ORAU TEAM

Dose Reconstruction

Project for NIOSH

Oak Ridge Associated Universities I Dade Moeller I MJW Technical Services

Page 1 of 22

DOE Review Release 01/13/2014

Document Title:

Fernald Environmental Management Project 

– Occupational Medical Dose

Document Number: ORAUT-TKBS-0017-3

Revision: 01

Effective Date: 01/02/2014

Type of Document: TBD

Supersedes: Revision 00

Subject Expert(s): Elyse M. Thomas

Approval: Signature on File Approval Date: 12/19/2013

Karen S. Kent, Document Owner

Concurrence: Signature on File Concurrence Date: 12/19/2013

James P. Griffin, Deputy Project Director

Concurrence: Signature on File Concurrence Date: 12/20/2013

Edward F. Maher, Objective 3 Manager

Concurrence: Vickie S. Short Signature on File for Concurrence Date: 12/19/2013

Kate Kimpan, Project Director

Approval: Signature on File Approval Date: 01/02/2014

David S. Sundin, Deputy Director, DCAS

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-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 2 of 22

PUBLICATION RECORD

EFFECTIVE 

DATE

REVISION 

NUMBER DESCRIPTION

02/11/2004 00 New Technical Basis Document for the Fernald Environmental 

Management Project – Occupational Medical Dose. Incorporates 

formal internal and NIOSH review comments. First approved issue. 

Initiated by Terry A. Kuykendall.

01/02/2014 01 Revision to correct errors in dose from LAT chest X-rays. Skin doses 

were added for all projections and periods. Dose to B-lymphocytes 

added. Incorporates formal internal and NIOSH review comments. 

Constitutes a total rewrite of the document. Training required: As 

determined by the Objective Manager. Initiated by Karen S. Kent.
Document No. ORAUT-TKBS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 3 of 22

TABLE OF CONTENTS

SECTION TITLE PAGE

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

3.1 Introduction .............................................................................................................................. 6

3.1.1 Purpose........................................................................................................................ 7

3.1.2 Scope........................................................................................................................... 7

3.2 Examination Frequencies......................................................................................................... 7

3.3 Equipment and Techniques...................................................................................................... 8

3.3.1 Keleket X-Ray Machine, 1952 to 1973.......................................................................... 8

3.3.2 Bennett Equipment, 1974 to 1987 ................................................................................ 9

3.3.3 General Electric X-Ray Machine, 1988 to 1993 .......................................................... 10

3.3.4 General Electric X-Ray Machine, 1994 to 2006 .......................................................... 10

3.3.5 2007 to Present .......................................................................................................... 10

3.4 Organ Dose Calculations ....................................................................................................... 11

3.5 Uncertainty............................................................................................................................. 11

3.6 Attributions and Annotations .................................................................................................. 11

References ........................................................................................................................................ 19

Glossary ............................................................................................................................................ 21

LIST OF TABLES

TABLE TITLE PAGE

3-1 Frequency of occupational chest X-rays at Fernald.................................................................. 7

3-2 Description of Fernald medical X-ray equipment...................................................................... 8

3-3 Organ dose equivalents for PA and LAT/OBL chest radiography, 1952 to 1987..................... 12

3-4 Organ dose equivalents for PA and LAT/OBL chest radiography, 1988 to 2006..................... 12

3-5 IREP dose distributions and corresponding statistical parameters for the dose 

to the B-lymphocytes..............................................................................................................13

3-6 Skin dose guidance for PA, LAT, and RAO chest projections, 1952 to 2006 .......................... 13

3-7 Skin dose equivalents for PA, LAT, and RAO chest projections, 1952 to 1987....................... 15

3-8 Skin dose equivalents and guidance for PA, LAT, and RAO chest projections, 

1988 to 2006..........................................................................................................................17
Document No. ORAUT-TKBS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 4 of 22

ACRONYMS AND ABBREVIATIONS

CFR Code of Federal Regulations

cGy centigray

cm centimeter

DCF dose conversion factor

DOE U.S. Department of Energy

DOL U.S. Department of Labor

EEOICPA Energy Employees Occupational Illness Compensation Program Act of 2000

ENSD entrance skin dose

eq equivalent

ESE entrance skin exposure

EXSD exit skin dose

FDA Food and Drug Administration

FEMP Fernald Environmental Management Project

FMPC Feed Materials Production Center

GE General Electric Company

Gy gray

HVL half-value layer

ICRP International Commission on Radiological Protection

in. inch

IREP Interactive RadioEpidemiological Program

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

kVp peak kilovoltage

LAT lateral

mA milliampere

mAs milliampere-second

mm millimeter

mR milliroentgen

mrem millirem

NCRP National Council on Radiation Protection and Measurements

NIOSH National Institute for Occupational Safety and Health

OBL oblique

ORAU Oak Ridge Associated Universities

PA posterior-anterior

PFG photofluorography

POC probability of causation

R roentgen

RAO right anterior oblique

RSD remote skin dose
Document No. ORAUT-TKBS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 5 of 22

SEC Special Exposure Cohort

SRDB Ref ID Site Research Database Reference Identification (number)

U.S.C. United States Code

§ section or sections
Document No. ORAUT-TKBS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 6 of 22

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-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 7 of 22

3.1.1 Purpose

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

energy employees who were employed at Fernald Environmental Management Project (FEMP)

3.1.2 Scope

This document contains the technical data necessary to estimate the radiation dose to organs from 

medical X-ray procedures that workers received at FEMP, formerly known as the Feed Materials

Production Center (FMPC). Under the requirements of EEOICPA, only the dose from medical X-rays 

received for screening and as a condition of employment is eligible to be included in dose 

reconstruction.

Occupational medical X-ray dose is a function of many variables including number and type of 

radiographic examinations, the projection(s) performed, degree of collimation or beam restriction, type 

of equipment and technique factors used. Section 3.2 discusses examination frequencies, and 

Section 3.3 describes the equipment and techniques FEMP used. Section 3.4 describes organ dose 

calculations and provides the results, and Section 3.5 discusses uncertainty in the results. 

3.2 EXAMINATION FREQUENCIES

Fernald required preemployment, annual, and termination physical examinations as part of its 

occupational health and safety program. These medical examinations typically included chest X-rays 

(Quigley 1951). A review of the claim file records and historical documentation indicated that the most 

common X-ray screening examination was the posterior-anterior (PA) chest projection. The lateral

(LAT) and right anterior oblique (RAO) chest appears on occasion, and was likely performed at the 

physician’s request. Both of these projections were useful for asbestos workers in evaluating 

asbestosis, an occupational disease. Therefore, the dose from these projections should be included 

in dose reconstruction. There is no evidence in the claim file records that photofluorography (PFG)

was performed on any workers, nor is there historical evidence of PFG equipment at Fernald.

The frequency of medical X-rays varied over the years of Fernald operation. Table 3-1 shows the 

frequency of chest X-ray screening for different age groups over the years of operation. The dose 

reconstructor should use the X-rays listed in the claim file records for dose reconstruction whenever 

those records are provided. The frequency listed in Table 3-1 can be used when records have not 

been provided.

Table 3-1. Frequency of occupational chest X-rays at Fernald.

Period Frequency Projection(s) Employees

1952–1981 Pre-employment PA chest All employeesa

Annual PA chest All employeesb

Termination PA chest All employeesb

1981–1987 Pre-employment l PA chest All employees

Annual PA chest Employees over 45 years oldc

Every 2 years PA chest Employees under 45 years oldc

1988-2006 Pre-employment l PA chest, LAT discretionary All employeesd

Annual (offered) PA chest, LAT discretionary All employeesd

a. Quigley (1951, p. 10).

b. Schoen and Heacker (1961, p. 4).

c. Rardin (1983, p. 12).

d. Jacoboski (1987, pp. 26–27).

The claim file records indicate the purpose of the X-ray examinations as “annual,” “pre,” for 

preemployment, “term” for termination, or “dispensary” for examinations requested as a result of
Document No. ORAUT-TKBS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 8 of 22

individual worker symptoms or injuries. For example, lumbar spine radiographs appear in some of the 

claim file records, but the reason indicated on the requisition is most often “dispensary,” which 

suggests that the lumbar spine radiographs were performed for individual back pain or injury but not 

for routine screening on asymptomatic workers. The dose from lumbar spine procedures (or any 

others for that matter) should not be included in dose reconstruction when the requisition states 

“dispensary” as a justification for the examination.

Many of the claim file records contain the X-ray requisition as well as the radiologists’ interpretation or 

report. The dates on these documents may be separated by a few days to a week, but may also 

contain the date the examination was actually performed. The dose reconstructor should look 

carefully at the dates on these documents to ensure that the number of X-ray procedures in dose 

reconstruction is accurate for each worker. It is possible that some of the X-ray examinations were 

performed off the FEMP site at local area hospitals, but there does not seem to be a fixed pattern, and 

no clear evidence exists in relation to when or for whom this might have occurred. If dose 

reconstructors are certain that X-rays were performed off-site, then dose from these procedures 

should not be included in dose reconstruction (ORAUT 2011b). Otherwise, dose reconstructors 

should assume that all X-ray procedures were performed on the Fernald site from 1952 to 2006, when 

buildings at Fernald were demolished and the X-ray equipment in them was removed from the site.

3.3 EQUIPMENT AND TECHNIQUES

What is known about the medical X-ray equipment Fernald used is summarized in Table 3-2 below, 

and each type and period of use is discussed in the following subsections.

Table 3-2. Description of Fernald medical X-ray equipment.

Period Equipment Technique Factors

1952–1973 Keleket X-ray unit, 2.5-mm Al eq total filtration Technique factors are unknown, but 

exposure in air measurements exist.a

1974–1987 Bennett X-Ray Corporation Model 300 6.7 mAs at 74 kVp for PA chest projections, 

with 2.5 mm Al eq total filtration,

b,c 6.7 mAs 

at 86 kvp,

d and 6.7 mAs at 90 kVpe for PA 

chest projections.

1988–1993 GE Model 46-2611-85G1, Lanex Regular 

screens/film

100 kVp, 200 mA, 0.025 sf.

1994–2006 GE Model 46-2611-85G1, plus Kodak InSight 

Thoracic Imaging System 

110kVp 8 mAs,

g and 126 kVp 6.4 mAsh

;

HVL 3.5 mm Al at 120 kVph.

a. Fischoff (1961, pp. 6-8).

b. Boback (1977, pp. 9-10).

c. Scudder (1974, p. 1).

d. Hinnefeld (1984, p.18).

e. Jacoboski (1987, p. 32).

f. Kodak (1988, p. 35).

g. Bolen (1995, p. 68).

h. Bolen (2000, p. 41).

3.3.1 Keleket X-Ray Machine, 1952 to 1973

Medical X-ray equipment was first installed at Fernald in 1952 (Blatz 1952). The make and model of 

the equipment is not known, and the technique factors are not available. 

The earliest information about actual X-ray equipment at Fernald is a survey in 1961 on a Keleket 

machine (Fischoff 1961). The purpose of the survey was to measure the exposure in air and on 

standard film badges for typical X-ray settings on the machine such as would be used to X-ray 

workers to determine the response of the film badge. Then, if a worker accidentally wore his badge 

during a medical X-ray examination, the film badge density could be corrected to the true occupational 
Document No. ORAUT-TKBS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 9 of 22

exposure with the calibration curves resulting from the survey results. Only two survey 

measurements (out of 15) were made at 72 in., the typical distance for chest X-rays. The two 

measurements at 72 in. were made at 90 kVp, at 50 and 150 mAs. Given the purpose of the survey, 

it was assumed these were the techniques for the PA and LAT chest, respectively, on this machine at 

this time. 

The two measurements described above show exposure in air results of 0.10 and 0.30 R for the 50-

and 150-mAs exposures at 90 kVp and 72 in. The survey states that the Keleket machine had 

2.5 mm Al eq total filtration. Using these data and the information and equations in ORAUT-OTIB0006, Dose Reconstruction from Occupational Medical X-Ray Procedures (ORAUT 2011a), the

resulting incident air kerma values (at 155 cm) for the PA and LAT chest X-rays are 0.122 and 0.367 

cGy, respectively. The half-value layer (HVL) at 90 kVp for 2.5 mm Al eq total filtration is 2.6 mm Al, 

which was rounded to 2.5 mm Al for selection of dose conversion factors (DCFs) for dose 

reconstruction. 

It is possible that the Keleket X-ray machine that was surveyed in 1961 was the original X-ray 

machine, which was installed at Fernald in 1952. However, this is not known for certain from the 

currently available information. Because it is possible, the organ doses that are calculated based on 

the measurements on the Keleket machine are assumed to be those from the start of X-rays at 

Fernald in 1952.

3.3.2 Bennett Equipment, 1974 to 1987

The manufacturer of the medical X-ray equipment that was used during this period is not clear, but 

several usable sources of technical information exist about the equipment. Survey measurements on 

the equipment are documented for 1977 (Boback 1977). The purposes of this survey were to 

measure the entrance skin exposures (ESE) for various X-ray examinations and to compare them to 

published national Entrance Skin Exposure Guides. The results show that the measured ESE on the 

Fernald equipment was 11.4 mR for chest technique factors of 74 kVp and 6.7 mAs. The data also 

specify that this measurement was for a 23-cm chest with a 72-in. source-to-image distance on a 

machine that had 2.5 mm Al equivalent (eq) total filtration. The HVL for 2.5 mm Al eq total filtration at 

74 kVp is 2.3 mm Al, which was rounded to an HVL of 2.5. This ESE result is reproducible using the 

data and cited reference. The ESE of 11.4 mR is equal to 0.01 cGy after converting the ESE to 

incident air kerma using the equations in ORAUT-OTIB-0006 (ORAUT 2011a). 

Another survey in 1974 to evaluate scatter around the X-ray room does not contain much information 

but indicates that the scatter measurements were performed at 6.7 mAs (Scudder 1974). It is likely 

that this refers to technique factors for a PA chest because the numbers correspond to the technique 

factors for the PA chest in Boback (1977). Therefore, the same organ dose values were used 

beginning in 1974.

The first concrete mention of the Bennett X-ray machine is in a survey of the X-ray equipment in 1984 

(Hinnefeld 1984, p. 16). This document describes survey procedures that would have been used on 

equipment that was manufactured after about 1974. However, no other technical details are provided. 

Technique factors in another procedure document from 1987 indicate that the technique factors for a 

large male were approximately 90 kVp, 100 mA, and 1/15 second (or 6.7 mAs) (Jacoboski 1987, 

p. 32). Using average air kerma rates for single-phase X-ray equipment in National Council on 

Radiation Protection and Measurements (NCRP) Report 102 (NCRP 1997, Table B-3) and correcting 

to a source-to-skin distance of 155 cm, these technique factors result in an incident air kerma of 0.017 

cGy for the PA chest.
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It is reasonable to conclude after reviewing these various sources of technical information that the 

X-ray machine FEMP used from 1974 to 1987 was probably the Bennett X-ray machine. The various 

survey results and technique factors all lead to similar incident air kerma results and HVLs. Organ 

doses for this period were based on the technique factors for a large male resulting in an incident air 

kerma of 0.017 cGy for the PA chest and 0.0425 cGy for the LAT chest (Jacoboski 1987, p. 32). The 

HVL for 90 kVp assuming 2.5 mm Al eq total filtration is 2.6 mm Al, which was rounded to 2.5 mm Al 

for selection of DCFs.

3.3.3 General Electric X-Ray Machine, 1988 to 1993

In March 1988 a new General Electric Company (GE) X-ray system was installed at Fernald. A chest 

technique chart from 1988 indicates that the techniques were developed by the Eastman Kodak 

Company for its Lanex Regular screen/film system, and that a 12:1 grid was to be used. The 

technique listed for the 23 cm PA chest is 100 kVp, 200 mA, and 0.025 second; that for the LAT chest 

was110 kVp, 200 mA, and 0.083 second (Gibson 1988). 

The Food and Drug Administration (FDA) performed two sets of ESE measurements on this machine 

in 1991 and 1993 that resulted in ESEs of 12.2 mR (Bolen 1991) and 15.3 mR (Bolen 1993). The 

HVL measured in 1993 was 2.5 mm Al at 80 kVp. Using Table B-2 of NCRP Report 102 (NCRP 

1997), this amount of total filtration would result in an HVL of 3.0 mm of Al at 100 kVp, the setting that 

would have been used for the PA chest. The organ doses for this period, then, are based on the 

higher of the two measured ESEs (15.3 mR) and an HVL of 3.0 mm Al for 100 kVp. Converting the 

ESE to incident air kerma using the equation in ORAUT-OTIB-0006 (ORAUT 2011a) results in an 

incident air kerma of 1.34 × 10-2 cGy for the PA chest, and 3.35 × 10-2 cGy for the LAT chest.

3.3.4 General Electric X-Ray Machine, 1994 to 2006

In 1993, Fernald changed the film-screen combination for chest X-rays to the Kodak Insight Thoracic 

Imaging System (Hinnefeld 1995), which required a change in the technique factors even though the 

X-ray machine remained the same. This chest imaging system consisted of two different screens in 

the front and the back of the film cassette and a dual emulsion film designed to be exposed by the 

respective front and back screens with zero crossover between the two. The design was intended to 

provide a longer contrast scale in the resulting image so the radiologist could better visualize both the 

high anatomical contrast of the lung fields and the low anatomical contrast of the mediastinum and 

heart in the same exposure, which has always been an imaging challenge. The slower speed of the 

overall film-screen system was offset by the additional diagnostic information in the images.

The FDA performed three sets of ESE measurements on this machine from 1995 to 1997, resulting in 

ESEs of 28.0 mR (Bolen 1995), 32.2 mR (Barnett 1997), and 30.2 mR (Bolen 2000). The HVL was 

reported in 1995 and 1999 as 2.9 and 2.8 mm Al at 90 kVp in those years, respectively. Using Table 

B-2 of NCRP Report 102 (NCRP 1997), this amount of total filtration would result in an HVL of 3.5 mm 

of Al at 110 to 120 kVp, the setting that was used for the PA chest in this period (Bolen 1995, 2000). 

FDA reported that they thought the measured ESE of 32.2 mR in 1997 could be lowered and worked 

with Fernald to lower it to 19.2 mR by increasing the kVp and lowering the mAs (Barnett 1997). 

Therefore, the organ doses for this period are based on the highest of the three measured ESEs (after 

correction) of 30.2 mR measured in 1999 and an HVL of 3.5 mm Al for 120 kVp. Converting the ESE 

to incident air kerma using the equation in ORAUT-OTIB-0006 (ORAUT 2011a) results in an incident 

air kerma of 2.65 × 10-2 cGy for the PA chest, and 6.625 × 10-2 cGy for the LAT chest.

3.3.5 2007 to Present

All the buildings at Fernald were demolished in approximately 2006. It is assumed that the X-ray 

equipment was removed at this time. Any worker X-rays after 2007 should be assumed to have been
Document No. ORAUT-TKBS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 11 of 22

taken off the site at local area clinics or hospitals and should not be included in dose reconstruction in 

accordance with ORAUT-OTIB-0079, Guidance on Assigning Occupational X-Ray Dose Under 

EEOICPA for X-Rays Administered Off Site (ORAUT 2011b).

3.4 ORGAN DOSE CALCULATIONS

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

previous sections. The organ dose equivalents are listed in Tables 3-3 and 3-4. The tissue at risk for 

chronic lymphocytic leukemia is the B-lymphocytes. The dose equivalent to the B-lymphocytes was 

determined using the method in ORAUT-OTIB-0082, Dose Reconstruction Method for Chronic 

Lymphocytic Leukemia (ORAUT 2012), site-specific information, and International Commission on 

Radiological Protection (ICRP) Publication 34 DCFs (ICRP 1982). The dose distributions and 

corresponding statistical parameters for the dose to the B-lymphocytes for each projection and period 

is listed in Table 3-5. The skin dose guidance for determining dose equivalent for the skin is found in 

Table 3-6, and the skin dose equivalents to all areas of skin are listed in Tables 3-7 and 3-8.

3.5 UNCERTAINTY

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

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

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

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

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

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

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

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

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

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

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

Rounding this up to ±30% provides an adequate and suitably conservative indication of uncertainty. 

Therefore, a total combined standard uncertainty of ±30% can be assumed for a derived dose 

equivalent to an individual organ other than the B-lymphocytes. Dose reconstructors should, 

therefore, input the organ dose equivalent as the mean of a normal distribution with a standard 

uncertainty of ±30%.

3.6 ATTRIBUTIONS AND ANNOTATIONS

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

section of this document.
Document No. ORAUT-TKBS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 12 of 22

Table 3-3. Organ dose equivalents (rem) for PA and LAT/OBL chest radiography, 1952 to 1987.

a

Organ

PA chest 

1952–1973

LAT/OBL chest 

1952–1973

PA chest 

1974–1987

LAT/OBL chest 

1974–1987

Thyroid 2.13E-02 5.02E-02 5.44E-04 4.89E-03

Eye/brain 3.91E-03 5.02E-02 5.44E-04 4.89E-03

Ovaries 2.05E-02 2.09E-02 1.70E-05 2.55E-05

Urinary bladder/prostate 2.05E-02 2.09E-02 1.70E-05 9.35E-03

Colon/rectum 2.05E-02 2.09E-02 1.70E-05 2.55E-05

Testes 1.11E-03 1.21E-03 1.70E-07 2.55E-05

Lungs (male) 5.12E-02 7.07E-02 7.12E-03 4.25E-06

Lungs (female) 5.51E-02 8.06E-02 7.67E-03 8.20E-03

Thymus 5.51E-02 8.06E-02 7.67E-03 9.35E-03

Esophagus 5.51E-02 8.06E-02 7.67E-03 9.35E-03

Stomach 5.51E-02 8.06E-02 7.67E-03 9.35E-03

Bone surface 5.51E-02 8.06E-02 7.67E-03 9.35E-03

Liver/gall bladder/spleen/pancreas 5.51E-02 8.06E-02 7.67E-03 9.35E-03

Remainder organs 5.51E-02 8.06E-02 7.67E-03 9.35E-03

Breast 5.99E-03 9.35E-02 8.33E-04 1.08E-02

Uterus 1.82E-02 1.58E-02 2.21E-05 2.55E-05

Bone marrow (male) 1.12E-02 1.36E-02 1.56E-03 1.57E-03

Bone marrow (female) 1.05E-02 1.06E-02 1.46E-03 1.23E-03

Entrance skinb 1.65E-01 4.95E-01 2.30E-02 5.74E-02

a. OBL = oblique.

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

of 1.35, 1.40, and 1.40 for HVLs of 2.5, 3.0, and 3.5 mm Al, respectively, from NCRP Report 102 (NCRP 1997, 

Table B-8). Skin doses for all areas of skin are provided in Tables 3-5, 3-6, and 3-7.

Table 3-4. Organ dose equivalents (rem) for PA and LAT/OBL chest radiography, 1988 to 2006.

a

Organ

PA chest 

1988–1993

LAT/OBL chest 

1988–1993

PA chest 

1994–2006

LAT/OBL chest 

1994–2006

Thyroid 6.16E-04 4.46E-03 1.64E-03 1.00E-02

Eye/brain 6.16E-04 4.46E-03 1.64E-03 1.00E-02

Ovaries 2.41E-05 3.02E-05 8.48E-05 1.06E-04

Urinary bladder/prostate 2.41E-05 3.02E-05 8.48E-05 1.06E-04

Colon/rectum 2.41E-05 3.02E-05 8.48E-05 1.06E-04

Testes 1.34E-07 3.35E-06 2.65E-07 6.63E-06

Lungs (male) 6.65E-03 7.91E-03 1.50E-02 1.83E-02

Lungs (female) 7.17E-03 8.94E-03 1.62E-02 2.05E-02

Thymus 7.17E-03 8.94E-03 1.62E-02 2.05E-02

Esophagus 7.17E-03 8.94E-03 1.62E-02 2.05E-02

Stomach 7.17E-03 8.94E-03 1.62E-02 2.05E-02

Bone surface 7.17E-03 8.94E-03 1.62E-02 2.05E-02

Liver/gall bladder/spleen/pancreas 7.17E-03 8.94E-03 1.62E-02 2.05E-02

Remainder organs 7.17E-03 8.94E-03 1.62E-02 2.05E-02

Breast 9.25E-04 9.61E-03 2.41E-03 2.09E-02

Uterus 3.08E-05 3.02E-05 7.95E-05 9.28E-05

Bone marrow (male) 1.57E-03 1.61E-03 3.87E-03 4.04E-03

Bone marrow (female) 1.50E-03 1.27E-03 3.74E-03 3.18E-03

Entrance skinb 1.88E-02 4.69E-02 3.71E-02 9.28E-02

a. OBL = oblique.

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

backscatter factors of 1.35, and 1.40 for HVLs of 2.5, 3.0, and 3.5 mm Al, respectively, from NCRP 

Report 102 (NCRP 1997, Table B-8). Skin doses for all areas of skin are provided in Tables 3-5, 3-6, 

and 3-7.
Document No. ORAUT-TKS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 13 of 22

Table 3-5. IREP dose distributions and corresponding statistical parameters for the dose to the B-lymphocytes.

Projection and Period IREP Distribution Parameter 1 Parameter 2 Parameter 3

PA Chest 1952-1973 Weibull 3 2.904482 0.033720 2.66728E-04

LAT Chest 1952-1973 Weibull 3 2.679219 0.044888 2.06358E-04

PA Chest 1974-1987 Weibull 3 2.053958 0.003243 9.46829E-06

LAT Chest 1974-1987 Weibull 3 2.065456 0.003958 7.26643E-06

PA Chest 1988-1993 Weibull 3 2.069225 0.003046 2.43073E-08

LAT Chest 1988-1993 Weibull 3 2.077655 0.003795 1.11464E-05

PA Chest 1994-2006 Weibull 3 2.076798 0.006927 4.18549E-05

LAT Chest 1994-2006 Weibull 3 2.090940 0.008836 2.05336E-05

Table 3-6. Skin dose guidance for PA, LAT, and RAO chest projections, 1952 to 2006.

a

Area of skin

PA chest 

guidance

≤1970

LAT chest 

guidance

≤1970

RAO chest 

guidance

≤1970

PA chest 

guidance

>1970

LAT chest

guidance

>1970

RAO chest 

guidance 

>1970

Right front shoulder EXSD ENSD EXSD EXSD ENSD EXSD

Right back shoulder ENSD ENSD ENSD ENSD ENSD ENSD

Left front shoulder EXSD EXSD EXSD EXSD EXSD EXSD

Left back shoulder ENSD EXSD ENSD ENSD EXSD ENSD

Right upper arm to elbow ENSD ENSD ENSD 10% ENSD ENSD 10% ENSD

Left upper arm to elbow ENSD EXSD ENSD 10% ENSD EXSD 10% ENSD

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

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

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

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

Right side of head including ear and temple 10% ENSD Eye/brain 10% EXSD 10% ENSD 10% ENSD 10% EXSD

Left side of head including ear and temple 10% ENSD Eye/brain 10% ENSD 10% ENSD 10% ENSD 10% ENSD

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

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

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

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

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

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

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

Right side of face Eye/brain Eye/brain EXSD Eye/brain 10% ENSD 10% EXSD

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

Right side of neck ENSD Eye/brain EXSD 10% ENSD 10% ENSD 10% EXSD

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

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

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

Front torso: base of neck to end of sternum EXSD Lung EXSD EXSD Lung EXSD
Document No. ORAUT-TKS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 14 of 22

Area of skin

PA chest 

guidance

≤1970

LAT chest 

guidance

≤1970

RAO chest 

guidance

≤1970

PA chest 

guidance

>1970

LAT chest

guidance

>1970

RAO chest 

guidance 

>1970

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

a. ENSD = entrance skin exposure; EXSD = exit skin exposure; RSD = remote skin dose.
Document No. ORAUT-TKS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 15 of 22

Table 3-7. Skin dose equivalents (rem) for PA, LAT, and RAO chest projections, 1952 to 1987.

a

Area of skin

PA chest 

1952–1973

LAT chest 

1952–1973

RAO chest 

1952–1973

PA chest 

1974–1987

LAT chest 

1974–1987

RAO chest 

1974–1987

Right front shoulder 3.6E-03 4.95E-01 2.2E-03 5.E-04 5.74E-02 3.E-04

Right back shoulder 1.65E-01 4.95E-01 4.95E-01 2.30E-02 5.74E-02 5.74E-02

Left front shoulder 3.6E-03 2.2E-03 2.2E-03 5.E-04 3.E-04 3.E-04

Left back shoulder 1.65E-01 2.2E-03 4.95E-01 2.30E-02 3.E-04 5.74E-02

Right upper arm to elbow 1.65E-01 4.95E-01 4.95E-01 2.3E-03 5.74E-02 5.7E-03

Left upper arm to elbow 1.65E-01 2.2E-03 4.95E-01 2.3E-03 3.E-04 5.7E-03

Left hand 1.65E-01 4.95E-02 4.95E-02 2.3E-03 5.7E-03 5.7E-03

Right hand 1.65E-01 4.95E-02 4.95E-02 2.3E-03 5.7E-03 5.7E-03

Left elbow, forearm, wrist 1.65E-01 4.95E-02 4.95E-02 2.3E-03 5.7E-03 5.7E-03

Right elbow, forearm, wrist 1.65E-01 4.95E-02 4.95E-02 2.3E-03 5.7E-03 5.7E-03

Right side of head including ear and temple 1.65E-02 5.02E-02 2.E-04 2.3E-03 5.7E-03 3.E-05

Left side of head including ear and temple 1.65E-02 5.02E-02 4.95E-02 2.3E-03 5.7E-03 5.7E-03

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

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

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

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

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

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

Left side of face 2.13E-02 5.02E-02 4.95E-01 5.E-04 5.7E-03 5.7E-03

Right side of face 2.13E-02 5.02E-02 2.2E-03 5.E-04 5.7E-03 3.E-05

Left side of neck 1.65E-01 5.02E-02 4.95E-01 2.3E-03 5.7E-03 5.7E-03

Right side of neck 1.65E-01 5.02E-02 2.2E-03 2.3E-03 5.7E-03 3.E-05

Back of head 1.65E-02 5.02E-02 4.95E-02 2.3E-03 5.7E-03 5.7E-03

Front of neck 2.13E-02 5.02E-02 5.02E-02 5.E-04 5.7E-03 4.9E-03

Back of neck 1.65E-01 5.02E-02 4.95E-01 2.3E-03 5.7E-03 5.7E-03

Front torso: base of neck to end of sternum 3.6E-03 8.06E-02 2.2E-03 5.E-04 9.4E-03 3.E-04

Front torso: end of sternum to lowest rib 3.6E-03 8.06E-02 2.2E-03 5.E-04 9.4E-03 3.E-04

Front torso: lowest rib to iliac crest 3.6E-03 8.06E-02 2.2E-03 5.E-05 9.E-04 3.E-05

Front torso: iliac crest to pubis 4.E-04 8.1E-03 2.E-04 5.E-05 9.E-04 3.E-05

Back torso: base of neck to mid-back 1.65E-01 8.06E-02 4.95E-01 2.30E-02 9.4E-03 5.74E-02

Back torso: mid-back to lowest rib 1.65E-01 8.06E-02 4.95E-01 2.30E-02 9.4E-03 5.74E-02

Back torso: lowest rib to iliac crest 1.65E-01 8.06E-02 4.95E-01 2.3E-03 9.E-04 5.7E-03

Back torso: buttocks (Iliac crest and below) 1.65E-02 8.1E-03 4.95E-02 2.3E-03 9.E-04 5.7E-03

Right torso: base of neck to end of sternum 1.65E-01 4.95E-01 2.2E-03 2.30E-02 5.74E-02 3.E-04

Right torso: end of sternum to lowest rib 1.65E-01 4.95E-01 2.2E-03 2.30E-02 5.74E-02 3.E-04

Right torso: lowest rib to iliac crest 1.65E-01 4.95E-01 2.2E-03 2.3E-03 5.7E-03 3.E-05

Right torso: iliac crest to pubis (right hip) 1.65E-02 4.95E-02 2.E-04 2.3E-03 5.7E-03 3.E-05

Left torso: base of neck to end of sternum 1.65E-01 2.2E-03 4.95E-01 2.30E-02 3.E-04 5.74E-02
Document No. ORAUT-TKS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 16 of 22

Area of skin

PA chest 

1952–1973

LAT chest 

1952–1973

RAO chest 

1952–1973

PA chest 

1974–1987

LAT chest 

1974–1987

RAO chest 

1974–1987

Left torso: end of sternum to lowest rib 1.65E-01 2.2E-03 4.95E-01 2.30E-02 3.E-04 5.74E-02

Left torso: lowest rib to iliac crest 1.65E-01 2.2E-03 4.95E-01 2.3E-03 3.E-05 5.7E-03

Left torso: iliac crest to pubis (left hip) 1.65E-02 2.E-04 4.95E-02 2.3E-03 3.E-05 5.7E-03

a. Values less than 1 mrem shown to one significant digit.
Document No. ORAUT-TKS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 17 of 22

Table 3-8. Skin dose equivalents (rem) and guidance for PA, LAT, and RAO chest projections, 1988 to 2006.

a

Area of skin

PA chest

1988–1993

LAT chest

1988–1993

RAO chest

1988–1993

PA chest

1994–2006

LAT chest

1994–2006

RAO chest

1994–2006

Right front shoulder 5.E-04 4.69E-02 2.E-04 1.1E-03 9.28E-02 6.E-04

Right back shoulder 1.88E-02 4.69E-02 4.69E-02 3.71E-02 9.28E-02 9.28E-02

Left front shoulder 5.E-04 2.E-04 2.E-04 1.1E-03 6.E-04 6.E-04

Left back shoulder 1.88E-02 2.E-04 4.69E-02 3.71E-02 6.E-04 9.28E-02

Right upper arm to elbow 1.9E-03 4.69E-02 4.7E-03 3.7E-03 9.28E-02 9.3E-03

Left upper arm to elbow 1.9E-03 2.E-04 4.7E-03 3.7E-03 6.E-04 9.3E-03

Left hand 1.9E-03 4.7E-03 4.7E-03 3.7E-03 9.3E-03 9.3E-03

Right hand 1.9E-03 4.7E-03 4.7E-03 3.7E-03 9.3E-03 9.3E-03

Left elbow, forearm, wrist 1.9E-03 4.7E-03 4.7E-03 3.7E-03 9.3E-03 9.3E-03

Right elbow, forearm, wrist 1.9E-03 4.7E-03 4.7E-03 3.7E-03 9.3E-03 9.3E-03

Right side of head including ear and temple 1.9E-03 4.7E-03 2.E-05 3.7E-03 9.3E-03 6.E-05

Left side of head including ear and temple 1.9E-03 4.7E-03 4.7E-03 3.7E-03 9.3E-03 9.3E-03

Front left thigh 6.E-06 7.E-06 7.E-06 1.E-05 2.E-05 2.E-05

Back left thigh 6.E-06 7.E-06 7.E-06 1.E-05 2.E-05 2.E-05

Front right thigh 6.E-06 7.E-06 7.E-06 1.E-05 2.E-05 2.E-05

Back right thigh 6.E-06 7.E-06 7.E-06 1.E-05 2.E-05 2.E-05

Left knee and below 2.E-06 3.E-06 3.E-06 5.E-06 6.E-06 6.E-06

Right knee and below 2.E-06 3.E-06 3.E-06 5.E-06 6.E-06 6.E-06

Left side of face 6.E-04 4.7E-03 4.7E-03 1.6E-03 9.3E-03 9.3E-03

Right side of face 6.E-04 4.7E-03 2.E-05 1.6E-03 9.3E-03 6.E-05

Left side of neck 1.9E-03 4.7E-03 4.7E-03 3.7E-03 9.3E-03 9.3E-03

Right side of neck 1.9E-03 4.7E-03 2.E-05 3.7E-03 9.3E-03 6.E-05

Back of head 1.9E-03 4.7E-03 4.7E-03 3.7E-03 9.3E-03 9.3E-03

Front of neck 6.E-04 4.7E-03 4.46E-03 1.6E-03 9.3E-03 1.00E-02

Back of neck 1.9E-03 4.7E-03 4.7E-03 3.7E-03 9.3E-03 9.3E-03

Front torso: base of neck to end of sternum 5.E-04 8.9E-03 2.E-04 1.1E-03 2.05E-02 6.E-04

Front torso: end of sternum to lowest rib 5.E-04 8.9E-03 2.E-04 1.1E-03 2.05E-02 6.E-04

Front torso: lowest rib to iliac crest 5.E-05 9.E-04 2.E-05 1.E-04 2.1E-03 6.E-05

Front torso: iliac crest to pubis 5.E-05 9.E-04 2.E-05 1.E-04 2.1E-03 6.E-05

Back torso: base of neck to mid-back 1.88E-02 8.9E-03 4.69E-02 3.71E-02 2.05E-02 9.28E-02

Back torso: mid-back to lowest rib 1.88E-02 8.9E-03 4.69E-02 3.71E-02 2.05E-02 9.28E-02

Back torso: lowest rib to iliac crest 1.9E-03 9.E-04 4.7E-03 3.7E-03 2.1E-03 9.3E-03

Back torso: buttocks (Iliac crest and below) 1.9E-03 9.E-04 4.7E-03 3.7E-03 2.1E-03 9.3E-03

Right torso: base of neck to end of sternum 1.88E-02 4.69E-02 2.E-04 3.71E-02 9.28E-02 6.E-04

Right torso: end of sternum to lowest rib 1.88E-02 4.69E-02 2.E-04 3.71E-02 9.28E-02 6.E-04

Right torso: lowest rib to iliac crest 1.9E-03 4.7E-03 2.E-05 3.7E-03 9.3E-03 6.E-05

Right torso: iliac crest to pubis (right hip) 1.9E-03 4.7E-03 2.E-05 3.7E-03 9.3E-03 6.E-05

Left torso: base of neck to end of sternum 1.88E-02 2.E-04 4.69E-02 3.71E-02 6.E-04 9.28E-02
Document No. ORAUT-TKS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 18 of 22

Area of skin

PA chest

1988–1993

LAT chest

1988–1993

RAO chest

1988–1993

PA chest

1994–2006

LAT chest

1994–2006

RAO chest

1994–2006

Left torso: end of sternum to lowest rib 1.88E-02 2.E-04 4.69E-02 3.71E-02 6.E-04 9.28E-02

Left torso: lowest rib to iliac crest 1.9E-03 2.E-05 4.7E-03 3.7E-03 6.E-05 9.3E-03

Left torso: iliac crest to pubis (left hip) 1.9E-03 2.E-05 4.7E-03 3.7E-03 6.E-05 9.3E-03

a. Values less than 1 mrem shown to one significant digit. 
Document No. ORAUT-TKBS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 19 of 22

REFERENCES

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T. Bolen (U.S. Department of Health and Human Services, Food and Drug Administration), 

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Management Program, Fernald, Ohio, April 17. [SRDB Ref ID: 3517, p. 75]

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Document No. ORAUT-TKBS-0017-3 Revision No. 01 Effective Date: 01/02/2014 Page 21 of 22

GLOSSARY

absorbed dose

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

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

backscatter

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

dose equivalent

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

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

from the absorbed dose.

exposure

(1) In general, the act of being exposed to ionizing radiation. (2) Measure of the ionization 

produced by X- and gamma-ray photons in air in units of roentgens.

gray (Gy)

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

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

100 rads.

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.

lumbar spine

The vertebrae of the lower back.

rad

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

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

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

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

derives from radiation absorbed dose.

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.

rem

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

radiation equivalent to that caused by 1 rad of high-penetration X-rays multiplied by a quality 

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

derives from roentgen equivalent in man; rem is also the plural.
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roentgen (R, sometimes r)

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

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

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

pressure. An exposure of 1 R is approximately equivalent to an absorbed dose of 1 rad in soft 

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

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.