See

discussions, stats, and author profiles for this publication at: [Link]

Effective dose conversion coefficients

calculated with gender-specific, adult voxel
phantoms for radiographic examinations
common in...

Conference Paper · January 2014

CITATIONS READS

4 162

6 authors, including:

Fernando Roberto de Andrade Lima Richard Kramer

CNEN - Comissão Nacional de Energia Nuclear Federal University of Pernambuco
84 PUBLICATIONS 504 CITATIONS 70 PUBLICATIONS 1,011 CITATIONS

SEE PROFILE SEE PROFILE

J.W. Vieira Eduardo C M Loureiro

Instituto Federal de Educação, Ciência e Tec… Universidade de Pernambuco
81 PUBLICATIONS 726 CITATIONS 13 PUBLICATIONS 159 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Simulation thin layers for heavy incidente particles by using Geant4-DNA View project

Monte Carlo simulations for organ dose estimation of CT scans View project

All content following this page was uploaded by Eduardo C M Loureiro on 17 May 2017.

The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document
and are linked to publications on ResearchGate, letting you access and read them immediately.
Effective dose conversion coefficients calculated with gender-specific, adult voxel phantoms for
radiographic examinations common in diagnostic radiology

F. R. A. Lima1, R. Kramer2, J. W. Vieira2, H. J. Khoury2, E. C. M. Loureiro3 and G. Hoff4

1
Centro Regional de Ciências Nucleares, CNEN, Recife, PE, Brazil..
E-mail: falima@[Link]
2
Departamento de Energia Nuclear, UFPE, Recife, PE, Brazil.
3
Escola Politécnica, UPE, Recife, PE, Brazil.
4
Faculdade de Física, PUCRS, Porto Alegre, RS, Brazil.

Abstract. Patient exposure from radiological examinations is usually quantified in terms of average
absorbed dose or equivalent dose to certain radiosensitive organs of the human body. As these
quantities cannot be measured in vivo, it is common practice to use physical or computational
exposure models, which simulate the exposure to the patient in order to determine not only the
quantities of interest (absorbed or equivalent dose), but also at the same time measurable quantities for
the exposure conditions given. The ratio between a quantity of interest and a measurable quantity is
called a conversion coefficient (CC), which is a function of the source and field parameters (tube
voltage, filtration, field size, field position, focus-to-skin distance, etc.), the anatomical properties of
the phantom, the elemental composition of relevant body tissues, and the radiation transport method
applied. As the effective dose represents a sum over 23 risk-weighted organ and tissue equivalent
doses, its determination practically implies the measurement or calculation of a complete distribution
of equivalent doses throughout the human body. This task can be resolved most efficiently by means
of computational exposure models, which consist of a virtual representation of the human body, also
called phantom, connected to a Monte Carlo radiation transport computer code. The recently
introduced MAX (Male Adult voXel) and FAXht (Female Adult voXel) head+trunk phantoms have
been chosen for this task. With respect to their anatomical properties these phantoms correspond fairly
well to the data recommended by the ICRP for the Reference Adult Male and Female.

1. Introduction

Conversion coefficients (CCs) between absorbed dose or equivalent dose to organs at risk and
measurable quantities commonly used in X-ray diagnosis have been calculated since 1976 mostly for
mathematical MIRD-type phantoms [1-8]. The reported doses have generally been normalized to
incident air kerma free-in-air at the surface of the patient (INAK), to entrance surface air kerma at the
surface of the patient including backscatter (ESAK), or to the dose-area product (DAP). As
tomographic or voxel phantoms have been developed only during recent years, few publications exist
until now which used this new type of phantom for absorbed or equivalent dose calculations in X-ray
diagnosis [9, 10].

The recently developed MAX (Male Adult voXel) [11] and FAXht (Female Adult voXel) head+trunk
phantoms [12] connected to the EGS4 Monte Carlo code [13] were used for an examination of the
chest and the abdomen to calculate CCs between effective dose [14] and ESAK at the center of the X-
ray beam where it enters the phantom’s body. The results will be compared with corresponding data
calculated for this study with the mathematical ADAM and EVA phantoms, and data published for the
NRPB MIRD-type phantom [3, 6, 8].

2. Materials and methods

2.1 Exposure models

2.1.1 The mathematical ADAM/EVA-GSF exposure model

The mathematical ADAM and EVA phantoms were introduced by Kramer et al [15] as gender-
specific derivatives of the hermaphrodite MIRD phantom (16). The form of the bodies and its organs
are described by mathematical expressions representing planes, circular and elliptical cylinders,

1
spheres, cones, tori, etc., and combinations and intersections thereof. Organ masses, body weights and
body heights correspond to the anatomical data for adult males and females recommended in the first
ICRP Reference Man Report, ICRP Publication No. 23 [17]. Figure 1 shows frontal views of the two
phantoms.
The GSF Monte Carlo code uses a non-analogue method, which applies the same photon transport
physics as the ALGAM code [20], the so-called fractional photon technique, in order to increase the
number of photon scattering events in deeply penetrated areas of the phantoms body, thereby reducing
the coefficient of variance. Rayleigh scattering and secondary electrons are not considered by this
code. The photon cross-section data were taken from Roussin et al [21].

FIG. 1. The mathematical ADAM and EVA phantoms

2.1.2 The voxel-based MAX/FAXht-EGS4 exposure model

FIG. 2a. The MAX phantom

2
 FIG. 2b. The FAXht phantom

Figures 2a and 2b show frontal views of the MAX and the FAXht phantoms, respectively.

The MAX (Male Adult voXel) phantom [11] and the FAXht (Female Adult voXel) head+trunk
phantom [12] are the first human voxel phantoms which correspond to the anatomical data
recommended by the second ICRP Reference Man Report, Publication No. 89 [22], for most organs
and tissues at risk. The two phantoms have been constructed based on CT images of patients. The
MAX and the FAXht phantoms are connected to the EGS4 Monte Carlo code [13], which simulates
coupled electron-photon transport through arbitrary media. The default version of EGS4 applies an
analogue Monte Carlo method, which was used for the calculations of this investigation. Rayleigh
scattering has normally been taken into account in the calculations. Although possible, secondary
electrons have not been considered in the present calculations, because of the range of diagnostic
photon energies and the quantities to be determined, namely equivalent dose to organs and tissues of
the human body averaged over the volume of interest. The photon cross-sections were taken from
Storm and Israel [23] and from Hubbell and Overbo [24].

2.2 Radiological examinations

From the data calculated for a variety of commonly performed radiographic examinations, this paper
will present effective doses for examinations of the chest and the abdomen. The exposure conditions
including the X-ray spectra [28] were the same used in the Monte Carlo calculations of the NRPB [3,
6, 8 ] for a MIRD-type hermaphrodite phantom.

The chest examinations for the male phantoms were done for posterior-anterior (PA) projection with a
focus-to-detector distance of 185cm, and a field size in the detector plane of 35cm x 44cm, while the
abdominal examinations were simulated for anterior-posterior (AP) projection with a focus-to-detector
distance of 85cm, and a filed size in the detector plane of 35cm x 47cm. The authors of the NRPB
studies justify the use of field sizes larger than commonly used X-ray films with the argument, that
thereby it was ensured that certain anatomical landmarks would appear inside the X-ray field
according to the guidelines of X-ray practitioners, which indicates that inter-organ distances in the
MIRD-type phantoms are sometimes too large.

For the female phantoms EVA and FAXht field sizes and the position of the center of the X-ray field
were reduced by 7.4%, which corresponds to the difference found between the body heights of the
male and the female reference persons [22].

All spectra used in the calculations represented a X-ray tube with constant potential generator,
tungsten target, 170 anode angle, and 2.5mm Al total filtration. The coefficients of variance for the
calculated effective doses were generally less than 2.5%.

3
2.3 Exposure conditions

The replacement of the ADAM/EVA-GSF exposure model by the MAX/FAXht-EGS4 exposure

model implies changes with respect to Monte Carlo codes, tissue compositions, and phantom
anatomies. The intention of this investigation is to study the dosimetric effect of each of these
parameters separately. Therefore the following five different exposure conditions a) – e) have been
investigated:

Monte Carlo codes

a) ADEV/GSF: The mathematical ADAM and EVA phantoms connected to the GSF Monte Carlo
code with tissue compositions used in Kramer et al [15] and Zankl et al [19];
b) ADEV: The mathematical ADAM and EVA phantoms connected to the EGS4 Monte Carlo
code with the tissue compositions used for a);

ICRU44 tissue compositions

c) ADEV44: The mathematical ADAM and EVA phantoms connected to the EGS4 Monte Carlo
code with tissue compositions taken from ICRU 44 [29], with a homogeneous mixture in all skeletal
voxels based on ICRP70 [30], and a homogeneous mixture for adipose and muscle in all unspecified
regions of the body.

Table 1. Tissue compositions

ATOM SOFT SOFT SKIN SKIN LUNGS LUNGS SKEL. SKEL. ADIMUS
ADEV44 ADEV ADEV44 ADEV ADEV44 ADEV ADEV44 ADEV ADEV44
[%] [%] [%] [%] [%] [%] [%] [%] [%]
H 10,5 10 10 10,2 10,3 10 7,2 7 10,6
C 12,5 23 20,4 26,9 10,5 10 31,3 23 30,8
N 2,6 2,3 4,2 4,3 3,1 2,8 3,2 3,9 2,4
O 73,5 63 64,5 58 74,9 76 41,1 49 55,4
Na 0,2 0,13 0,2 0,01 0,2 0,2 0,1 0,32 0,1
Mg 0,015 0,005 0,007 0,1 0,11
P 0,2 0,24 0,1 0,3 0,2 0,08 5,3 6,9 0,128
S 0,18 0,22 0,2 0,15 0,3 0,23 0,25 0,17 0,227
Cl 0,22 0,14 0,3 0,25 0,3 0,27 0,1 0,14 0,1
K 0,21 0,21 0,1 0,1 0,2 0,2 0,05 0,15 0,245
Ca 0,01 0,14 0,007 11,3 9,9
Fe 0,01 0,006 0,002 0,04 0,008
-3 1.469 (1.486)
ρ [gcm ] 1,05 0,98 1,09 1,105 0,26 0,296 1,012
SOFT = soft tissue; SKEL. = skeleton; ADIMUS: Homogeneous mixture of 36.2% Adipose +
63.8% Muscle.

Table 1 shows the tissue compositions for the ADEV phantoms, which represent the elemental mass
fractions and densities taken from Kramer et al [15], while ADEV44 represent the new tissue
compositions taken from ICRU Report No.44 [18]. The density of the ADEV skeletal mixture was
later corrected to 1.4 [Link]-3 [25]. ADIMUS represents a homogeneous mixture of 36.2% adipose and
63.8% muscle, which is the percentage distribution for the two tissues found in the MAX phantom. As
the FAXht phantom is still uncompleted with respect to the total masses of adipose and muscle, a
corresponding female percentage will be available only after the addition of legs and arms to the
FAXht phantom.

4
 1.1
MEA(ADEV44) / MEA(ADEV)

1.05

0.95

0.9
0 20 40 60 80 100 120 140 160 180 200

Photon Energy (keV)

SOFT LUNGS SKELETON ADIMUS/SOFT-TISSUE SKIN

FIG. 3. Ratios of mass-energy absorption coefficients

For photon energies up to 200 keV according to the ratios of the mass-energy absorption (MEA)
coefficients shown in Figure 3, the replacement of the ADEV by the ADEV44 tissue compositions
would lead to an increase of equivalent dose to soft-tissue organs, to the bones, and to the skin., while
the lungs equivalent dose would not change significantly. The equivalent dose to the ADIMUS
mixture in unspecified regions would be lower than before to the soft-tissue mixture. For the effective
dose this is significant, because other tissues surrounded by the ADIMUS mixture experience less
shielding than before, and consequently their equivalent doses would generally increase.

Anatomies

d) MHOM/FHOM: The MAX and FAX phantoms connected to the EGS4 Monte Carlo code with
ICRU44 tissue compositions, with the same homogeneous mixture in all skeletal voxels, and for
adipose and muscle in all unspecified regions of the body used for c).

The MAX and the FAXht phantoms have heterogeneous skeletal tissue distributions among the voxel
of their skeletons, which was realized by the CT number method described in Kramer et al [11]. For
the mathematical phantoms ADAM44 and EVA44 this cannot be achieved, because their construction
is not based on digital CT images with grey values, and also separately segmented regions for adipose
and muscle are not available for the mathematical phantoms.

In order to compare the dosimetric effects of the different anatomies only, a MAXHOM and a
FAXhtHOM phantom were derived from the MAX and the FAXht phantom, respectively, based on
the following changes:

- all skeletal voxels of the MAXHOM and the FAXhtHOM phantoms have the ADEV44 skeletal
mixture from Table 1, and
- all segmented regions of adipose and muscle in the MAXHOM and the FAXhtHOM phantom
have the ADIMUS mixture from Table 1.

Heterogeneous skeleton and adipose-muscle distribution

e) MAX/FAX: The MAX and FAXht phantoms connected to the EGS4 Monte Carlo code with
ICRU44 tissue compositions, heterogeneous skeleton and separately segmented regions for adipose
and muscle.

5
 3. Results

Conversion coefficients between effective dose and ESAK for tube voltages between 60 and 120 kV
are shown in Figure 4 for a posterior-anterior chest radiograph, and in Figure 5 for an anterior-
posterior examination of the abdomen.

3.1 Monte Carlo code (a – b)

The curves ADEV-GSF and ADEV represent the calculations for the ADAM and EVA phantoms
connected to the GSF and the EGS4 Monte Carlo code, respectively. The average percentage
difference found is 1.9% for the chest radiograph, and 0.9% for the examination of the abdomen,
which means that they are smaller than the coefficients of variance reported in section 2.2 for the
Monte Carlo codes.

0.2
Equivalent dose / Entrance surface air-

CHEST
0.18

0.16
kerma (Gy/Gy)

0.14

0.12

0.1
EFFECTIVE DOSE
0.08

0.06
50 60 70 80 90 100 110 120 130
Tube voltage (kVcp)

MIRD/NRPB ADEV-GSF ADEV ADEV44 MHOM/FHOM MAX/FAXht

FIG. 4. Effective dose conversion coefficients for chest radiograph

0.22
Equivalent dose / Entrance surface air-

ABDOMEN
0.2

0.18
kerma (Gy/Gy)

0.16

0.14

0.12
EFFECTIVE DOSE
0.1

0.08
50 60 70 80 90 100 110 120 130
Tube voltage (kVcp)

MIRD/NRPB ADEV-GSF ADEV ADEV44 MHOM/FHOM MAX/FAXht

FIG. 5. Effective dose conversion coefficients for abdominal radiograph

6
3.2 Tissue composition (b – c)

The curves ADEV and ADEV44 represent the calculations for the ADAM and the EVA phantoms for
the two sets of tissue compositions shown in Table 2. For both X-ray examinations the ADEV44
curves are significantly greater than the ADEV curves, which confirms the expectations derived from
the data shown in Figure 3

3.3 Anatomy (c – d)

The effect of replacing the anatomies of the mathematical phantoms by those of the voxel phantoms is
demonstrated by the differences between curves ADEV44 and MHOM/FHOM.
Similar to results reported for whole-body exposure to external photon radiation [26, 27], these curves
confirm a significant decrease of the effective dose.

The main reasons are:

- the anatomic structure of the realistic human skeleton, which causes significantly more
shielding to underlying radiosensitive soft-tissue organs compared to the MIRD skeleton. The ribcage
of the mathematical phantoms, for example, has no sternum, and the ribs are a set of equidistantly
spaced horizontal tori, which allow for a significant unattenuated passage of radiation to reach soft-
tissue organs, like the lungs, the thymus, the liver, the stomach, etc. Also, for PA-incidence the
naturally shaped and positioned pelvis of the voxel phantoms causes more shielding for the bladder,
and the colon than the MIRD pelvis.
- the supine position patients usually have during scanning of CT images intensifies this effect,
because soft-tissue organs, like the lungs, the liver, the stomach, etc. could have been shifted more into
the ribcage.
- the MAX phantom, and especially the FAXht phantom, have generally significantly thicker
layers of adipose and muscle compared to the mathematical phantoms, which causes more shielding
for underlying radiosensitive organs and tissues.

As for the two radiological examinations considered, this decrease of the effective dose is greater for
the chest examination because for PA-incidence the anatomical difference between the two skeletal
structures represents the predominant cause for a significant decrease of equivalent dose to
radiosensitive organs and tissues contributing to the effective dose, while for the anterior-posterior
abdominal radiograph mainly different thicknesses of overlying ADIMUS layers, and differences of
organ positions, like for the stomach, and for the colon are the main cause for the decrease.

3.4 Heterogeneous skeleton and separately distributed adipose and muscle (d – e)

The dosimetric consequences of the introduction of heterogeneously distributed skeletal tissues and
separately distributed adipose and muscle can be seen in Figures 4 and 5 from the difference between
the curves MHOM/FHOM and MAX/FAXht.

As for the abdominal AP radiograph, the equivalent doses to the contributing important organs and
tissues, like gonads, colon, stomach, bladder, liver, etc. are not significantly affected by overlying
skeletal structures, but rather by overlying adipose and/or muscle. Both voxel phantoms, especially the
FAXht phantom, have for AP-incidence relatively thick layers of adipose overlying many
radiosensitive organs and tissues. While the ADIMUS mixture has a density of 1.012 gcm-3 , adipose
has a density of 0.95 gcm-3 , which means that abdominal organs and tissues lying under layers of
adipose would receive higher equivalent doses because of reduced shielding, which leads to an
increase of the MAX/FAX effective dose relative to the MHOM/FHOM effective dose.

For the PA chest examination the difference between the MAX/FAXht and the MHOM/FHOM
effective dose is mainly a function of the density changes in skeletal structures, like the ribcage, and
the spine, and to a lesser extent because of the separately distributed adipose and muscle. Compared to

7
the skeletal density of 1.469 gcm-3 for the MHOM/FHOM skeleton, the average skeletal densities in
the MAX/FAXht ribcages is 1.52 gcm-3 and in the spines 1.27 gcm-3 , respectively. For tube voltages
up to 85 kV more shielding by the ribcages on the one hand, and less shielding by the spines and the
adipose on the other hand cancel each other out, while for energies above 90 kV the net effect is less
shielding, i.e. greater equivalent doses to radiosensitive organs and tissues, and therefore an increase
of the effective dose.

One can conclude that for given exposure conditions, tissue composition, and position the equivalent
dose to an organ or tissue of the human body is basically a function of the compositional and structural
shielding caused by the tissues in its vicinity.

Figures 4 and 5 show also the MIRD/NRPB data [3, 6, 8] calculated for a hermaphrodite MIRD-type
phantom with male body dimensions. Compared to the ADEV-GSF effective dose one expects the
MIRD/NRPB effective dose to be somewhat smaller, because for the same organs and tissues the
female equivalent doses are generally greater than those for the male body. For the chest radiograph
shown in Figure 4 the average difference between the MIRD/NRPB and the ADEV-GSF curve is ca.
3%, which corresponds to this expectation. However for the abdominal examination shown in Figure 5
the MIRD/NRPB effective dose is on average 12.7% smaller than the ADEV-GSF effective dose. For
the time being no reasonable explanation has been found for this difference.

4. Conclusions

In order to investigate the dosimetric consequences for the effective dose if a MIRD-based exposure
model is replaced by a voxel-based model, various parameters, like the Monte Carlo code, the
compositions of body tissues, and the phantom anatomy, have been considered separately.

The data shown in the previous section demonstrate that the change of the Monte Carlo code had no
significant impact on the effective dose, while the update of the tissue compositions with the ICRU44
data led to an increase of the effective dose of 7.4% on average for the chest radiograph, and of 3.4%
on average for the abdominal examination.

The replacement of the mathematical phantoms by true to nature human anatomies causes generally a
decrease of the effective dose, which is 27.7% on average for the chest radiograph, and 10.9% on
average for the abdominal examination.

The introduction of a heterogeneous skeleton, and of separately segmented regions for adipose and
muscle can have an increasing or a decreasing effect on the effective dose, depending on the densities
of the bones, and the masses of adipose and muscle located inside the X-ray beam volume.

For the complete replacement of the ADEV-GSF exposure model by the MAX/FAXht-EGS4 exposure
model a net decrease of the effective dose of 22.4% on the average was found for the chest radiograph,
and of 3.8% for the abdominal examination.

5. Acknowledgement

The authors would like to thank CNPq and FACEPE for the financial support.

6. References

1. Kramer R. and Drexler G., Zum Verhaeltnis von Oberflächen- und Körperdosis in der
Roentgendiagnostik, 7. Wissenschaftliche Tagung der Deutschen Gesellschaft fuer Medizinische
Physik e.V., Heidelberg, 5.-7.5.1976, In: Medizinische Physik, Band 2, p. 683-695,
Herausgegeben von [Link], Huethig Verlag, Heidelberg, 1976.

8
2. Rosenstein M., Organ doses in Diagnostic Radiology, US Department of Health, Education and
Welfare, Bureau of Radiological Health, BRH Tech., Publ. DA 76-8030, 1976.
3. Jones D. G. and Wall B. F., Organ Doses from Medical X-ray Examinations Calculated Using
Monte Carlo Techniques, National Radiological Protection Board, Chilton, Didcot, Oxon OX11
0RQ, UK, NRPB-R186, 1985.
4. Drexler G., Panzer W., Widenmann L., Williams G. and Zankl M., The Calculation of Dose
from External Photon Exposures Using Reference Human Phantoms and Monte Carlo Methods,
Part III: Organ Doses in X-Ray Diagnosis, Institut für Strahlenschutz, GSF- Gesellschaft für
Umwelt und Gesundheit, D-8042 Neuherberg, GSF-Bericht 11/90, 1990.
5. Le Heron J. C., Estimation of effective dose to the patient during medical x-ray examinations
from measurements of the dose-area product, Phys. Med. Biol., Vol.37, No.11, 2117-2126,
1992.
6. Hart D., Jones D. G. and Wall B. F., Estimation of Effective Dose in Diagnostic Radiology from
Entrance Surface Dose and Dose-Area Product Measurements, National Radiological Protection
Board, Chilton, Didcot, Oxon OX11 0RQ, UK, NRPB-R262, 1994.
7. Servomaa A. and Tapiovaara M., Organ Dose Calculation in Medical X-Ray Examinations by
the Program PCXMC, Rad. Prot. Dos. Vol.80, Nos 1-3, pp.213-219, 1998.
8. Hart D., Jones D. G. and Wall B. F., Normalised Organ Doses for Medical X-ray Examinations
Calculated using Monte Carlo Techniques, National Radiological Protection Board, Chilton,
Didcot, Oxon OX11 0RQ, UK, NRPB-SR262, 1994.
9. Zankl M., Panzer W. and Herrmann C., Calculation of Patient Doses Using a Human Voxel
Phantom of Variable Diameter, Rad. Prot. Dos. Vol.90, Nos 1-2, pp.155-158, 2000.
10. Akahane K., Kai M., Kusama T. and Saito K., Dose estimation of patients from diagnostic X-ray
based on CT-voxel phantom, Proceedings of the Ninth EGS4 Users’ Meeting in Japan, KEK
Proceedings 2001-22, p.87-91, 2001.
11. Kramer R., Vieira J. W., Khoury H. J., Lima F. R. A. and Fuelle D., All About Max: A Male
Adult Voxel Phantom for Monte Carlo Calculations in Radiation Protection Dosimetry, Phys.
Med. Biol., 48, No.10, 1239-1262, 2003.
12. Loureiro E. C. M., Kramer R., Vieira J. W., Khoury H., Lima, F. R. A. and Hoff G.,
Construction of the FAXht (Female Adult voXel) head+trunk phantom from CT images of
patients for applications in radiation protection, submitted to IRPA11, 2004.
13. Nelson W. R., Hirayama H. and Rogers D. W. O. The EGS4 Code System SLAC-265 Stanford
Linear Accelerator Center, Stanford University, Stanford, California, 1985.
14. ICRP - 1990 Recommendations of the International Commission on Radiological Protection.
ICRP Publication 60 International Commission on Radiological Protection, Pergamon Press,
Oxford, 1991.
15. Kramer R., Zankl M., Williams G., Drexler G., The Calculation of Dose from External Photon
Exposures Using Reference Human Phantoms and Monte Carlo Methods. Part I: The Male
(ADAM) and Female (EVA) Adult Mathematical Phantoms. GSF-Report [Link] July
[Link] für Strahlenschutz, GSF-Forschungszentrum für Umwelt und Gesundheit,
Neuherberg-München, 1982.
16. Snyder W. S., Ford M. R., Warner G. G., Watson G. G., Revision of MIRD Pamphlet No. 5
Entitled “Estimates of absorbed fractions for monoenergetic photon sources uniformly
distributed in various organs of a heterogeneous phantom”. ORNL-4979, Oak Ridge National
Laboratory, Oak Ridge, Tenn., 1974.
17. ICRP - Report of the Task Group on Reference Man. ICRP Publication 23. International
Commission on Radiological Protection, Pergamon Press, Oxford, 1975
18. Kramer R., Ermittlung von Konversionsfaktoren zwischen Körperdosen und Relevanten
Strahlungskenngrößen bei Externer Röntgen- und Gamma-Bestrahlung Gesellschaft für
Strahlen- und Umweltforschung, München-Neuherberg, GSF-Bericht-S-556, 1979.
19. Zankl M., Drexler G., Petoussi-Henss N. and Saito K., The Calculation of Dose from External
Photon Exposures Using Reference Human Phantoms and Monte Carlo Methods. Part VII:
Organ Doses due to Parallel and Environmental Exposure Geometries GSF-Report 8/97. Institut
für Strahlenschutz, GSF-Forschungszentrum für Umwelt und Gesundheit, München-
Neuherberg, 1997.

9
 20. Warner G. G. and Craig A. M., ALGAM: A Computer Program for Estimating Internal Dose for
Gamma-Ray Sources in a Man Phantom Oak Ridge National Laboratory, Oak Ridge, Tenn.,
USA, Report ORNL-TM-2250, 1968.
21. Roussin R. W., Knight J. R., Hubbell J. H. and Howerton R. J., Description of the DLC-
99/HUGO package of photon interaction data in ENDF/B-V format Report No. ORNL-RSIC-46
(ENDF-335), Radiation Shielding Information Center, Oak Ridge National Laboratory, Oak
Ridge, TN, USA, 1983.
22. ICRP 89, Basic Anatomical and Physiological Data for Use in Radiological Protection:
Reference Values, International Commission on Radiological Protection, Pergamon Press,
Oxford, 2003.
23. Storm E. and Israel H. I., Photon Cross-sections from 1 keV to 100 MeV for Elements Z=1 to
Z=100 Atomic Data and Nucl. Tables 7, 565, 1970.
24. Hubbell J. H. and Overbo I., Relativistic Atomic Form Factors and Photon Coherent Scattering
Cross Sections J. Phys. Chem. Ref. Data 9, 69, 1979.
25. Cristy M. and Eckerman K. F., Specific Absorbed Fractions of Energy at Various Ages from
Internal Photon Sources ORNL/TM-8381 Vol. 1-7,Oak Ridge National Laboratory, Oak Ridge,
Tenn., USA, 1987.
26. Kramer R., Vieira J. W., Khoury H. J., and Lima F. R. A., MAX meets ADAM: A dosimetric
comparison between a voxel-based and a mathematical model for external exposure to photons,
Phys. Med. Biol. (accepted for publication), 2004.
27. Kramer R., Vieira J. W., Khoury H. J., Loureiro E. C. M., Lima F. R. A. and Hoff G., (2004b),
Comparison of effective dose between tomographic and mathematical phantoms for external
exposures to photons, submitted to the 11 Congress of the International Radiation Protection
Association, 2004.
28. Cranley K., Gilmore B. J., Fogarty G. W. A. and Desponds L., Catalogue of Diagnostic X-ray
Spectra and Other Data, The Institute of Physics and Engineering in Medicine (IPEM), Report
No 78, Electronic Version prepared by D Sutton, September 1997.
29. ICRU - Tissue substitutes in radiation dosimetry and measurement ICRU Report
[Link] Commission on Radiation Units and Measurements, Bethesda, MD, 1989.
30. ICRP - Basic Anatomical and Physiological Data for use in Radiological Protection: The
Skeleton ICRP Publication [Link] Commission on Radiological Protection, Pergamon
Press, Oxford, 1995.

10

View publication stats