides a more detailed 
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and complete listing of recommended organ DCFs as a function of the x-ray procedure 

performed. 

• Determining Dose Equivalent to Skin – Section 6.0 discusses the concept of deriving 

the main objective of OTIB-0006 for skin dose reconstruction: the entrance skin dose 

(ENSD). The equation for deriving ENSD is provided in Equation 6-1 on page 23 of 

OTIB-0006. 

Section 6.0 also addresses the exit skin dose (EXSD), the dose to the skin outside, but 

near, the primary beam, and the remote skin dose (RSD). 

• Types and Frequency of X-Ray Screening – Section 7.0 summarizes the most 

commonly used occupational medical procedures, which are: 

- Radiographic chest

- Chest photofluorographic 

- Chest fluoroscopy 

- Lumbar spine 

- Pelvis

- Thoracic and cervical spine

• Uncertainty Analysis – Section 8.0 discusses the derivation of an overall uncertainty of 

+30% in occupational medical x-ray dose assignment.

• Attachment A – This attachment lists the name of the organ to use for a given 

International Classification of Diseases, Ninth Edition (ICD-9), code as a function of the 

type of x-ray procedure performed, which includes: 

- Chest: Tables A-1 and A-2 

- Lumbar spine: Table A-3 

- Thoracic spine: Table A-4 

- Cervical spine: Table A-5 

• Attachment B – This attachment lists the DCFs, skin dose guidance, and organ or skin 

dose numerical values as a function of the type of x-ray procedure performed. The 

attachment includes: 

1. DCFs:

- Thoracic and cervical spine: Table B-1 

- Chest: Tables B-2 and B-3 

2. Skin dose guidance:

- Chest through 1970: Table B-4 

- Lumbar spine and pelvis: Table B-5 

- Thoracic spine: Table B-6 

- Cervical spine: Table B-7 
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- Chest after 1970: Table B-8

- Lumbar spine: Table B-9

3. Organ dose (in units of rem): 

- Chest view: Table B-10

- Lumbar spine and pelvis view: Table B-13

- Thoracic and cervical spine view: Table B-15

4. Skin dose (in rem): 

- Chest view: Tables B-11 and B-12

- Lumbar spine and pelvis view: Table B-14

- Thoracic and cervical spine view: Table B-16

3.0 SC&A’S EVALUATION OF ORAUT-OTIB-0006

The following sections summarize SC&A’s evaluation of the technical approach and 

documentation used in OTIB-0006. 

3.1 EVALUATION OF THE TECHNICAL APPROACH USED IN ORAUT-OTIB-0006

SC&A evaluated the technical approach the National Institute for Occupational Safety and 

Health (NIOSH) used in OTIB-0006 to derive dose reconstruction parameters for assigning dose 

from occupational medical x-ray. The following major areas that could affect dose reconstruction

were evaluated.

3.1.1 Equations and Units

SC&A analyzed the equations and units used in OTIB-0006 and found them to be generally 

applicable and correct, with one observation.

Observation 1: Need Clarification for DCF Units in Attachment B – Tables B-1, B-2, and 

B-3 (captions on pages 87, 88, and 89, respectively) list DCFs for various x-ray projections in 

units of “(mGy/Gy × 10-3 rem-Gy/cGy-mGy)” where Gy = gray, cGy = centigray, and mGy = 

milligray.

It is not obvious what unit the multiplication factor of 10-3 applies to and why it is there, because

1.0 rem is equal to 1.0 cGy for photon dose, and there are units of mGy/mGy and Gy/Gy that 

cancel each other out. 

3.1.2 Terminology

SC&A found the terminology used in OTIB-0006 to be consistent with other documents used in 

assigning occupational medical x-ray dose, such as ORAUT-PROC-0061, Revision 04, 

Occupational Medical X-Ray Reconstruction (NIOSH 2017), and ORAUT-OTIB-0005, 

Revision 05, Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model Selection 

by ICD-9 Code (NIOSH 2012).
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3.1.3 Technical Information

SC&A analyzed the technical information presented in OTIB-0006 and found it to be applicable 

and mostly correct. However, several areas appeared to need clarification or more complete 

information. These are discussed in the following observations.

Observation 2: Need Clarification for Changing Chest Thickness – OTIB-0006 Table 3-1 

lists the body part thickness for various x-ray procedures. Table 3-1 lists 24 centimeters (cm) for 

the thickness of the chest and abdomen; Footnote a of Table 3-1 states this value without citing a 

reference in the footnote. The description of revisions on page 3 of OTIB-0006 states:

Changed part thickness in Table 3-1 for anterior-posterior and posterior-anterior 

projections to 24 cm, except the cervical spine.

Other sources list the chest thickness as ranging from 20 cm to 25 cm (Cahoon 1961, PDF 

page 33), and 20 cm to 26 cm (Kereiakes and Rosenstein, 1980, PDF pages 34–35). While a 

selection of 24 cm for the standard chest thickness is reasonable, it would be helpful to clarify 

the reasoning for changing the value from 23 cm in the previous ORAUT-OTIB-0006, 

Revision 04 (NIOSH 2011), to 24 cm in OTIB-0006, Revision 05. 

Observation 3: Difference in Source-to-Image Distance – OTIB-0006 Table 3-1 lists the 

source-to-image distance (SID) for various x-ray procedures. For a cervical spine lateral 

procedure, Table 3-1 lists the SID as 72 inches/183 cm, with Footnote d stating: 

The 72-in. [183 cm] SID is used for the LAT cervical spine to reduce 

magnification. 

However, International Commission on Radiological Protection (ICRP) Publication 34 (ICRP 

1982), Table A9, PDF page 36, lists a SID of 102 cm for a cervical spine view. The use of a SID 

of 183 cm in OTIB-0006 instead of 102 cm needs further clarification.

Observation 4: Need References and Derivation of Kerma Values in Table 4-1 – OTIB-0006 

Table 4-1 lists incident air kerma values for various x-ray procedures. However, while some of 

the footnotes provide site research database (SRDB) references, most do not provide PDF page 

numbers. These are generally large documents and PDF page numbers would be very helpful. 

Additionally, it would be helpful to indicate the numerical value of the original data used, such 

as the number of milliroetgen, etc., used to derive the resulting kerma values listed in Table 4-1. 

As it presently stands, it is very difficult to use the references listed to verify the values 

recommended in Table 4-1. 

Observation 5: Thoracic and Cervical Spine Dose Assignments after 1970 Need 

Clarification – Table B-1 lists DCF values for determining dose equivalents from thoracic and 

cervical spine procedures through 1970. OTIB-0006 provides DCF values after 1970 for other 

x-ray procedures, such as for the chest. It needs to be clarified if dose from thoracic and cervical 

spine procedures are to be assigned after 1970, since DCFs are not provided post-1970 for 

thoracic and cervical spine procedures. 
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Observation 6: Breast Dose Reference Needs Clarification – OTIB-0006 Table B-3, 

Footnote e on page 89, and Table B-13, Footnote f on page 108, both list a reference to Huda and 

Bissessur (1990) for deriving dose to the breast. However, Huda and Bissessur (1990) only 

mention the breast in Table II, PDF page 5, and lists dose fraction values for the breast as a 

function of x-ray procedure. Dose fraction values for the breast listed in Huda and Bissessur

relevant to Tables B-3 and B-13 of OTIB-0006 are 0.10 for the lumbar-spine anterior-posterior 

procedure, and 0.00 for lumbar-spine lateral and pelvis anterior-posterior procedures. It is not 

obvious how the dose values for the breast in Table B-13, page 107, were derived using the dose 

fractions from the Huda and Bissessur (1990) reference. 

Observation 7: Need to Retain Important Information from Attachment C of ORAUTPROC-0061 – There are three situations regarding the amount of information provided for 

occupational medical dose reconstruction in a site’s profile document: 

1. Site profile provides complete skin dose information for the various skin locations –

In this situation, the skin doses in OTIB-0006 and information in Attachment C of 

ORAUT-PROC-0061, Revision 03, Occupational Medical X-ray Dose Reconstruction

for DOE Sites (NIOSH 2010), are not needed.

2. Site profile does not provide any occupational medical dose data – In this situation, 

the skin doses in OTIB-0006 can be used.

3. Site profile provides some skin dose information – Some site profiles provide basic 

information on skin dose, such as ENSD, but do not provide detailed dose values as is 

contained in Tables B-10 through B-16 of OTIB-0006 for various skin cancer locations. 

Since the ENSD for that site may be different than that recommended in OTIB-0006, 

Tables B-10 through B-16 of OTIB-0006 would not be applicable. It then becomes 

necessary to manually calculate the EXSD, RSD, and the ENSD near but outside the 

primary beam, using equations provided on page 20 of ORAUT-PROC-0061, Revision 

03 (NIOSH 2010), in conjunction with data in Tables C-3 and C-4 of ORAUT-PROC0061, Revision 03. However, it appears that this necessary information in Attachment C 

of ORAUT-PROC-0061, Revision 03, is being phased out without being retained in 

either ORAUT-PROC-0061, Revision 04 (NIOSH 2017), or OTIB-0006. The description 

of changes on page 2 of ORAUT-PROC-0061, Revision 04 (NIOSH 2017), states: 

Revision initiated to ensure consistency with ORAUT-OTIB-0006. 

Appendix C on the calculation of skin dose deleted as duplicate of 

ORAUT-OTIB-0006 content. [Emphasis added.]

SC&A recommends that the essential information for skin dose that is contained in 

Attachment C, pages 20-22 of ORAUT-PROC-0061, Revision 03 (NIOSH 2010), be retained 

and carried forward for further use in dose reconstructions for sites without detailed skin dose 

data. 
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3.2 EVALUATION OF DOCUMENTATION USED IN ORAUT-OTIB-0006

SC&A evaluated the documentation used in OTIB-0006 for assigning occupational medical 

x-ray dose and found the document is well written and informative. It is a relatively complex and 

large document, and, as such, SC&A found several items of documentation that need to be 

corrected or clarified.

• Page 3: The description in this paragraph of the revisions that took place in OTIB-0006, 

Revision 05, is difficult to follow because many of the tables are labeled incorrectly (it 

applies the old table numbers from Attachment A of Revision 04 [NIOSH 2011] to the 

new tables in Attachment B in Revision 05). The following are some examples:

- “Added dose for bone surface anterior-posterior lordotic in Table B-7 for 1971 to 

1985” – It appears that this should read Table B-2, not Table B-7.

- “Corrected Table B-10 entrance skin dose through 1970 for anterior-posterior 

and lateral lumbar spine to account for proper backscatter factor.” – It appears 

that this should read Table B-13, not Table B-10.

- “Corrected Table B-11 lateral lumbar spine through 1970 for back torso: 

buttocks (iliac crest and below) to include E-02.” – It appears that this should read 

Table B-14, not Table B-11. 

- “Corrected Table B-13 fourth column title to left posterior oblique thoracic 

spine.” – It appears that this should read Table B-16, not Table B-13, and the fifth 

column, not the fourth column (counting all columns from left to right). 

- “Corrected Table B-1 to B-3 anterior-posterior lordotic chest dose conversion 

factors and added footnote.” – It appears that this should read Table B-2, not 

Table B-1 to B-3, because the term “AP [anterior-posterior] lordotic” only 

appears in Table B-2. 

• Page14: The last paragraph on this page states: 

An assumption of poor collimation of radiographs through 1970 might 

necessitate the use of DCFs from ICRP Publication 34 (ICRP 1982) other 

than those for the intended examination, because ICRP Publication 34 

DCFs are based on properly collimated beams. [Emphasis added.]

Additionally, the captions of Tables A-2, A-3, A-4, and A-5 use the terminology:

Selection of organs for [various procedures] X-ray dose reconstruction 

based on ICD-9 code when different organ selection required based on 

view

SC&A assumes that this means that the dose reconstructor may need to use a different 

organ than would normally be used because of the x-ray procedure (i.e., view) used in the 

exam. However, this is not very obvious from the wording and it would be helpful to 
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have this concept more clearly stated. It would also be beneficial to provide an example 

or more details regarding appropriate organ selection. 

• Page 26: The second paragraph on this page states: 

The incident air kerma for a LAT chest X-ray is assumed to be 2.5 times 

that of a PA chest, a conservative value based on measurements from 

Hanford (Kirklin et al. ca. 1969) where a factor of 1.94 was observed...

Because of the many pages in the referenced document, it would have been helpful for 

the page number to have been included. It appears that the factor of 1.94 was derived 

from dividing the LAT chest dose of 0.153 roentgen by the PA chest dose of 

0.079 roentgen, as provided on PDF pages 161 and 162, respectively, of the reference. 

• Page 27: The last paragraph on this page states: 

The resolution of PFG systems was not as good as conventional film 

screen systems; only 6 line/pairs per mm rather than about 9 or per mm... 

[Emphasis added.]

SC&A found that, according to Goodwin, Quimby, and Morgan (1970), p. 108 (PDF

page 63), this should read: 

The resolution of PFG systems was not as good as conventional film 

screen systems; only 6 line/pairs per mm rather than about 9 or 10 

line/pairs per mm... [Emphasis added.]

• Page 37: The last paragraph on this page states: 

Using the inverse square law, the entrance skin dose is calculated based 

on the part thickness for PA Chest and LAT... [Emphasis added.]

SC&A found that this apparently should read: 

Using the inverse square law, the entrance skin dose is calculated based 

in part on the thickness for PA Chest and LAT... [Emphasis added.]

• Page 38: The second column, second row, of Table 8.1 reads:

Lumb. Vert 37-32 

SC&A found that for the lumbar vertical (Lum. Vert.) view, the thickness value 

(according to Cahoon 1961, PDF page 33) should read: 

Lumb. Vert 27-32 
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This error did not affect the derivation of the 7.5 cm chest thickness value quoted at the 

top of page 38, which was derived from averaging the maximum and minimum values 

already correctly listed in Table 8.1 (i.e., (34.4 cm – 27 cm) = 7.4 cm, rounded to 7.5 cm. 

• Page 52: The fourth column (for the lumbar spine view) in the table on this page for 

ICD-9 code 170.4 should instruct the dose reconstructor to “See Table A-3,” not 

Table A-5. 

• Page 52: The fourth column (for the lumbar spine view) in the table on this page for 

ICD-9 code 170.5 should instruct the dose reconstructor to “See Table A-3,” not 

Table A-5. 

• Page 60: The fourth column (for the lumbar spine view) in the table on this page for 

ICD-9 code 195.4 should instruct the dose reconstructor to “See Table A-3,” not 

Table A-5. 

• Page 113: Footnote a for Table B-15 provides the following references:

Dose equivalents through 1970 are based on measured values (Lincoln 

and Gupton 1958) for skin, testes, and ovaries for the thoracic spine, and 

measured values (Braestrup and Wycoff 1958) for testes, ovaries, and 

uterus for the cervical spine. 

Lincoln and Gupton 1958 (Table IX, PDF page 8) does provide the dose values as listed 

in Table B-15 of OTIB-0006 for the thoracic spine view for the skin, testes, and ovaries. 

However, Braestrup and Wycoff 1958 is a textbook and does not provide the doses for 

the testes, ovaries, and uterus for the cervical spine view. This may be an incorrect 

reference.

4.0 SUMMARY AND CONCLUSIONS 

Equations and Units – SC&A analyzed the equations and units used in OTIB-0006 and found 

them to be generally applicable and correct, with one observation, which is discussed in 

Section 3.1.1 of this report: 

• Observation 1: Need Clarification for DCF Units in Attachment B 

Terminology – SC&A found the terminology used in OTIB-0006 to be consistent with other 

documents used by NIOSH for assigning occupational medical x-ray dose. 

Technical Information – SC&A analyzed the technical information presented in OTIB-0006 

and found it to be applicable and mostly correct. However, there were several areas that appear

to need clarification or more complete information. SC&A had the following observations, 

which were discussed in Section 3.1.3 of this report: 

• Observation 2: Need Clarification for Changing Chest Thickness

• Observation 3: Difference in Source-to-Image Distance 
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• Observation 4: Need References and Derivation of Kerma Values in Table 4-1

• Observation 5: Thoracic and Cervical Spine Dose Assignments after 1970 Need 

Clarification

• Observation 6: Breast Dose Reference Needs Clarification

• Observation 7: Need to Retain Important Information from Attachment C of 

ORAUT-PROC-0061

Documentation – SC&A evaluated the documentation used in OTIB-0006 for assigning 

occupational medical x-ray dose and found the document was well written and informative. It is 

a relatively complex and large document, and, as such, SC&A found several items that need to 

be corrected or clarified. These items are discussed in Section 3.2 of this report.

5.0 REFERENCES

Braestrup and Wyckoff 1958. C.B. Braestrup and H.O. Wyckoff, Radiation Protection, Charles 

C. Thomas, Springfield, IL. 1958. [SRDB Ref. ID 32408]

Cahoon 1961. J.B. Cahoon, Formulating X-Ray Technics, Fifth Edition, Duke University Press, 

Durham, NC. 1961. [SRDB Ref. ID 38740]

Goodwin, Quimby, and Morgan 1970. P.N. Goodwin, E.H. Quimby, and R.H. Morgan, Physical 

Foundations of Radiology, Fourth Edition, Harper and Row Publishers, New York, NY. 1970. 

[SRDB Ref. ID 169064]

Huda and Bissessur 1990. W. Huda & K. Bissessur, “Effective Dose Equivalents, HE, in 

Diagnostic Radiology,” Medical Physics, Vol. 17, No. 6 (1990), pp. 998–1003. [SRDB Ref.

ID 75101]

ICRP 1982. Protection of the Patient in Diagnostic Radiology, ICRP Publication 34, 

International Commission on Radiological Protection, Ann. ICRP 9 (2-3). 1982. [SRDB Ref. ID 

32466]

Kereiakes and Rosenstein 1980. J.G. Kereiakes & M. Rosenstein, Handbook of Radiation Doses 

in Nuclear Medicine and Diagnostic X-Ray, CRC Press, Boca Raton, FL. June 1980. [SRDB 

Ref. ID 11109]

Kirklin et al. 1969. C.W. Kirklin, B.D. Nuss, K.R. Heid, F.L. Rising, F.E. Adley, and E.B. 

Lavelle, The AEC Health and Mortality Study: Its Purpose, Scope, and Design and the 

Supporting Data Systems from the Hanford Operations: Retrospective and Continuing Phases of 

Data Acquisition, unpublished study, Hanford Environmental Health Foundation, Richland, WA. 

1969. [SRDB Ref. ID 12330]

Lincoln and Gupton. 1058. T.A. Lincoln and E.D. Gupton, “Radiation Doses in Diagnostic 

X-Ray Procedures,” Radiology, Vol, 71 (August 1958), pp. 208–215. [SRDB Ref. ID 11099]
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NIOSH 2010. Occupational Medical X-Ray Dose Reconstruction for DOE Sites, ORAUTPROC-0061, Revision 03, National Institute for Occupational Safety and Health, Cincinnati, OH. 

March 3, 2010.

NIOSH 2011. Dose Reconstruction from Occupational Medical X-Ray Procedures, ORAUTOTIB-0006, Revision 04, National Institute for Occupational Safety and Health, Cincinnati, OH. 

June 20, 2011.

NIOSH 2012. Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model Selection 

by ICD-9 Code, ORAUT-OTIB-0005, Revision 05, National Institute for Occupational Safety 

and Health, Cincinnati, OH. December 20, 2012.

NIOSH 2017. Occupational Medical X-Ray Dose Reconstruction, ORAUT-PROC-0061, 

Revision 04, National Institute for Occupational Safety and Health, Cincinnati, OH. June 6, 

2017.

NIOSH 2018. Dose Reconstruction from Occupational Medical X-Ray Procedures, ORAUTOTIB-0006, Revision 05, National Institute for Occupational Safety and Health, Cincinnati, OH. 

August 13, 2018.