ORAU TEAM

Dose Reconstruction

Project for NIOSH

Oak Ridge Associated Universities I Dade Moeller I MJW Technical Services

Page 1 of 19

DOE Review Release 04/22/2013

Document Title:

Portsmouth Gaseous Diffusion Plant –

Occupational Medical Dose

Document Number: ORAUT-TKBS-0015-3

Revision: 03

Effective Date: 04/08/2013

Type of Document: TBD

Supersedes: Revision 02

Subject Expert(s): Elizabeth K. Algutifan and Elyse M. Thomas

Approval: Signature on File Approval Date: 04/05/2013

Elizabeth K. Algutifan, Document Owner

Concurrence: Signature on File Concurrence Date: 04/04/2013

John M. Byrne, Objective 1 Manager

Concurrence: Signature on File Concurrence Date: 04/04/2013

Edward F. Maher, Objective 3 Manager

Concurrence: Vickie S. Short Signature on File for Concurrence Date: 04/04/2013

Kate Kimpan, Project Director

Approval: Signature on File Approval Date: 04/08/2013

James W. Neton, Associate Director for Science

New Total Rewrite Revision Page Change

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

REVISION AND DISCARD / DESTROY ALL COPIES OF THE PRIOR REVISION.
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 2 of 19

PUBLICATION RECORD

EFFECTIVE 

DATE

REVISION

NUMBER DESCRIPTION

01/05/2004 00 New technical basis document for the Portsmouth Gaseous Diffusion 

Plant – Occupational Medical Dose. First approved issue. Initiated 

by Mark Notich.

07/19/2004 01 Incorporates comments from internal and NIOSH formal reviews. 

Approved Issue of Revision 01. Initiated by Mark Notich.

07/07/2006 02 Deletes the uterus as an analogue/surrogate organ in Table 3-10 on 

page 16 in Section 3.4.5 as per Task 5 comment. Updates required 

introductory language on pages 6 and 7 in Section 3.1. Revised to 

change from a page change (Rev 01 PC-1-B) to a revision (Rev 02-

A) as a result of NIOSH comment. Added a Purpose and Scope 

subsection to the Introduction (Section 3.1). Approved issue of 

Revision 02. This revision results in a reduction in assigned dose 

and no PER is required. Training required: As determined by the 

Task Manager. Initiated by Paul J. Demopoulos. 

04/08/2013 03 This site profile was predominantly revised to address Sanford

Cohen & Associates concerns about the document as identified in 

SC&A-TR-TASK1-0020, Review of the NIOSH Site Profile for the 

Portsmouth Gaseous Diffusion Plant (see Section 3.3.1). Added skin 

doses for all applicable projections and exposure periods. Updated 

information to conform with revised ORAUT-OTIB-0006, Dose 

Reconstruction from Occupational Medical X-Ray Procedures. 

Updated references and added Attributions and Annotations section. 

Revised information on exposure periods based on recent issuance 

of ORAUT-OTIB-0079, Guidance on Assigning Occupational X-Ray 

Dose Under EEOICPA for X-Rays Administered Off Site. Updated 

pre-1982 X-ray doses, added lumbar spine doses, and added new 

period for 2010 – present based on new information. Incorporates 

formal internal and NIOSH review comments. Constitutes a total 

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

Objective Manager. Initiated by Elizabeth K. Algutifan.
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 3 of 19

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 Frequencies......................................................................................................... 6

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

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

3.3.2 Chest Radiography 1954 Through 1981 ....................................................................... 7

3.3.3 Chest Radiography 1982 Through 1991 ....................................................................... 8

3.3.4 Chest Radiography 1992 Through 2009 ....................................................................... 8

3.3.5 Chest Radiography 2010 Through the Present............................................................. 8

3.3.6 Lumbar Spine Radiography 1970-1975 (approximate) ................................................. 8

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

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

3.6 Attributions and Annotations .................................................................................................... 9

References ........................................................................................................................................ 10

Glossary ............................................................................................................................................ 11

ATTACHMENT A, ORGAN DOSE TABLES ...................................................................................... 14

LIST OF TABLES

TABLE TITLE PAGE

3-1 Default frequency of occupational chest X-rays at PORTS....................................................... 7

3-2 Description of the X-ray equipment used at PORTS................................................................. 8

A-1 Organ dose equivalents for chest projections for all periods................................................... 14

A-2 Organ dose equivalents for AP and LAT lumbar spine projections, 1970 to 1975 .................. 14

A-3 Skin dose guidance and skin dose equivalents for chest projections, 1954 to 1981 ............... 15

A-4 Skin dose guidance and skin dose equivalents for chest projections, 1982 to present ........... 16

A-5 Skin dose guidance and skin dose equivalents for lumbar spine projections, 1970 to 

1975.......................................................................................................................................18
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ACRONYMS AND ABBREVIATIONS

AP anterior-posterior

CFR Code of Federal Regulations

cm centimeter

DOE U.S. Department of Energy

EEOICPA Energy Employees Occupational Illness Compensation Program Act of 2000

ENSD entrance skin dose

EXSD exit skin dose

GE General Electric Company

HVL half-value layer

ICRP International Commission on Radiological Protection

in. inch

IREP Interactive RadioEpidemiological Program

kVp peak kilovoltage

LAT lateral

m meter

mA milliampere

mm millimeter

mR milliroentgen

mrem millirem

NIOSH National Institute for Occupational Safety and Health

PA posterior-anterior

PER Program Evaluation Report

PFG photofluorography

POC probability of causation

PORTS Portsmouth Gaseous Diffusion Plant

RSD remote skin dose

SSD source-to-skin distance

TBD technical basis document

U.S.C. United States Code

§ section or sections
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 5 of 19

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-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 6 of 19

3.1.1 Purpose

The purpose of this technical basis document (TBD) is to describe the occupational medical X-ray 

screening program and practices at the Portsmouth Gaseous Diffusion Plant (PORTS). This 

document discusses historical and current practices for the evaluation of dose from medical X-ray 

screening procedures for PORTS workers. Dose reconstructors will use this information as needed to 

assign medical X-ray doses to workers’ EEOICPA claims at PORTS.

3.1.2 Scope

PORTS required preemployment, periodic, and termination physical examinations as part of its

occupational health and safety program (Ely et al. 1957). These medical examinations typically 

included chest X-rays and, for some workers, preemployment lumbar spine X-rays. The doses from 

these X-ray procedures depended not only on the characteristics of the X-ray machine and the 

techniques used, but also on the frequency of the examinations. Other types of examinations, such 

as knee or ankle X-rays, were given for on-the-job injuries or at the discretion of the medical director. 

X-ray examinations other than posterior-anterior (PA) chest and AP and LAT lumbar spine X-rays do 

not appear to have been performed for occupational health screening and are, therefore, not eligible 

to be included in dose reconstruction under EEOICPA. 

This TBD contains supporting evidence for the evaluation of occupational X-ray dose from medical 

screening of workers at PORTS. 

3.2 EXAMINATION FREQUENCIES

The PORTS medical records include notations in individual worker files regarding the date and 

purpose of the X-ray examinations, and are assumed to be complete. Almost all of the X-rays in the

claim file records are PA chests, but a subset of workers received preemployment lumbar spine Xrays.

Review of the available historical documentation pertaining to the occupational medical program at 

PORTS and in the claim file records from 1954 to the present revealed that the PA chest on 14-in. × 

17-in. film was the most common screening procedure in connection with preemployment, periodic, or 

termination medical examinations, but that some workers received a PFG chest, or preemployment 

anterior-posterior (AP) and lateral (LAT) lumbar spine X-ray. Any other radiographic examinations of 

PORTS employees that might have occurred were necessitated by illness or injury and, therefore, 

were not part of the screening process. 

Dose reconstructors should assign dose from chest (including PFG) and lumbar spine X-rays 

according to the recorded frequency in the provided medical records in each worker’s claim file. Dose 

reconstructors can use the default frequency to assign X-ray dose if individual worker records were 

not submitted by the site for a particular worker. Table 3-1 lists the default frequency of chest X-rays 

for different age groups through the years and identifies specific groups of workers. Typically, one PA 

chest projection was taken. 
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 7 of 19

Table 3-1. Default frequency of occupational chest X-rays at PORTS.

Period Exam Frequency Comment

1954–1987 PA Chest 

(14 in. by 

17 in.) 

Preemployment/termination, annual 

periodica

All workers.

PFG

(1954-

1957)

Annually All workers.

1988–1997 PA Chest 

(14 in. by 

17 in.)

Preemployment/terminationb All workers.

Annuallyb Be workers and asbestos workers 

> 35 years old.

Every 5 yearsb Asbestos workers.

1998–

present

PA Chest 

(14 in. by 

17 in.)

Preemployment/terminationc All workers, except pregnant 

women.

Every 5 years, or annually if >35 years 

old

Asbestos workers.

Every 10 years if <30 years old. All workers except asbestos 

workers.

Every 5 years if 30–45 years old. All workers except asbestos 

workers.

Every 3 years if >45 years old. All workers except asbestos 

workers.

a. From a review of claim file records.

b. Conrad (1988).

c. Barch and Noel (1998, p. 6).

3.3 EQUIPMENT AND TECHNIQUES

3.3.1 Chest Photofluorography

Chest photofluorography (PFG) was used sporadically until as late as the early 1960s. PFG used a 

smaller film (for example 4-in. × 5-in.), a smaller source-to-skin distance (SSD) (42 in.), and a higher 

peak kilovoltage (kVp) and a greater exposure than conventional chest radiography on 14-in. × 17-in. 

film. Exposure was regulated by photometers, which used the exposure to the film to determine the 

time of exposure. 

Evidence of PFG is found in several claim file records for PORTS workers, although no historical 

information about a PFG machine at PORTS has been found in captured records. They appear in the 

claim file records from 1954 to 1957. All records indicate stereoscopic PFG performed on 4-in. × 10-

in. film. Because the PFG machine could have been in a mobile van that stopped at the PORTS 

facility, the PFG should be assumed to have been performed on the PORTS site. 

Because no historical information has been located for the PFG machine used to radiograph PORTS 

workers, the organ doses for PFG come from ORAUT-OTIB-0006, Dose Reconstruction from 

Occupational Medical X-ray Procedures (ORAUT 2011). These are reproduced in Attachment A, 

Tables A-1 and A-2.

3.3.2 Chest Radiography 1954 Through 1981

There was a dispensary building at PORTS from the beginning of operations, and it appears to have 

contained an X-ray room (Wingfoot 1954; ORAUT 2012). However, no more specific information 

about the type of X-ray equipment or technique factors has been found for this period. Therefore, the 

organ doses for this period are based on the information in ORAUT-OTIB-0006 (ORAU 2011). Since 

ORAUT-OTIB-0006 assumes poor collimation before 1970, the same assumption is made for 

PORTS, and the organ doses reported here reflect that assumption.
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3.3.3 Chest Radiography 1982 Through 1991

There is evidence that a General Electric (GE) KXE 225 machine was installed at PORTS in 1982 

(Author unknown 1985, p. 29). In 1984, measurements were made on this machine, which indicate a 

half-value layer (HVL) of 2.4 mm Al at 60 kVp, and a measured entrance skin exposure (ESE) of 

10 mR for a PA chest (Bassett 1984). 

While actual techniques are not known for this period, organ doses were derived assuming an HVL of 

3.5 mm Al, because chest X-rays would have been performed at a higher kVp than that at which the 

HVL was measured. The 10-mR ESE was converted to incident air kerma according to equation (1) 

in ORAUT-OTIB-0006 (ORAU 2011) for the organ dose calculations. Organ doses are listed in 

Attachment A, Tables A-1 and A-2.

A procedure manual for the medical X-ray quality assurance tests by Bassett (1985) describes the 

tests that were presumably performed during this period.

3.3.4 Chest Radiography 1992 Through 2009

A survey was made on GE equipment by Food and Drug Administration personnel in 1992 (Bolen 

1992). It is not clear if this is the same GE equipment that was installed in 1982. At that time, the 

technique for PA chest X-rays was reported as 110 kVp, 320 mA, and 0.083 second. The ESE was 

measured by Bolen with a 23-cm chest phantom, with a resultant ESE of 17 mR at 110 to 120 kVp 

(Bolen 1992). The 17-mR ESE was converted to incident air kerma according to equation (1) in 

ORAUT-OTIB-0006 (ORAU 2011) for the organ dose calculations.

In 1994, measurements were made on the X-ray machine, which indicate an HVL of 3.3 mm Al at 

80 kVp (Author unknown 1994). The HVL for dose reconstruction is assumed to be 4.0 mm Al (NCRP 

1997) at the 110 to 120 kVp reportedly used for chest radiography (Bolen 1992). Organ doses based 

on these measurements are listed in Tables A-1 and A-2.

3.3.5 Chest Radiography 2010 Through the Present

In approximately 2010, a Toshiba high frequency X-ray machine was installed at PORTS (ORAUT

2012). This machine uses anatomical selectors on the control panel and, therefore, traditional 

technique factors might not be available until measurements are made and documented on this 

machine. Therefore, the doses from this period are based on those in ORAUT-OTIB-0006 (ORAU 

2011).

A summary description of the X-ray equipment used at PORTS is included in Table 3-2. 

Table 3-2. Description of the X-ray equipment used at PORTS.

Technique Period Equipment

PFG 1954–1957 No specific information available

Conventional 14-in. × 17-in. chest X-rays 1954–1981 No specific information available

Conventional 14-in. × 17-in. chest X-rays 1982–1991 GE KXE 225

Conventional 14-in. × 17-in. chest X-rays 1992–2009 GE equipment

Conventional 14-in. × 17-in. chest X-rays 2010–present Toshiba equipment

3.3.6 Lumbar Spine Radiography 1970-1975 (approximate)

As mentioned above, most of the X-rays of workers during this period were PA chests, but a subset of 

workers received an AP and LAT lumbar spine X-ray as preemployment screening, especially around 

the 1970 to 1975 timeframe, although these dates are approximate. If lumbar spine X-rays were 
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 9 of 19

taken as preemployment screening and appear in the claim file records, dose reconstructors should 

include the dose from them in the dose reconstruction. The organ doses from the lumbar spine 

procedures come from ORAUT-OTIB-0006 (ORAU 2011).

3.4 ORGAN DOSE CALCULATIONS

Specific organ doses to be assigned for PA chest X-rays calculated using the dose conversion factors 

found in International Commission on Radiological Protection (ICRP) Publication 34 (ICRP 1982) are 

given in Attachment A, Table A-1. Doses were calculated according to the method described in 

ORAUT-OTIB-0006 (ORAUT 2011). Doses for organs not listed in ICRP Publication 34 but specified 

in the Interactive RadioEpidemiological Program (IREP) code were determined according to the 

scheme described in ORAUT-OTIB-0006. 

3.5 UNCERTAINTY

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

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

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

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

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

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

5. Variation in SSD as a result of worker size (±10%). 

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

correction of output intensity changes from differences 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, for a derived dose equivalent to an individual organ, a total combined standard uncertainty 

of ±30% can be assumed. Dose reconstructors should, therefore, input the organ dose equivalent as 

the mean of a normal distribution with a standard uncertainty of ±30%.

3.6 ATTRIBUTIONS AND ANNOTATIONS

All information requiring identification was addressed via references integrated into the References

section of this document. 
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 10 of 19

REFERENCES

Author unknown, 1985, PMS Data Record – Tables A. [SRDB Ref ID: 75962, pp. 24-27]

Author unknown, 1994, Above Table X-Ray Survey Report, March 3. [SRDB Ref ID: 23928, pp. 2-4]

Barch, D., and A. A. Noel, 1998, Chest X-Ray Frequency, ESH-M-086, Piketon, Ohio, November 20. 

[SRDB Ref ID: 75987, pp. 3-7]

Bassett, A. C., 1984, “Medical X-ray Quality Assurance,” memorandum to [Name redacted] (Medical 

Department), Goodyear Atomic Corporation, Industrial Hygiene and Health Physics, Piketon, 

Ohio, August 28. [SRDB Ref ID: 75967]

Bassett, A. C., 1985, Medical X-ray Quality Assurance Tests, GAT-S-39, Goodyear Atomic 

Corporation, Industrial Hygiene and Health Physics, Piketon, Ohio, January 15. [SRDB Ref 

ID: 8158]

Bolen, T. R., 1992, “X-Ray Facility Survey,” letter to W. Lyon (Martin Marietta Energy Systems), 

Department of Health and Human Services, Public Health Service, Food and Drug 

Administration, Cincinnati, Ohio, August 24. [SRDB Ref ID: 23924]

Conrad, D. E., 1988, “Chest X-Radiography,” April 5. [SRDB Ref ID: 75985]

Ely, T., Harris, W.B., Sterner, J.H., Schoen, A.A., and Hayes, D.F., 1957. “Health Protection at 

Paducah and Portsmouth,” memorandum to [Name redacted], April 16. [SRDB Ref ID: 

98610]

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

Diagnostic Radiology, Publication 34, Pergamon Press, Oxford, England.

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

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

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

Support, Cincinnati, Ohio, October. 

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

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

Performance and Use), Report 102, Third Reprinting, Bethesda, Maryland.

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

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

ORAUT (Oak Ridge Associated Universities Team) 2012. Documented Communication on the 

Occupational Medical Program at Portsmouth, Oak Ridge, Tennessee, December 3. [SRDB 

Ref ID: 121127]

Wingfoot (Wingfoot Clan Newsletter), 1954. GAT Medical Program Emphasizes Prevention, 

December, 15, 1954. [SRDB Ref ID: 120061]
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 11 of 19

GLOSSARY

anterior-posterior (AP)

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

radiation passes through the body from the front to the back. See exposure geometry.

backscatter

Reflection or refraction of radiation at angles over 90 degrees from its original direction.

bremsstrahlung

Electromagnetic radiation released as a result of inelastic scattering of a moving charged 

particle within the nucleus of an atom. X-rays produced in a typical medical X-ray tube 

frequently originate from inelastic scattering of accelerated electrons in the anode material.

dose

In general, the specific amount of energy from ionizing radiation that is absorbed per unit of 

mass. Effective and equivalent doses are in units of rem or sievert; other types of dose are in 

units of rads, reps, or grays.

dose conversion factor

Ratio of dose equivalent in tissue or organ to entrance kerma in air at the surface of the 

person being radiographed.

error

Difference between the correct, true, or conventionally accepted value and the measured or 

estimated value. Sometimes used to mean estimated uncertainty. See uncertainty.

exposure geometry

Orientation (physical positioning) of a person or object in relation to a radiation source. This 

geometry is a factor in the radiation dose to various parts of the body. See anterior-posterior, 

posterior-anterior, and lateral in relation to radiography.

gaseous diffusion plant 

Facility where uranium hexafluoride (UF6) gas is filtered to enrich the 235U and separate it from 

238U. 

half-value layer (HVL)

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

attenuates an X-ray beam to one half the original kerma rate. It is a measure of the X-ray 

beam quality.

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.

kilovoltage (kVp)

The electrical potential difference in units of kilovolts between the cathode and the anode in 

the X-ray generating tube. See technique.
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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.

occupational medical dose

Dose from X-ray procedures performed for medical screening of workers as part of an 

occupational health program. Doses from X-rays used to diagnose diseases or injuries, even 

if incurred on the job, are not considered screening and are, therefore, not eligible to be 

included in dose reconstruction under EEOICPA.

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 35 mm, 70 mm, 4-inch × 5-inch, or 4-inch × 10-inch film. PFG was the 

primary method of screening large populations for tuberculosis before the advent of 

nonradiographic screening methods.

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. See exposure geometry.

preemployment X-ray

An X-ray, usually of the chest, taken before hire or assignment to a specific job. The purpose 

of preemployment X-rays was to screen for active disease, such as tuberculosis.

projection

Description of the path of an X-ray beam from the X-ray tube to the image receptor. For 

example, posterior-anterior and lateral are two common projections in chest radiography.

radiography

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

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.

stereoscopic

Noting or pertaining to simulated three-dimensional viewing of photographic or radiographic 

images with two views of the same image taken at slightly different angles.

source-to-skin distance (SSD)

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

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

technique

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

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

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

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

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

a fixed peak kilovoltage.
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 13 of 19

uncertainty

Standard deviation of the mean of a set of measurements. The standard error reduces to the 

standard deviation of the measurement when there is only one determination. See error.

X-ray

(1) See X-ray radiation. (2) See radiograph.

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.
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Table A-1. Organ dose equivalents (rem) for chest projections for all periods.

a

Organ

PFG

1954–1957a

PA chest

14- × 17-in.

1954–1970b

PA chest

14- × 17-in.

1971–1981b

PA chest

14- × 17-in.

1982–1991c

PA chest

14- × 17-in.

1992–2009d

PA chest

14- × 17-in.

2010–

presentb

Thyroid 3.94E–01 3.48E-02 3.20E-03 5.43E–04 1.16E-03 3.90E-03

Eye/brain 7.25E–02 6.40E-03 3.20E-03 5.43E–04 1.16E-03 3.90E-03

Ovaries 2.50E–02 2.50E-02 1.00E-04 2.80E–05 7.75E-05 2.60E-04

Urinary bladder/prostate 2.50E–02 2.50E-02 1.00E-04 2.80E–05 7.75E-05 2.60E-04

Colon/rectum 2.50E–02 2.50E-02 1.00E-04 2.80E–05 7.75E-05 2.60E-04

Testes 5.00E–03 5.00E-03 1.00E-06 8.76E–08 1.49E-07 5.00E-07

Lungs (male) 9.50E–01 8.38E-02 4.19E-02 4.95E–03 9.36E-03 3.14E-02

Lungs (female) 1.02E+00 9.02E-02 4.51E-02 5.35E–03 1.00E-02 3.37E-02

Thymus 1.02E+00 9.02E-02 4.51E-02 5.35E–03 1.00E-02 3.37E-02

Esophagus 1.02E+00 9.02E-02 4.51E-02 5.35E–03 1.00E-02 3.37E-02

Stomach 1.02E+00 9.02E-02 4.51E-02 5.35E–03 1.00E-02 3.37E-02

Bone surface 1.02E+00 9.02E-02 4.51E-02 5.35E–03 1.00E-02 3.37E-02

Liver/gall bladder/

spleen/pancreas

1.02E+00 9.02E-02 4.51E-02 5.35E–03 1.00E-02 3.37E-02

Remainder organs 1.02E+00 9.02E-02 4.51E-02 5.35E–03 1.00E-02 3.37E-02

Breast 1.11E–01 9.80E-03 4.90E-03 7.98E–04 1.73E-03 5.80E-03

Uterus 2.50E–02 2.50E-02 1.30E-04 2.63E–05 7.75E-05 2.60E-04

Bone marrow (male) 2.09E–01 1.84E-02 9.20E-03 1.28E–03 2.65E-03 8.90E-03

Bone marrow (female) 1.95E–01 1.72E-02 8.60E-03 1.24E–03 2.56E-03 8.60E-03

Entrance skine 3.06E+00 2.70E-01 1.35E-01 1.24E–02 2.12E-02 7.00E-02

a. Doses for PFG are from ORAUT-OTIB-0006 (ORAUT 2011) and assumed to be stereoscopic views.

b. Based on ORAUT-OTIB-0006 (ORAUT 2011).

c. Based on Bassett (1984).

d. Based on Bolen (1992) and Author unknown (1994).

e. Entrance skin dose (ENSD) is determined by multiplying the incident air kerma by the backscatter factors of 1.35, 1.41, 

and 1.42 for HVLs of 2.5, 3.5, and 4.0 mm Al, respectively, from National Council on Radiation Protection and 

Measurements (NCRP) Report 102 (NCRP 1997, Table B-8). Skin doses for all areas of skin are provided in 

Tables A-3 and A-4.

Table A-2. Organ dose equivalents (rem) for AP and LAT lumbar spine

projections, 1970 to 1975 (approximately).a

Organ AP lumbar spine LAT lumbar spine

Thyroid 2.73E-04 3.48E-05

Eye/brain 2.73E-04 3.48E-05

Ovaries 1.97E-01 1.64E-01

Urinary bladder/prostate 1.97E-01 1.64E-01

Colon/rectum 1.97E-01 1.64E-01

Testes 3.82E-03 2.78E-03

Lungs (male) 7.19E-02 4.87E-02

Lungs (female) 7.19E-02 4.87E-02

Thymus 7.19E-02 4.87E-02

Esophagus 7.19E-02 4.87E-02

Stomach 1.97E-01 1.64E-01

Bone surface 1.97E-01 1.64E-01

Liver/gall bladder/spleen/pancreas 1.97E-01 1.64E-01

Remainder organs 1.97E-01 1.64E-01

Breast 9.56E-04 2.07E-03

Uterus 2.61E-01 1.08E-01

ATTACHMENT A

ORGAN DOSE TABLES

Page 1 of 6
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 15 of 19

Organ AP lumbar spine LAT lumbar spine

Bone marrow (male) 3.37E-02 7.66E-02

Bone marrow (female) 3.37E-02 7.66E-02

Entrance skinb 1.230E+00 4.70E+00

a. Based on ORAUT-OTIB-0006, (ORAUT 2011), one AP and one LAT projection.

b. ENSD is determined by multiplying the incident air kerma by the backscatter factor 

of 1.35, for HVL of 2.5 mm Al, from NCRP Report 102 (NCRP 1997, Table B-8). 

Skin doses for all areas of skin are provided in Table A-5.

Table A-3. Skin dose guidance and skin dose equivalents (rem) for chest projections, 1954 to 1981.

a

Area of skin

PFG 1954–1957 PA chest 1954–1970 PA chest 1971–1981

Guidance Dose Guidance Dose Guidance Dose

Right front shoulder EXSD 6.67E–02 EXSD 5.9E-03 EXSD 2.9E-03

Right back shoulder ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.35E-01

Left front shoulder EXSD 6.67E–02 EXSD 5.9E-03 EXSD 2.9E-03

Left back shoulder ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.35E-01

Right upper arm to elbow 10% ENSD 3.06E–01 ENSD 2.70E-01 10% ENSD 1.35E-02

Left upper arm to elbow 10% ENSD 3.06E–01 ENSD 2.70E-01 10% ENSD 1.35E-02

Left hand ENSD 3.06E+00 ENSD 2.70E-01 10% ENSD 1.35E-02

Right hand ENSD 3.06E+00 ENSD 2.70E-01 10% ENSD 1.35E-02

Left elbow, forearm, wrist 10% ENSD 3.06E–01 ENSD 2.70E-01 10% ENSD 1.35E-02

Right elbow, forearm,

wrist

10% ENSD 3.06E–01 ENSD 2.70E-01 10% ENSD 1.35E-02

Right side of head 

(including ear and 

temple)

10% ENSD 3.06E–01 10% ENSD 2.70E-02 10% ENSD 1.35E-02

Left side of head 

(including ear and 

temple)

10% ENSD 3.06E–01 10% ENSD 2.70E-02 10% ENSD 1.35E-02

Front left thigh RSD (0.52 m) 9.E–04 RSD (0.52 m) 8.E-05 RSD (0.52 m) 4.E-05

Back left thigh RSD (0.52 m) 9.E–04 RSD (0.52 m) 8.E-05 RSD (0.52 m) 4.E-05

Front right thigh RSD (0.52 m) 9.E–04 RSD (0.52 m) 8.E-05 RSD (0.52 m) 4.E-05

Back right thigh RSD (0.52 m) 9.E–04 RSD (0.52 m) 8.E-05 RSD (0.52 m) 4.E-05

Left knee and below RSD (0.86 m) 3.E–04 RSD (0.86 m) 3.E-05 RSD (0.86 m) 1.E-05

Right knee and below RSD (0.86 m) 3.E–04 RSD (0.86 m) 3.E-05 RSD (0.86 m) 1.E-05

Left side of face Eye/brain 7.25E–02 Eye/Brain 6.4E-03 Eye/Brain 3.2E-03

Right side of face Eye/brain 7.25E–02 Eye/Brain 6.4E-03 Eye/Brain 3.2E-03

Left side of neck 10% ENSD 3.06E–01 ENSD 2.70E-01 10% ENSD 1.35E-02

Right side of neck 10% ENSD 3.06E–01 ENSD 2.70E-01 10% ENSD 1.35E-02

Back of head 10% ENSD 3.06E–01 10% ENSD 2.70E-02 10% ENSD 1.35E-02

Front of neck Eye/brain 7.25E–02 Eye/Brain 6.4E-03 Thyroid 3.2E-03

Back of neck 10% ENSD 3.06E–01 ENSD 2.70E-01 10% ENSD 1.35E-02

Front torso: base of neck 

to end of sternum

EXSD 6.67E–02 EXSD 5.9E-03 EXSD 2.9E-03

Front torso: end of 

sternum to lowest rib

EXSD 6.67E–02 EXSD 5.9E-03 EXSD 2.9E-03

Front torso: lowest rib to 

iliac crest

EXSD 6.67E–02 EXSD 5.9E-03 10% EXSD 3.E-04

Front torso: iliac crest to 

pubis

10% EXSD 6.7E–03 10% EXSD 6.E-04 10% EXSD 3.E-04

Back torso: base of neck 

to mid–back

ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.35E-01

ATTACHMENT A

ORGAN DOSE TABLES

Page 2 of 6
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 16 of 19

Area of skin

PFG 1954–1957 PA chest 1954–1970 PA chest 1971–1981

Guidance Dose Guidance Dose Guidance Dose

Back torso: mid–back to 

lowest rib

ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.35E-01

Back torso: lowest rib to 

iliac crest

ENSD 3.06E+00 ENSD 2.70E-01 10% ENSD 1.35E-02

Back torso: buttocks 

(Iliac crest and below)

10% ENSD 3.06E–01 10% ENSD 2.70E-02 10% ENSD 1.35E-02

Right torso: base of neck 

to end of sternum

ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.35E-01

Right torso: end of 

sternum to lowest rib

ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.35E-01

Right torso: lowest rib to 

iliac crest

ENSD 3.06E+00 ENSD 2.70E-01 10% ENSD 1.35E-02

Right torso: iliac crest to 

pubis (right hip)

10% ENSD 3.06E–01 10% ENSD 2.70E-02 10% ENSD 1.35E-02

Left torso: base of neck 

to end of sternum

ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.35E-01

Left torso: end of 

sternum to lowest rib

ENSD 3.06E+00 ENSD 2.70E-01 ENSD 1.35E-01

Left torso: lowest rib to 

iliac crest

ENSD 3.06E+00 ENSD 2.70E-01 10% ENSD 1.35E-02

Left torso: iliac crest to 

pubis (left hip)

10% ENSD 3.06E–01 10% ENSD 2.70E-02 10% ENSD 1.35E-02

a. Values less than 0.1 mrem shown to one significant digit.

Table A-4. Skin dose guidance and skin dose equivalents (rem) for chest 

projections, 1982 to present.

a

Area of skin

PA chest ≥ 

1971

PA chest 

1982–

1991

PA chest 

1992–2009

PA chest 

2010–

present

Guidance Dose Dose Dose

Right front shoulder EXSD 4.E-04 7.E-04 2.4E-03

Right back shoulder ENSD 1.24E-02 2.12E-02 7.00E-02

Left front shoulder EXSD 4.E-04 7.E-04 2.4E-03

Left back shoulder ENSD 1.24E-02 2.12E-02 7.00E-02

Right upper arm to elbow 10% ENSD 1.2E-03 2.1E-03 7.0E-03

Left upper arm to elbow 10% ENSD 1.2E-03 2.1E-03 7.0E-03

Left hand 10% ENSD 1.2E-03 2.1E-03 7.0E-03

Right hand 10% ENSD 1.2E-03 2.1E-03 7.0E-03

Left elbow, forearm, wrist 10% ENSD 1.2E-03 2.1E-03 7.0E-03

Right elbow, forearm, 

wrist

10% ENSD 1.2E-03 2.1E-03 7.0E-03

Right side of head 

(including ear and 

temple)

10% ENSD 1.2E-03 2.1E-03 7.0E-03

Left side of head 

(including ear and 

temple)

10% ENSD 1.2E-03 2.1E-03 7.0E-03

Front left thigh RSD (0.52m) 4.E-06 8.E-06 3.E-05

Back left thigh RSD (0.52m) 4.E-06 8.E-06 3.E-05

Front right thigh RSD (0.52m) 4.E-06 8.E-06 3.E-05

ATTACHMENT A

ORGAN DOSE TABLES

Page 3 of 6
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 17 of 19

Area of skin

PA chest ≥ 

1971

PA chest 

1982–

1991

PA chest 

1992–2009

PA chest 

2010–

present

Guidance Dose Dose Dose

Back right thigh RSD (0.52m) 4.E-06 8.E-06 3.E-05

Left knee and below RSD (0.86m) 2.E-06 3.E-06 1.E-05

Right knee and below RSD (0.86m) 2.E-06 3.E-06 1.E-05

Left side of face Eye/brain 5.E-04 1.2E-03 3.9E-03

Right side of face Eye/brain 5.E-04 1.2E-03 3.9E-03

Left side of neck 10% ENSD 1.2E-03 2.1E-03 7.0E-03

Right side of neck 10% ENSD 1.2E-03 2.1E-03 7.0E-03

Back of head 10% ENSD 1.2E-03 2.1E-03 7.0E-03

Front of neck Thyroid 5.E-04 1.2E-03 3.9E-03

Back of neck 10% ENSD 1.2E-03 2.1E-03 7.0E-03

Front torso: base of neck 

to end of sternum

EXSD 4.E-04 7.E-04 2.4E-03

Front torso: end of 

sternum to lowest rib

EXSD 4.E-04 7.E-04 2.4E-03

Front torso: lowest rib to 

iliac crest

10% EXSD 4.E-05 7.E-05 2.E-04

Front torso: iliac crest to 

pubis

10% EXSD 4.E-05 7.E-05 2.E-04

Back torso: base of neck 

to mid–back

ENSD 1.24E-02 2.12E-02 7.00E-02

Back torso: mid–back to 

lowest rib

ENSD 1.24E-02 2.12E-02 7.00E-02

Back torso: lowest rib to 

iliac crest

10% ENSD 1.2E-03 2.1E-03 7.0E-03

Back torso: buttocks 

(Iliac crest and below)

10% ENSD 1.2E-03 2.1E-03 7.0E-03

Right torso: base of neck 

to end of sternum

ENSD 1.24E-02 2.12E-02 7.00E-02

Right torso: end of 

sternum to lowest rib

ENSD 1.24E-02 2.12E-02 7.00E-02

Right torso: lowest rib to 

iliac crest

10% ENSD 1.2E-03 2.1E-03 7.0E-03

Right torso: iliac crest to

pubis (right hip)

10% ENSD 1.2E-03 2.1E-03 7.0E-03

Left torso: base of neck 

to end of sternum

ENSD 1.24E-02 2.12E-02 7.00E-02

Left torso: end of 

sternum to lowest rib

ENSD 1.24E-02 2.12E-02 7.00E-02

Left torso: lowest rib to 

iliac crest

10% ENSD 1.2E-03 2.1E-03 7.0E-03

Left torso: iliac crest to 

pubis (left hip)

10% ENSD 1.2E-03 2.1E-03 7.0E-03

a. Values less than 0.1 mrem shown to one significant digit.

ATTACHMENT A

ORGAN DOSE TABLES

Page 4 of 6
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 18 of 19

Table A-5. Skin dose guidance and skin dose equivalents (rem) for lumbar 

spine projections, 1970 to 1975 (approximately).

a

Area of skin

AP lumbar 

spine ≥ 1971

AP 

lumbar 

spine

LAT lumbar 

spine ≥ 1971

LAT lumbar 

spine

Guidance Dose Guidance Dose

Right front shoulder 10% ENSD 1.23E-01 10% ENSD 4.70E-01

Right back shoulder 10% EXSD 2.7E-03 10% ENSD 4.70E-01

Left front shoulder 10% ENSD 1.23E-01 10% EXSD 2.1E-03

Left back shoulder 10% EXSD 2.7E-03 10% EXSD 2.1E-03

Right upper arm to elbow 10% ENSD 1.23E-01 10% ENSD 4.70E-01

Left upper arm to elbow 10% ENSD 1.23E-01 10% EXSD 2.1E-03

Left hand 10% ENSD 1.23E-01 10% EXSD 2.1E-03

Right hand 10% ENSD 1.23E-01 10% ENSD 4.70E-01

Left elbow, forearm, wrist 10% ENSD 1.23E-01 10% EXSD 2.1E-03

Right elbow, forearm, 

wrist

10% ENSD 1.23E-01 10% ENSD 4.70E-01

Right side of head 

(including ear and 

temple)

Eye/brain 3.E-04 Eye/brain 3.E-05

Left side of head 

(including ear and 

temple)

Eye/brain 3.E-04 Eye/brain 3.E-05

Front left thigh 10% ENSD 1.23E-01 10% EXSD 2.1E-03

Back left thigh 10% EXSD 2.7E-03 10% EXSD 2.1E-03

Front right thigh 10% ENSD 1.23E-01 10% ENSD 4.70E-01

Back right thigh 10% EXSD 2.7E-03 10% ENSD 4.70E-01

Left knee and below RSD (0.60m) 3.E-04 RSD (0.60m) 5.E-04

Right knee and below RSD (0.60m) 3.E-04 RSD (0.60m) 5.E-04

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

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

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

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

Back of head Eye/brain 3.E-04 Eye/brain 3.E-05

Front of neck Eye/brain 3.E-04 Eye/brain 3.E-05

Back of neck Eye/brain 3.E-04 Eye/brain 3.E-05

Front torso: base of neck 

to end of sternum

10% ENSD 1.23E-01 Lung 4.87E-02

Front torso: end of 

sternum to lowest rib

ENSD 1.23E+00 Lung 4.87E-02

Front torso: lowest rib to 

iliac crest

ENSD 1.23E+00 Lung 4.87E-02

Front torso: iliac crest to 

pubis

ENSD 1.23E+00 Lung 4.87E-02

Back torso: base of neck 

to mid–back

10% EXSD 2.7E-03 Lung 4.87E-02

Back torso: mid–back to 

lowest rib

EXSD 2.68E-02 Lung 4.87E-02

Back torso: lowest rib to 

iliac crest

EXSD 2.68E-02 Lung 4.87E-02

Back torso: buttocks 

(Iliac crest and below)

EXSD 2.68E-02 Lung 4.87E-02

ATTACHMENT A

ORGAN DOSE TABLES

Page 5 of 6
Document No. ORAUT-TKBS-0015-3 Revision No. 03 Effective Date: 04/08/2013 Page 19 of 19

Area of skin

AP lumbar 

spine ≥ 1971

AP 

lumbar 

spine

LAT lumbar 

spine ≥ 1971

LAT lumbar 

spine

Guidance Dose Guidance Dose

Right torso: base of neck 

to end of sternum

10% ENSD 1.23E-01 10% ENSD 4.70E-01

Right torso: end of 

sternum to lowest rib

ENSD 1.23E+00 ENSD 4.70E+00

Right torso: lowest rib to 

iliac crest

ENSD 1.23E+00 ENSD 4.70E+00

Right torso: iliac crest to 

pubis (right hip)

ENSD 1.23E+00 ENSD 4.70E+00

Left torso: base of neck 

to end of sternum

10% ENSD 1.23E-01 10% EXSD 2.1E-03

Left torso: end of 

sternum to lowest rib

ENSD 1.23E+00 EXSD 2.06E-02

Left torso: lowest rib to 

iliac crest

ENSD 1.23E+00 EXSD 2.06E-02

Left torso: iliac crest to 

pubis (left hip)

ENSD 1.23E+00 EXSD 2.06E-02

a. Values less than 0.1 mrem shown to one significant digit.

ATTACHMENT A

ORGAN DOSE TABLES

Page 6 of 6