Paper
A HISTORY OF MEDICAL INTERNAL DOSIMETRY
Audrey T. S.-Stelson, Evelyn E. Watson, and Roger J. Cloutier*
Abstract-This paper presents a short history of the develop-
ment of medical internal dosimetry. It reviews the evolution of
the equations and discusses the development of various math-
ematical models used to improve radiation absorbed dose
estimates. The contributions of Leonidas Marinelli, Edith
Quimby, William Mayneord, Robert Loevinger, Walter Sny-
der, and others are emphasized.
Health Phys. 69(5):766-782; 1995
Key words: dosimetry, internal; dose, absorbed; dose assess-
ment; radiation, medical
INTRODUCTION
THISPAPER reviews the calculational techniques that have
been used to estimate the radiation dose a patient would
receive from the administration of radioactive material
and identifies some of the individuals who made an
impact on the development of medical internal dosime-
try.
The history of internal dosimetry could have begun
soon after the discovery of radioactivity by A. Henri
Becquerel in 1896; however, the beginning actually
occurred much later after the development of charged
particle accelerators in the mid 1930’s. These devices
made several radioactive isotopest available in sufficient
quantities to be used for diagnostic and therapeutic
purposes at a limited number of medical institutions.
Internal dosimetry blossomed after World War I1 be-
cause nuclear reactors, developed during the war, made
radioactive isotopes readily available to the entire med-
ical community in almost unlimited quantities.
THE EARLY PERIOD: 1896 TO THE MID 1930’s
Becquerel’s discovery of natural radioactivity led to
considerable interest in the properties of radioactive
decay. However, unlike its x-ray counterpart, which
found an immediate use for medical diagnosis and
therapy, radioactivity was initially only a curiosity to the
* Oak Ridge Institute for Science and Education, Oak Ridge, T N
37831-0117.
(Munuscript received 31 October 1994; revised manuscript re-
ceived 23 May 1995, accepted 12 July 1995)
0017-9078/95/$3.00/0
Copyright 0 1995 Health Physics Society
+ In the early 1900’s, the term radioactive “isotopes” was used
instead of radioactive “nuclides.” We follow the terminology used at
that time.
766
medical community. One reason for this was the low
specific activity of uranium, the first material discovered
to be radioactive. Because uranium has a specific activity
of only about 1.2 X lo4 Bq g-’, the dose rate near small
quantities of uranium is but a fraction of that produced by
even the simplest x-ray tube.
After Marie Curie separated polonium and radium
from uranium ore in 1898, the specific activity situation
changed dramatically. Because radium has a specific
activity of about 3.7 X 10’” Bq g-’, small masses of
radium produce high dose rates. This feature was seized
upon for therapy, and small capsules or needles contain-
ing radium were used as external sources or as implants
in tumors (Early and Landa 1995).
The availability of high-specific-activity material
also made tracer studies possible. The first radioactive
tracer experiment is attributed by Marshall Brucer
(Brucer 1990) to George de Hevesy. In 1911 Hevesy
added “some active deposit” to a meat pie prepared by
his landlady on Sunday. On Wednesday, he discovered
activity in the souffle, thus verifying his suspicions that
the remains of Sunday’s meals reappeared transposed
into a later meal. A formal description for using “radio-
elements as indicators” was published by Hevesy and
Fritz Paneth in 1913 (Hevesy and Paneth 1913).
Tracer studies in humans were not performed until
the late 1920’s when Hermann L. Blumgart and cowork-
ers used a progeny of radon as a tracer to study blood
flow (Blumgart and Yens 1927; Blumgart and Weiss
1927). The solution, containing radium C (’l4Bi), was
employed to measure arm-to-arm circulation time. A
Wilson cloud chamber was used as the detector (Fig. 1).
The discovery of artificial radioactivity by Frederick
Joliot and his wife Irene Joliot-Curie in 1934 provided a
new source of radioactivity (Joliot and Curie 1934).
Initially the artificial radioactive material was produced
by bombarding light elements with alpha particles. This
technique also led to the discovery of neutrons that were
even more effective in producing artificial radioactivity.
Ultimately neutrons produced radioisotopes of elements
beyond uranium, which in the 1930’s was at the end of
the periodic table. Samuel Glasstone’s Sourcebook on
Atomic Energy is a good reference for these develop-
ments (Gkdsstone 1967).
At about the same time, the late 1920’s and early
1930’s, charged particle accelerators were invented and
later improved. These included the Cockcroft-Walton
and Van de Graff accelerators as well as the cyclotron,
 Medical internal dosimetry 0 A. T. S-STELSON
Fig. 1. Diagram of relation of the lead shield and the detecting
device to the patient. A , detecting device; B, lead shield through
which the left arm passes; V , right arm (Blumgart et al. 1927).
Reproduced from The Journal of Clinical Investigation by copy-
right permission of The Society for Clinical Investigation (original
caption).
invented by Ernest 0. Lawrence in 1929. In 1932, John
D. Cockcroft and Ernest T. S. Walton used artificially
accelerated protons to cause the disintegration of lithium.
Later, similar reactions led to the production of many
different forms of artificial radioactivity (Glasstone
1967).
The stage was now set for the use of artificial
radioisotopes as tracers and even as therapeutic agents.
Unencapsulated material could be injected, ingested,
inhaled, or otherwise introduced into the body. Radium
had already been used in a similar manner and as a
luminizing agent in industry. These practices provided
the first indications of the hazards of internally adminis-
tered radioactivity.
THE INTERMEDIATE PERIOD: 1930’s
AND 1940’s
During the early 1 9 3 0 ’ radioactive
~~ materials, now
available by artificial means, began to play a limited role
in the diagnosis and therapy of patients. The principal
diagnostic test, and almost the only one, was the use of
radioactive iodine for thyroid uptake studies. The func-
tion of the thyroid was known to be very important to the
well-being of the patient and iodine, radioactive or not,
would concentrate in this endocrine gland. Fig. 2 shows
a child undergoing this test. A “sensitive” Geiger-
Mueller detector was used to measure the radioactivity.
32P was used for treating various blood disorders such as
leukemia and polycythemia Vera, but to a much lesser
extent than the diagnostic use of radioiodine.
Initially, knowledge of the patient’s radiation dose
from either diagnostic or therapeutic use of artificial
radioactivity was of little concern. In the diagnostic
situation, the amount of radioiodine administered was
based on the need to detect sufficient gamma rays from
the thyroid gland. For the therapeutic use of 32P in blood
disorders, the amount of activity administered was based
on previous experience with x rays and the effect of the
32P on the patient’s blood levels. As more artificial
LT AL
Fig. 2. Early arrangements for counting activity of radioiodine in
the thyroid gland, about 1941. (From the files of J. Hamilton,
courtesy of P. W. Durbin, Lawrence Berkeley Laboratory.) (Stan-
nard 1988.)
radioisotopes became available, concern about the pa-
tient’s dose (amount of energy absorbed by tissue) began
to develop.
At this time, procedures existed for calculating the
internal dose from therapeutic implants of radium and
radon as capsules, needles, or seeds. The goal of the
implants was to produce radiation exposures that would
cause the death of the tumor cells while limiting the
damage to normal tissue. Several different techniques or
source arrangements were developed to accomplish this
goal. One of the most widely used techniques was the
Manchester System (Meredith 1947). This system relied
upon specific source arrays for which tables of exposure
were produced by Ralston Paterson and Herbert M.
Parker (1934). The tables provided exposure-rate values
at various distances from different source arrays. Parker
had a major health physics role during the Manhattan
Project and at the Hanford Project of the U.S. Atomic
Energy Commission, Energy Research and Development
Administration, and Department of Energy. For many
years he was a key member of the National Council on
Radiation Protection and Measurements (NCRP).*
* A collection of Parker’s publications along with a description of
his career was edited by Kathren et al. (1986).
768 Health Physics
The first paper on the internal dosimetry of artificial
radioisotopes was presented by Leonidas D. Marinelli of
Memorial Hospital, New York, in 1941 at the Annual
Meeting of the American Radium Society. His presenta-
tion, titled “Dosage Determinations with Radioactive
Isotopes,” was later published (Marinelli 1942). His goal
was “to furnish the radiologist with the means of deter-
mining to a first approximation, the amount of radioac-
tive material to be prescribed in order to deliver to tissue
a dose of radiation specified in terms of units already in
general use.”
Internal dosimetry initially considered only the beta
particle emissions from a uniformly distributed radioiso-
tope. This was considered justifiable because the beta
dose was known to be several times the gamma dose.
Marinelli’s technique involved calculating the num-
ber of ion pairs produced in a gram of air per roentgen.
He then used 32.2 electron volts per ion pair to calculate
the amount of energy (ergs) absorbed per gram. From the
average energy of the beta, he could determine the
number of beta particles required to give the same
number of ergs as were calculated for 1 roentgen.
Marinelli called this number of beta particles per gram, 1
equivalent roentgen (e.r.). Typographical errors in two
equations and a complex symbolism made this paper
difficult to understand.
Of general historic interest, Marinelli’s first paper
acknowledged the assistance of the Works Projects
Administration (WPA) of New York City (Marinelli
1942). The WPA was created during President Franklin
D. Roosevelt’s administration. Organized in 1935 as the
Works Progress Administration, it was renamed the
Works Projects Administration in 1939. The Agency
provided work for needy unemployed persons by insti-
tuting public works projects but also supported projects
in adult education, the arts, and science.
A gap in published papers related to the medical
uses of radionuclides and internal dosimetry exists from
about 1941 to 1946. This gap occurred because of World
War 11, which for the United States began in 1941 and
ended in 1945.
After World War 11, Marinelli, Edith H. Quimby,
and Gerald J. Hine published a sequel to Marinelli’s 1942
paper (Marinelli et al. 1948a). It had the same general
title, “Dosage Determination with Radioactive Isotopes,”
but included the subtitle, “Practical Considerations in
Therapy and Protection.” They addressed the errors in
the 1942 paper and for the “convenience of the reader,”
reproduced the section on the fundamental relation of
equivalence between concentration of beta emitters in
tissue and radiation dose. The description of the dosim-
etry in this paper is much clearer and the symbolism is
much improved.
The total dose, D,, in equivalent roentgens (e.r.), is
D, = K p C (e.r.), (1)
where
K, = 88 E,T (e.r. per pcd g-’);
November 1995, Volume 69, Number 5
pcd = number of microcuries destroyed;$
C = the initial number of microcuries per gram of
tissue;
E = the average energy per decay in MeV; and
T = the half life in days.
In both the 1942 and the 1948 papers, the authors
assumed that all of the beta energy would be absorbed
within the tissue containing the radioactive material
because “practically all radiation emitted is utilized
therein.”
The dose per hour and per day was calculated as
follows:
dp(hour) = D,f,;and (2)
dp(day) = DPfd, (3)
where,f, andf, are the fraction of the total disintegrations
occurring per hour or per day. A table provided the
values of fi, and f, and information about the average
energy.
In the 1942 paper, Marinelli stated that “Of the few
radioactive isotopes suitable and available at present for
therapy, 32P is the most extensively used.” The average
energy of the emitted particle was listed as 700 electron-
kilovolts (* 5%).”
With this information and the basic equation for the
equivalent roentgen, Marinelli reported that 7.46 X lo7
disintegrations of 32P per gram of tissue would result in
one equivalent roentgen.
Part I1 of the 1942 paper provides “Dosage Esti-
mates on Leukemic Patients.” Marinelli reported that
“the number of disintegrations within a tissue. . . de-
pends on the metabolic uptake as well as on the meta-
bolic elimination of the isotope by the tissue itself.” He
stated: “Our meager knowledge of these factors pre-
cludes any determination of radiation dosage in most
tissues, because it is not possible at present to determine
directly the radioactivity of tissues in patients as a
function of time.” A footnote explains that the material
available at autopsy is at present scanty. Even at this
early date, Marinelli recognized the major impediment to
obtaining good estimates of the internal dose. In the
summary, Marinelli noted that “The main difficulties
encountered in isotope dosimetry are of biological na-
ture.. . .” Lack of biological data continues to be a
significant impediment to accurate dose estimation even
SO years later.
To solve his problem, Marinelli assumed that met-
abolic elimination in tissue follows an exponential pro-
cess. Thus, the number of atoms present in a tissue could
be described as follows:
N, = N e - ( A r + h)f
(4)
where A, is “the fraction of isotope atoms disintegrating
per unit time” and h is the fraction of isotope atoms
eliminated (biologically) during the same time interval.
(i The symbol for curie did not officially become Ci until 1964.
l1 The average energy is now reported as 694.9 kiloelectron volts.
 Medical internal dosimetry 0 A. T. S.-STEI.SON
Marinelli fully comprehended the concepts of inter-
nal dosimetry as shown by his statement that “Since the
radiation dose is proportional to the number of dis-
integrations times the average energy of disintegration
Vp, it is evident that the isotope which will deliver
the highest radiation dose to a tissue is the one for which
( N V p A,.)/(& + A) is largest and not necessarily the
isotope which is taken up in the highest concentration.”
Using differential equations, Marinelli also introduced
the equations needed to describe the movement of an
isotope from one tissue to another.
Marinelli et al. (1948a) also addressed the problem
of calculating the radiation dose from gamma emitters.
His approach to the gamma dose problem was analogous
to that used for dose calculation of interstitial implants of
gamma-ray sources:
D, = K , C g (e.r.), (5)
where
K , = 1.44 t I,, x
1.44t = average life of the isotope in hours;
I , = dose rate in roentgens per hour at 1 cm in
air from an unfettered point source of 1mc;
C = initial number of microcuries/gram of tis-
sue; and
g = a geometric factor in centimeters that de-
pends on the size and shape of the tissue
mass under consideration and the absorp-
tion of gamma rays.
Fig. 3 shows the physical relationship that was used
to calculate the dose at a point. The value of g for point
Q from the total volume is
Fig. 3. Volume Vwith a concentration of C mc per gram (Marinelli
1948a). Reproduced with copyright permission from the American
Roentgen Ray Society (original caption).
ET AL. 769
I’
The geometric factor, g, for a point at the center of
a sphere is
4rr
g= (1 - e-””) (cm) (7)
~
fl.
where R = radius of a sphere.
For spheres that have a diameter of <10 cm,
g=4rrR (cm).
However, the sphere is not a good approximation of
the shape of the human body. The trunk of the body does
resemble a right cylinder (Fig. 4) and so the value of g
was calculated as follows:
Although this expression was not directly integrable,
Marinelli et al. (1948a) obtained a fair approximation of
it by expanding the exponential terms into a series of
terms and using only the first two terms for a solution.
Marinelli et al. noted that the calculation of g was
exceedingly complex for a nonuniform distribution of a
radioisotope. They might also have added that calcula-
Fig. 4. Cylinder of radius R and height 2 2 (Marinelli 1948a).
Reproduced with copyright permission from the American Roent-
gen Ray Society (original caption).
770 Health Physics November 1995. Volume 69. Number 5

tion of the g factor for unusual shapes was also very

complex. Therefore, calculations were limited to spheres,
cylinders, and ellipsoids.
Although the 1948 paper was written to explain how
the dose to a patient could be calculated, the authors also
made a special calculation to determine the concentration
in microcuries per gram that would give a dose of 0.1 e.r.
per 24 h. This dose rate was the acceptable exposure rate
for radiation workers in the 1940’s.
The same authors, Marinelli, Quimby, and Hine, had
two similar articles on dosimetry published in 1948.
Their two-part article on “Dosage Determination with
Radioactive Isotopes” appeared in Nucleonics (Marinelli

et al. 1948b and c). Nucleonics, established in 1947, was
for many years the most prestigious journal for nuclear-
related articles.
Part I, subtitled “Fundamental dosage formulae,”
developed the equations for calculating the dose from
beta and gamma radiations similar to those described
above. The doses were calculated in terms of equivalent
roentgens’ because “it is highly desirable to express these
doses in terms of roentgens, since that unit is generally
employed for therapy with X-rays and radium.”
The authors referenced William V. Mayneord as a
source for many of the geometric factors required for the
internal dose equation (Mayneord 1945). Mayneord often
used the reciprocal relationship in his calculations. This
relationship was first reported by Louis V. King (1912)
who showed “that the ionization per unit volume at a
point P due to a distribution of N moles per unit volume
throughout a mass occupying a surface S, is equal to the
total ionization throughout S due to N moles of radioac-
tive matter concentrated at P.”
Because the equations of integral dose (total energy
absorbed) from a point source of radiation to a volume
are the same as those for the dose to a point from an
extended source, Mayneord was able to use the reciproc-
ity theorem to solve many difficult geometric problems
in internal dosimetry, particularly before the introduction
of computers and Monte Carlo codes. Using this ap-
proach, Mayneord calculated the integral dose for a
human phantom made of cylinders of various sizes (Fig.
5). This was an extension of the work done by Frederick
Bush (1946). In the early development of medical phys-
ics, Mayneord played a leading role and his papers are
cited frequently in the literature.
Part I of Marinelli’s Nucleonics article also includes
a tabulation of basic information for 38 isotopes includ-
ing radiation disintegration mode, energies, etc. This is
perhaps the first compilation of information needed for
internal dosimetry. Previously such information had been
scattered throughout the literature.
In Part 11, subtitled “Biological Considerations and
Practical Applications,” the concept of Differential Ab-
sorption Ratio (D.A.R.) was introduced. The D.A.R.,
The equivalent roentgen was essentially the same as the
roentgen equivalent physical (rep) which was introduced by Herb
Parker and widely used in occupational health physics (Kathren et al.
1986).
I
HEAD
Fig. 5. Variation of integral dose for a point source placed at
various positions on the central axis of the body. The doses have
been calculated for an isotope with k = 10 r h -’ mc-’ at 1 cm.
and are modified from the data of Bush (Brit .I. Radiology 19:14;
1946) (Mayneord 1953) (original caption).
which deals with the problem of nonuniform distribution
of radioactivity in the body, is the ratio of the concen-
tration in a tissue to the average concentration in the
body. Thus a tissue with a D.A.R. of 10 would receive a
dose 10 times the average whole-body dose. Supporting
the need to know the D.A.R., Marinelli said that the
“most exhaustive information” on the distribution of 32P
in mice shows that the highest radiation dose is given to
bone, followed in order by spleen, liver, kidney, muscle,
and blood. He also stated that most adult human data
obtained from autopsies of leukemic patients did not
contradict the results in mice. As might have been
expected, radioisotope distribution data from animals
were already being used to predict the dose to humans.
His paper included comments on the safety of
administering a radioactive isotope and stated that a “safe
dose is assumed to be 0.1 r per day for the entire body;”
however, “When tracer studies are to be carried out once
or a few times . . . for diagnostic purposes, the physician
may legitimately employ doses considerably in excess of
those. . . [which are] permitted for continuous expo-
sure.” Apparently the occupational dose limit of 0.1 r dC’
was having an impact on the practice of medicine even at
this early date.
The 1948 papers (Marinelli et al. 1948a, b, c)
acknowledged the support of the Office of Naval Re-
search. This group was one of the initial financial
supporters for the Manhattan Project that led to the
development of the atomic bomb. After the war they
continued to support military research but they also
 Medical internal dosimetry 0 A. T. S.-STELSON
ET AL. 771

represented the first “peacetime venture by the U.S. Table 1. Data on Standard M a n lTavlor 1984).
Government into the large-scale support of basic work in Organs Mass (g)
science” (Pfieffer 1949). In a sense, they were the Mu sc1es 30,000
forerunner of the National Science Foundation. During Skeleton, Bones 7,000
the early years of the Atomic Energy Commission Red marrow 1,500
(AEC), the AEC distributed its research funds to univer- Yellow marrow 1,500
sities through the Office of Naval Research (Hewlett and Blood 5,000
Gastrointestinal tract 2,000
Duncan 1969). Lungs 1,000
Before World War 11, recommendations about the Liver 1,700
safe use of x rays and radium came from the U.S. Kidneys 300
Advisory Committee on X rays and Radium Protection. Spleen 150
Pancreas 70
This group suspended activities during the war and in Thyroid 20
1946 was reorganized as the National Committee (later Testes 40
Council) on Radiation Protection and Measurements Heart 300
(NCRP) (Taylor 1979). The NCRP and a newly re- Lymphoid tissue 700
Brain 1,500
established International Commission on Radiological Spinal cord 30
Protection (ICRP) met in 1949 to settle some fundamen- B1adder 150
tal radiation protection issues. The ICRP had last met in Salivary glands 50
1937 and its first formal meeting after WWII was not Eyes 30
Teeth 20
held until 1950. Prostate 20
Because the 1949 meeting included experts from the Adrenals 20
United States, Britain, and Canada, the meetings became Thymus 10
known as the Tripartite Conferences (Taylor 1984). The Skin and subcutaneous tissue 8,500
Other tissues and organs not separately defined 8,390
experts met first in Canada in September 1949; in
Total body weight 70,000
England, July 1950; and in the United States, March
1953. The main purpose of the meetings was to develop Total water intake per day 2.5 L
In food 1.0 (including water of oxidation)
compatible radiation protection practices. In fluid 1.5
One of the issues discussed at the first meeting of Total water output per day 2.5 L
the Tripartite Conference was the need for a “standard Sweat 500 cm3
man.” It was agreed that a common set of human Lungs 400
Feces 100
anatomical and physiological data be adopted for internal Urine 1,500
dosimetry calculations. In the United States at that time, Overall water content of 50 L (70% of 70 kg)
the size of the various human organs were most fre- body
quently based on information compiled by Hermann Total surface area of respiratory tract 70m’
Lisco of Argonne National Laboratory (Lisco 1949). Respiratory interchange area 50
Nonrespiratory area (Upper tract, 20
Table 1 shows the information that was available to the trachea, bronchioles)
Tripartite group. The duration of occupational exposure in the Standard Man:
K. Z. Morgan, then director of health physics at Oak 8 hoursiday -standard day.
Ridge National Laboratory, accepted responsibility for 48 hoursiweek -standard week.”
50 weeks/year (2,000 hoursiyear) -standard year.
evaluating the suitability and accuracy of the Standard
Man data. His group, which included M. R. Ford, M. J. a The 40-h work week was adopted in the United States in 1962 with the
passage of the Work Week Hours Act.
Cook, I. Tipton, S. R. Bernard, and later W. S. Snyder,
produced major compilations on Standard Man, later
renamed Reference Man, that were published by the
ICRP. Today, the Reference Man data are available in distributed radioisotopes from its reactors to many
ICRP Publication 23 (ICRP 1975). groups, especially groups performing medical and bio-
When World War I1 ended in 1945, there was a great logical research. On 2 August 1946, the first “official”
deal of concern about who should control atomic energy: radioactive isotope shipment to the private sector was
the civilians or the military? After heated debate by made from Clinton Laboratories, now Oak Ridge Na-
Congress, an Atomic Energy Act was passed and signed tional Laboratory (Hewlett and Anderson 1962). One
by President Harry S. Truman on 1August 1946. The Act millicurie of 14C was produced in the Graphite Reactor
assigned this responsibility to a civilian Atomic Energy and given to the Barnard Free Skin and Cancer Hospital
in St. Louis, Missouri.’
Commission (AEC) (Hewlett and Anderson 1962). The
During the first year of distributions, over eleven
official transfer of the military atomic energy program to
hundred shipments were made to 160 organizations
the AEC was made on 1 January 1947. (Stannard 1988).
Even before the AEC took over, the military desired
to demonstrate that research and development related to ’ A clever public relations program allowed many different
the atomic bomb also had peaceful uses. To emphasize groups to claim the honor of having received the first radioisotope
this point, the military, and later the AEC, readily shipment (Brucer 1990).
772 Health Physics
In the late 1940’s, the AEC established medical
research programs at Oak Ridge, Brookhaven, and Ar-
gonne. The distribution of reactor-produced isotopes and
the establishment of medical research programs by the
AEC set the stage for the 1950’s to be a time of
exponential growth in the use of radioactive materials in
humans.
DOSIMETRY TAKES HOLD: 1950’s
Medical physicist Edith Quimby was well known in
the 1940’s and 1950’s for educating physicians on the
intricacies of radiation physics. Her chapter on the
“Dosimetry of Internally Administered Radioactive Iso-
topes” (Quimby 1951) had a similar impact on those
starting to use the newly available radionuclides. * *
Quimby ’s approach to internal dosimetry was the same
as that presented in the paper she coauthored earlier with
Marinelli (1948a). She recognized that equivalent roent-
gen, roentgen equivalent, tissue roentgen, and roentgen
equivalent physical (rep) were all defined differently but
all essentially meant the same thing.
Quimby noted that many organs could be approxi-
mated by spheres. This concept was later used by the
ICRP in its early report on internal dosimetry (ICRP
1960). Quimby’s chapter also included a sample calcu-
lation for 1 3 ’ 1 in the thyroid. This calculation was
extended to give the “safe tracer dose,” which was the
activity that would deliver 0.3 r in the first week. The
occupational exposure limit had been lowered to 0.3 r per
week.
Quimby also expanded on the Differential Absorp-
tion Ratio that was previously included in her 1948 paper
with Marinelli (1948a). She noted that (1) the D.A.R.
value depends upon the time of measurement, and (2) no
rule existed for determining the optimal time to be used
to compare the D.A.R.s. She also pointed out that human
data on the distribution of radioisotopes were lacking and
that data on long-lived isotopes were especially scanty.
She admonished physicians that “No human studies with
long-lived isotopes should be undertaken until a consid-
erable amount of animal work indicates their justifica-
tion.”
C. F. Stroebel’s chapter in the same book as Quim-
by’s chapter (Stroebel and Hall 1951) discussed the use
of 32P in humans. The following quote gives some idea
of how the doses were calculated: “The determination of
dosage may be done by use of a logarithmic scale. . . . An
ordinary Keuffel and Esser slide rule may be used.”
Senior readers of this report will quickly recognize this as
the standard K & E slide rule on which they made their
calculations and for which three-significant-digit preci-
sion was a goal. Younger readers will not understand the
nostalgia the statement affords many of us. Instead they
will grab their pocket calculators and be quick to report
answers with seven-digit precision.
** About this time the term “radionuclide” began to replace
“radioisotope.”
November 1995, Volume 69, Number 5
In discussing the treatment of hyperthyroidism, John
Hurst and John Karr (1951) made clear that the dose
which physicians were accustomed to using when admin-
istering radioactive material was not the roentgen nor
equivalent roentgen but rather the amount of activity
administered. They reported that three approaches to
determining the required dose (activity) were being
followed for hyperthyroidism:
1) A basic dose is administered. If the toxicity persists,
repeat the dose;
2) Adjust the size of the dose depending on the size of
the gland; and
3) Select the dose based on the uptake of a tracer dose
and gland size.
By the early 1950’s, the proximity of the Oak Ridge
Institute of Nuclear Studies’ (ORINS) Medical Division
to the source of the radionuclides, the X-10 reactor at
Oak Ridge, made the Institute one of the leading nuclear
medicine centers in the world. Directed by Marshall
Brucer, this group conducted not only medical research
but also symposia and training courses. In September
1953, ORINS presented a combination symposium/train-
ing program at which Robert Loevinger discussed the
“Calculation of Radiation Dosage in Internal Therapy
with 1-131” (Loevinger 1955).?+
Loevinger outlined a technique for internal dosime-
try. The beta dose equation, based on one rep being equal
to 93 ergs of absorbed energy per gram of tissue, was
D, = 79.3 E, TeflC (rep), (9)
where
EP = average energy of the beta radiation in MeV;
T,, = effective half-time in days; and
C =the concentration in pcg-l.
At the same meeting Harald Rossi announced that in
July 1953, the International Radiological Congress had
adopted the rad as 100 ergs per gram, and so the above
equation would become:
D, = 73.8 E, TeflC (rad). (10)
(Rossi 1955).
The gamma dose equation was
D, = 0.0346 Z,, TeflC g (roentgen), (11)
where
I, =r
per h at 1 cm in air from a point source of 1
mc;
T,, = effective half-time in days;
C = concentration in Fcg-l; and
g = geometric factor in cm.
Loevinger cautioned the reader, “This is a simple-
looking equation, but don’t let it fool you. It is not easy
tt Robert Loevinger was the 1993 recipient of the Health Physics
Society Distinguished Scientific Achievement Award.
 Medical internal dosimetry 0 A. T. S.-STELSON
ET AL. 773

to use, since we can seldom determine g in any practical

case.”
Loevinger stressed that the value of g depended
upon the model used to represent a body and “ . . . it
should be thoroughly understood that the calculations
really apply only to the model. Application of the
calculated results to a real biological system (patient or
animal) requires a judgment of the extent to which the
system does or does not satisfy the simplifying assump-
tions of the model.”
Loevinger also said “The development of a satisfac-
tory model might proceed as follows: First, a very simple
model will serve as a basis for conducting and interpret-
ing the first experiments in a new field. This model is
changed to include new information, and new experi-
ments are suggested by an improved model. If this
process eventually arrives at a model, which is in
substantial agreement with experience, and which allows
adequate prediction of future results, then the model is
said to be ’true’. We may then even allow ourselves to
forget that it is a mere model.” In addition, Loevinger
described a mathematical model of the trunk of a human
with the thyroid gland embedded in the trunk (Fig. 6).
When discussing uncertainties, Loevinger stated that
the disintegration scheme of 1311is probably well enough
known that the dosimetry constants will not change by
more than a few percent in the future. However, uncer-
tainty about the amount of radioiodine in the thyroid may
be as great as a factor of three, and direct measurement of
the thyroid organ activity should be better than indirect
urinalysis. To improve the measurements, a suitable
physical phantom was required.
As the use of radionuclides in medicine increased,
so did the number of articles and chapters on internal A d m i n i s t e r e d 1131 goes 5c”, t o thyroid
dosimetry. In 1953, Mayneord and Warren K. Sinclair** t o trunk
wrote an informative chapter for the Advances in Bio-
logical and Medical Physics. They recognized that a Fig. 6. Elemental model for 13*1 dosimetry (Loevinger 1955)
common system of dosimetry would be advantageous, (original caption).
and the gamma- and beta-ray dose equations should be in
identical form. They pointed out that the dose rate for a
uniformly distributed beta emitter was uniform except dosimetry fundamentals, external dosimetry, and dosirn-
near the surface of the tissue containing the emitter. etry for implants; however, there were two chapters
However, when a gamma emitter was uniformly distrib- related to internal dosimetry. The chapter titled “Inter-
uted throughout a tissue, the dose was not uniform. At the nally Administered Radioisotopes,” by Loevinger, Holt,
surface of the tissue, the dose would be only about one and Hine, summarized the methods for doing internal
half of that at the center. The gamma-ray problem dose calculations. The equations presented are similar to
required the calculation of g which had been done for those developed earlier. This clearly written chapter
spheres, cylinders, and ellipsoids; however, for complex provides valuable instructions and admonitions on what
geometries, graphical integration was often necessary. is important. For example, “The initial uptake period can
They represented the human body with an ellipsoid that ordinarily be ignored in dosimetry calculations if the
had a ratio of the axes of 5 to 1. effective half-life for elimination is at least twenty times
In 1956, the first edition of Radiation Dosimetry was the effective half-time for uptake” and “The resolution of
published. Edited by Hine and Brownell (1956), the book the concentrations into (exponential) components is for
served as the “gold standard” on dosimetry for many convenience of computation only. The individual com-
medical and health physicists until updated by Attix and ponents do not necessarily have any relationship to true
Roesch (1968). Most of the first edition was devoted to biological turnover rates, half-times, volumes of distri-
butions or any other significant biological parameters.”
** After leaving England, Sinclair joined the staff of the M. D.
Marinelli’s concept of treating low-energy gamma and x
Anderson Hospital in Houston, Texas, then went to Argonne National rays as if they were beta radiation (Marinelli et al. 1948a)
Laboratory before serving as President of the NCRP 1977-1991. was extended by Loevinger et al. (1956b) to include
114 Health Physics
other forms of nonpenetrating radiations such as internal
conversion electrons, Auger electrons, and low-energy x
rays.
The estimation of the gamma dose still depended
upon the calculation of an average geometric factor, S.
This calculation was by no means trivial, and it was
usually done by using simple geometries such as cylin-
ders and spheres. Initially Bush (1946), then Mayneord
and Sinclair (1953), and now Loevinger, put cylinders
together to form a human body. This mathematical
phantom was used to calculate the value of j for the
various parts of the body. Bush had also calculated the
effect of elongation and shape on the integral dose and
had concluded that large changes in shape resulted in
only small variations in the integral dose (Bush 1949).
Earlier Marinelli et al. (1948a) had calculated the
radionuclide tissue concentration that would result in a
patient dose of 0.1 ex. per 24 h, which was the occupa-
tional dose limit at that time. Later Quimby calculated
the concentration that would result in a patient dose of
0.3 r wk-', which was the occupational dose limit in
1951. Mayneord and Sinclair (1953) now stated that the
dose to patients who are expected to live for many years
and have diagnostic tests applied time after time should
have dose limits based on weekly tolerance dosages for
radiation workers. Loevinger et al. (1 956b) likewise
calculated the radionuclide tissue concentration that
would result in 0.3 rad wk-', which was then the
maximum permissible dose to the critical tissue for
occupational workers.
THE GOLDEN AGE: 1960-1980
As the 1960's began, the technique used to calculate
the gamma dose was about to change drastically. No
longer would the slide rule, planimeter, or desk-type
adding machines be used to solve differential and inte-
gral equations (Fig. 7). Computers that performed high-
speed repetitive calculations would take over. One tech-
nique proved very valuable to internal dosimetry. Called
the Monte Carlo calculation, this technique statistically
follows the paths of gamma rays as they pass through
matter by using the probabilities of interaction to deter-
mine if an interaction would occur. This procedure is
repeated until each gamma ray has been totally absorbed
or escapes the body. Knowledge about the life histories
of a few gamma rays is not useful but the life histories of
tens of thousands of gamma rays give a reasonable
approximation of where the gamma rays deposit their
energy. This technique allows for the source to be of any
shape and the volume in which the interactions occur to
be of any shape. It was first considered for internal dose
calculations by Loevinger et al. (1956a) but not actually
applied until Ellett et al. (1964, 1965) published tables
for various photon energies and phantom shapes. Be-
cause the computers performed repetitive calculations,
the tedious task of calculating the geometric factor was
gone forever, and new sourceltarget combinations were
possible.
November 1995, Volume 69, Number 5
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The development of instrumentation for imaging the
gamma rays from radionuclides within the human body
also improved significantly in the early 1960's. Nuclear
medicine departments were being established around the
world and particularly in the United States. Radionu-
clides were still being used for therapeutic purposes;
however, many physicians were focusing on administer-
ing radionuclides to patients for diagnosis by in vivo
gamma imaging (often called scanning). Emphasis was
on developing radiopharmaceuticals (radionuclides used
as pharmaceuticals) that emitted significant amounts of
gamma radiation instead of beta radiation.
Because of the increase in nuclear medicine proce-
dures, particularly for diagnosis, several members of the
Society of Nuclear Medicine" (SNM) recognized a need
for improving the methods of estimating absorbed radi-
ation dose. Several needs were apparent. The descrip-
tions of the emissions from radionuclides were not
complete. Most listings included only the alpha, beta, and
gamma emissions without adequate information on x
rays or Auger and conversion electrons. Even the
gamma-ray yields were given in relative numbers so that
absolute values were difficult to obtain. The methods for
estimating dose needed to be made more consistent. The
models used for estimating the energy absorption were
not truly representative of the human body. Data on the
distribution and retention of radionuclides were limited
and often inaccurate. John U. Hidalgo, President-elect of
the Society of Nuclear Medicine in 1963, was informed
BB The Society of Nuclear Medicine was formed in 1954 and
focused primarily on diagnostic uses of radionuclides in medicine.
 Medical internal dosimetry 0 A. T. S.-STELSON
of these concerns by many SNM members.! One of
Hidalgo’s first acts as President was to direct the Soci-
ety’s Secretary, Craig Harris, to organize an ad hoc
committee that would attack the problems.
The first meeting of “The Society’s ad hoc commit-
tee on dose calculations” was held in November 1964,
with Edward M. Smith, John McAfee, Gordon Linden-
blad, Jonathan P. Miller, and C. Craig Harris in atten-
dance. Smith was chairman, and Harris served as secre-
tary. Smith and Harris, along with Robert H. Rohrer (not
present at the first meeting), were primarily concerned
with the decay information of radionuclides that was
lacking in available tables. McAfee proposed that the
work be extended to an in toto study of the radiophar-
macological problem including stability of label and
radiochemical purity. Mones Berman of the National
Institutes of Health (NIH) was present as an invited
observer-advisor and reported that a Task Group of the
International Commission on Radiation Units (ICRU)
was studying tracer kinetics. The task group’s work was
directed toward use of tracers in the study of systems and
not directly aimed at dosimetry but was complementary
to the goals of the Committee.
Several other important aspects of internal dosime-
try were examined. Smith discussed the defects of the
spherical organ model and the concept of effective
radius.“ He also stressed (and the group agreed) that the
mission of the SNM Committee was technical evaluation
of dose and not the evaluation of hazards, efficacy, and
other such topics as the “critical” organ dose.
Because of the lack of appropriate biologic informa-
tion, the Committee was interested in establishing a
central agency for collecting and disseminating biologi-
cal data. The possibility of establishing a standard fetus,
standard child (possibly several ages), and a standard
woman was also considered as a complement to the
Standard Man being developed by the ICRP for radiation
protection purposes.
Several scientists in disciplines other than nuclear
medicine were also concerned with improving the accu-
racy of absorbed dose estimates. Gordon Brownell,
William H. Ellett, and A. B. Callahan in Boston; Walter
Snyder and Mary Rose Ford in Oak Ridge; Robert
Loevinger of the National Bureau of Standards; and
Mones Berman with the NIH were working on different
aspects of the internal dose problem. Recognizing this,
the SNM committee began to collaborate with them and
ask for their advice.
At the second meeting, January 1965, the name
Committee on Medical Internal Radiation Dose (MIRD)
was selected and Monte Blau and Ed Smith were named
Cochairmen. The initial membership of the Committee
was Edward M. Smith, Monte Blau, Gordon Lindenblad,
C. Craig Harris, Duke University Medical Center, Durham, NC,
personal communication, June, 1994.
The ICRP used a series of spheres as its model of man and his
organs (ICRP 1960). Because several members of the ICRP commit-
tees also had an interest in nuclear medicine dosimetry, each group
benefited from the work of the other.
ET AL. 775
John McAfee, Karin R. Corey, Richard Peterson, C.
Craig Harris, Jack Krohmer, Robert H. Rohrer, Jonathan
P. Miller, James Robertson, and Henry N. Wagner, Jr.
Consultants to the Committee were Robert Greenlaw,
Mones Berman, Robert Loevinger, and Gordon L.
Brownell.
At its first meeting, the committee had agreed that
an upper and lower estimate of the absorbed dose would
be preferable to a definitive statement of the absorbed
dose; however, at the second meeting the decision was
made that the objective of calculating doses according to
age groupings and pathologic-state variations would be
preferable and not be in conflict with the Standard Man
concept.
The third meeting, held on 10 May 1965, resulted in
the statement that the primary objective of the MIRD
Committee was to provide the medical and scientific
communities with the most accurate estimate (as ex-
pressed in rad) of the dose that a patient receives from
radiopharmaceuticals administered for diagnostic stud-
ies. The Committee would “collect, collate, and evaluate
metabolic, chemical and nuclear data on various radio-
pharmaceuticals and merge this information into a real-
istic estimate of the patient dose using the most appro-
priate dose calculation techniques.””
At this MIRD meeting, Loevinger presented his
approach to a unified beta-gamma dose calculation
method. He suggested that the Committee get away from
“such fantasies as uniform distributions, and start with a
rational approach.” He indicated that present methods
were inadequate, giving his chapters in Radiation Do-
simetry, edited by Hine and Brownell, as examples
(Loevinger et al. 1956a and b). He noted the “schizo-
phrenic” nature of those methods: gamma dose calcula-
tions were derived from radium therapy and beta meth-
ods descended from Marinelli’s “energy emitted equals
energy absorbed” approach. * * *
During these early meetings, the Committee was
developing the objectives and goals that would govern
the future activities of the Committee for the next 25
years. At the June 1966 meeting, Robert Loevinger
presented a draft of the Loevinger and Berman paper that
described a unified approach to dosimetry. This approach
revolutionized dosimetry calculations and was published
as the first MIRD pamphlet (Loevinger and Berman
1968). According to the minutes of the meeting, the
Committee enthusiastically engaged in a discussion of
the schema and its concepts.
Also at this meeting, Gordon Brownell urged the
Committee to convert physical data of radiations from
nuclides into whoie-body absorbed dose, organ absorbed
dose, and gonadal absorbed dose, stating the biologic
data that were employed. He also proposed that they
abandon the use of the roentgen as a unit, the specific
gamma-ray constant (r),and the geometric factor ( j ) in
absorbed dose calculations. The absorbed fraction tabu-
## Report from Edward M. Smith to the President of the Society
of Nuclear Medicine, 26 March 1965.
* * * Minutes of MIRD Committee meeting, 10 May 1965.
776 Health Physics
lations proposed by Brownell and Ellett would eventu-
ally be published as MIRD Pamphlet No. 3 (Brownell et
al. 1968).
Martin Berger described his activities in computing
build-up factors for gamma radiation for energies as low
as 15 keV and the energy dissipated by P-particles in
tissue-equivalent materials. These results were published
in MIRD Pamphlets Nos. 2 and 7 (Berger 1968, 1971).
At the February 1967 meeting, the manuscript of
Pamphlet No. 1 (Loevinger and Berman 1968) was
accepted pending a few changes. General dose equations
and dose equations for the uniform isotropic model were
presented in this pamphlet. For example, the dose equa-
tion for a volume being irradiated by a region r was given
as
This eqn could also be written as
D ( v t r) = A r c A, @((v
I
tr ) .
Definitions and symbols for cumulated activity (A),
absorbed dose (D),absorbed dose rate (R), absorbed
fraction (+), and specific absorbed fractions (a) were
chosen at this time. A term called the equilibrium dose
constant (A), the product of the emitted energy of a
radionuclide and a conversion constant, was introduced.
The name equilibrium dose constant was later seen as a
misnomer and is now simply defined as mean energy
emitted per nuclear transition (Loevinger et al. 1989). A
revised Pamphlet No. 1 was published in 1976 (Loev-
inger and Berman 1976). This pamphlet extended the
equations to include the use of "S values". The S value
was defined as
c A,@,,(v
I
+ 4.
The concept of residence time was also examined in
the revised pamphlet. Berman, who brought to the
committee valuable knowledge about tracer kinetics and
the use of compartmental analysis, described residence
time in greater detail in MIRD Pamphlet No. 12 (Berman
1977).
The absorbed dose equation using residence time
and S values is given as
~
(rkk) = 2 7 h s(rk rh) 2 (15)
h
where
D (rk) = the mean dose to target region k ;
T~ = residence time of a radionuclide in source
region h; and
S =the mean dose per unit cumulated activity.
The third pamphlet prepared by Brownell et al.
(1968) included absorbed fractions for photon dosimetry
in spheres, ellipsoids, and right circular cylinders calcu-
November 1995, Volume 69, Number 5
lated by the Monte Carlo technique. Values were tabu-
lated for photon energies of 0.020, 0.030, 0.040, 0.060,
0.080, 0.100, 0.160, 0.364, 0.662, 1.46, and 2.75 MeV.
Thomas Dillman of Ohio Wesleyan University at-
tacked the problem of tabulating nuclear decay data for
internal dose purposes. His efforts resulted in MIRD
Pamphlet No. 4 (Dillman 1969) as well as updates
(Dillman 1970; Dillman and Von der Lage 1975; Weber
et al. 1989).
Bryant Jones of the Food and Drug Administration
(FDA) attended the February 1967 meeting, and the
Committee discussed with him the role of the FDA in the
use of radiopharmaceuticals. At this time the AEC was in
the process of transferring regulatory authority for radio-
pharmaceuticals to the FDA. The FDA intended to
continue the requirement for dosimetry data with each
New Drug Application.
In 1968, Walter Snyder of Oak Ridge National
Laboratory joined the MIRD Committee. He brought
expertise in the development of mathematical models of
(13)
the human body and the use of the Monte Carlo codes for
internal dosimetry. He also was an important link to the
ICRP because he served on ICRP Committee I1 that was
responsible for the development of internal dose esti-
mates for radiation workers. He initiated work with the
help of Gordon Warner that resulted in the calculation of
absorbed fractions, specific absorbed fractions, and S
values for a model of Reference Man. These results not
only provided information for calculating absorbed doses
for radiopharmaceuticals, but also were incorporated by
the ICRP and regulatory agencies into the dose equiva-
lents for radionuclides required to meet radiation protec-
tion standards. As justification for the use of the Monte
Carlo results rather than the classical ICRP results (ICRP
1960), Snyder compared the results of these methods, as
shown in Fig. 8.
(14)
The use of S values has simplified the calculation of
internal dose estimates but has also created some diffi-
culties along the way. One that was perceived fairly early
was that although most radioactivity was localized in one
or two organs, some fraction of the total activity was
distributed throughout the remainder of the body. The
S-value tables do not include values for remainder of the
body as a source organ. Roger Cloutier et al. (1973)
published equations to convert the absorbed fraction
values for the total body irradiating target organs to
absorbed fraction values for remainder of the body
irradiating target organs. A later publication by Jack L.
Coffey and Evelyn E. Watson (1979) extended this to
corrections for S values. At approximately the same time,
Hans D. Roedler"' and Alexander Kaul were also
ttl- Hans D. Roedler died in 1989 in an automobile accident. The
career of this talented scientist, physician, and musician was ended at
the age of 45. Among his accomplishments were an extensive
compilation of dosimetric information for more than 160 radioisotopes
and radiopharmaceuticals (Kaul et al. 1973), a thesis on radiation
exposure from radiopharmaceuticals and the limits of the accuracy of
dose calculations (Roedler 1977), and a pocket compilation of internal
radiation dose estimates in diagnostic nuclear medicine (Roedler et al.
1978).
 Medical internal dosimetry 0 A. T. S.-~TELSON
\ \
L , , ! * , , , . I
.;
I 1 4 , I 1
.Oz .Q4..06081 3 .4.5.5;.a$u
examining this problem (Roedler and Kaul 1976) and
showed that the correction was most important for target
organs that contain little or no activity.
In addition to continuous support from the Society
of Nuclear Medicine, the MIRD Committee began re-
ceiving funding from the Bureau of Radiological Health
(BRH) of the Public Health Service in 1965. The BRH
support continued for about 20 years with Donald Ham-
ilton representing BRH at most meetings. The sale of
MIRD pamphlets by the Society of Nuclear Medicine
also provided financial support for the MIRD Committee
activities .
The membership of the Committee has changed
over the years; however, the primary objectives and goals
have continued much as they began. The leadership of
the Committee has focused on the major issues of
concern to the nuclear medicine community. The follow-
ing people have chaired the Committee: Edward Smith
(also Executive Secretary), Monte Blau, Robert Rohrer,
Roger Cloutier, Katherine Lathrop, James Robertson,
David Weber, and Evelyn Watson. Several individuals
have served for long periods of time. These include
Edward Smith, James Robertson, Robert Loevinger, and
Katherine Lathrop. Lathrop probably holds the service
record. She was appointed in 1967 and still serves on the
Committee.
Soon after the publication of the MIRD Committee
documents, nuclear medicine physicians and medical
physicists around the world began to accept the pro-
nouncements of this group as the most definitive and
valuable statements regarding internal dosimetry of ra-
ET AL. 777
diopharmaceuticals. The impact of the MIRD Committee
on internal dosimetry can be evaluated by its publications
(Table 2). These include pamphlets on dose equations,
decay scheme data, absorbed fractions, specific absorbed
fractions, and S values. Also included are instructive
pamphlets and books that describe the schema developed
for calculating absorbed dose estimates and methods for
processing biologic data and developing cumulated ac-
tivities for use in the dose calculations.
The MIRD Committee has made use of research by
scientists other than those who were official members of
the committee. The lack of biologic retention and distri-
bution data caused the committee to enlist the help of
nuclear medicine departments that were willing to collect
data from humans. These data were utilized in the series
of MIRD Dose Estimate Reports that have been pub-
lished in the Journal of Nuclear Medicine (Table 3).
These dose estimates represent excellent examples of
data collection and analysis for dosimetry. They address
the effect of route of administration, chemical form of the
radionuclide, and disease on the internal dose estimate.
. , ,
The internal dosimetry of nuclear medicine procedures
3 1 was given a big boost in 1977 when Frank DeLand,
Editor of the Journal of Nuclear Medicine, issued a
directive to authors requiring dosimetry data to be
included in articles describing new radiopharmaceuticals.
Most published absorbed dose estimates are based
on the mathematical model of Reference Man developed
initially by Henry Fisher and Walter S. Snyder (Fisher
and Snyder 1966; Snyder et al. 1969). This model,
sometimes called the MIRD phantom, includes female
organs as well as male organs so that dose estimates can
be made for women as well as for men. Other special
models, however, have been developed by groups such
as the Internal Dosimetry group at Oak Ridge National
Laboratory, the Radiation Internal Dose Information
Center at Oak Ridge Associated Universities, and H.
Yamaguchi and coworkers at the National Institute of
Radiological Sciences, Chiba, Japan (Yamaguchi et al.
1975). The Oak Ridge National Laboratory group created
a series of mathematical models for the newborn, one-
year-old, five-year-old, ten-year-old, and fifteen-year-old
(Warner et al. 1975; Poston 1976).*** Oak Ridge Asso-
ciated Universities developed a model of the pregnant
woman during the nine months of pregnancy (Cloutier et
al. 1977).333 Scientists at the National Radiological
Institute in Japan applied the transformation method to
the MIRD Reference Man model to obtain absorbed
fractions for various physiques. Reference Man and his
kinfolk continue to evolve and are the basis for most
internal dose estimates.
Several efforts addressed the problem of nonuni-
form distribution of radionuclides within organs and
tissues. Jack Coffey and coworkers developed a heart
*** Development of the age-dependent mathematical phantoms
continues at ORNL (Cristy 1980; Cristy and Eckerman 1987).
*ii* After many years of collaboration between ORAU and ORNL,
mathematical models and specific absorbed fractions at various stages
of pregnancy have been published (Stabin et al. 1994).
77x Health Physics November 1995, Volume 69, Number 5

Table 2. List of MIRD pamphlets and books.

MIRD
pamphlet
no. Title and authors References
1 A schema for absorbcd-dose calculations for biologically distributed J. Nucl. Med. 9(Suppl.1):7-14; 1968.
radionuclides. Robert Loevinger and Mones Berman.
1, Revised A revised schema for calculating thc absorbed dose from biologically New York: The Society of Nuclear
distributed radionuclides. Robcrt Locvinger and Mones Berman. Medicine; 1976.
2 Energy deposition in water by photons from point isotropic sources. J. Nucl. Med. 9(Suppl.1):15-25; 1968.
Martin J. Berger
3 Absorbed fractions for photon dosimetry. G. L. Brownell, W. H. J. Nucl. Med. 9(Suppl.1):27-39; 1968.
Ellett, and A. R. Reddy
4 Radionuclide decay schemes and nuclear parameters for use in J. Nucl. Med. 1O(SuppI.2):5-32; 1969.
radiation-dose estimation. L. T. Dillman.
5 Estimates of absorbed fractions for monoenergetic photon sources I. Nucl. Med. tO(Supp1.3):5-52; 1969.
uniformly distributed in various organs of a heterogeneous
phantom. W. S. Snyder, Mary R. Ford, G. G. Warner, and H. L.
Fisher, Jr.
5 , Revised Estimates of specific absorbed fractions for photon sources uniformly New York: The Society of Nuclear
distributed in various organs of a heterogeneous phantom. Walter Medicine; 1978.
S. Snyder, Mary R. Ford, and Gordon G. Warner.
6 Radionuclide decay schemes and nuclear parameters for use in J. Nucl. Med. ll(Supp1.4):5-32; 1970.
radiation-dose estimate, Part 2. L. T. Dillman.
7 Distribution of absorbed dose around point sources of electrons and J. Nucl. Med. 12(Supp1.5):5-23; 1971.
beta particles in water and other media. Martin J. Berger.
8 Absorbed fractions for small volumes containing photon-emitting J. Nucl. Med. 12(Supp1.5):25-32;
radioactivity. W. H. Ellett and R. M. Humes. 1971.
9 Radiation dose to humans from Se-75-L-Selenomethionine. Katherine J. Nucl. Med. 13(Supp1.6):7-30; 1972.
A. Lathrop, R. Eugene Johnston, Monte Blau, and Edmund 0.
Rothschild.
10 Radionuclide decay schemes and nuclear parameters for use in New York: The Society of Nuclear
radiation-dose estimation. L. T. Dillman and F. C. Von der Lagc. Medicine; 1975.
I1 “S,” absorbed dose per unit cumulated activity for selected New York: The Society of Nuclear
radionuclides and organs. W. S. Snyder, M. R. Ford, G. G. Medicine; 1975.
Warner, and S. B. Watson.
12 Kinetic models for absorbed dose calculations. Mones Berman. New York The Society of Nuclear
Medicine; 1977.
13 Specific absorbed fractions for photon sources uniformly distributed J. Nucl. Med. 22:65-71; 1981.
in the heart chambers and heart wall of a heterogeneous phantom.
Jack L. Coffey, Mark Cristy, and Gordon G. Warner.
Book MIRD primer for absorbed dose calculations. Robert Loevinger, New York: The Society of Nuclear
Thomas F. Budinger, and Evelyn E. Watson. Medicine; 1988 (reprinted 1991).
Book MIRD: radionuclide data and decay schemes. David A. Weber, Keith New York: The Society of Nuclear
F. Eckcrman, L. Thomas Dillman, and Jeffrey C. Ryman. Medicine; 1989.

model. This model divided the heart into chambers and
muscle compartments (Coffey et al. 1981). John McAfee
devised a model of the kidney that made a distinction
between the cortex, medulla, and collection system
(McAfee 1970). McAfee also noted that the bladder
collection rate and changes in bladder volume would
affect the radiation dose. Snyder and Ford (1976) devel-
oped a “dynamic bladder” model to account for these
changes.
Probably the most difficult nonuniform source dis-
tribution was studied by Frederick W. Spiers, who
devoted many years of research to the special problems
of determining the absorbed dose received by bone and
bone marrow from external and internal irradiation.
Spiers applied both theory and meticulous measurements
of the bone and bone marrow in his efforts to advance our
knowledge about this important subject (Spiers 1968).
In 1969, an international symposium on Medical
Radionuclides: Radiation Dose and Effect was organized
by staff of the Oak Ridge Institute of Nuclear Studies
(ORINS) as a part of an AEC Symposium Series. This
was the first major meeting to address the issues of
internal dosimetry for nuclear medicine procedures. The
authors listed in the table of contents of the proceedings
(Cloutier et al. 1970) read like a “Who’s Who” of
internal dosimetry and nuclear medicine: E. H. Quimby,
E. M. Smith, W. S. Snyder, L. T. Dillman, M. J. Berger,
K. Z. Morgan, H. N. Wellman, N. G. Trott, H. S.
Winchell, W. B. Nelp, M. K. Loken, J. G. McAfee, R. J.
Cloutier, E. E. Watson, F. W. Spiers, R. E. Rowland, V.
P. Bond, H. N. Wagner, R. H. Rohrer, R. Loevinger, S.
R. Bernard, J. G. Kereiakes and E. L. Saenger.
A series of similar symposia has been held approx-
imately every five years in Oak Ridge, Tennessee. Each
of these has drawn a broad spectrum of speakers and
participants, and the proceedings have made important
contributions to the internal dosimetry information base
(Cloutier et al. 1976; Watson et al. 1981; Schlafke-
Stelson and Watson 1986; Watson and Schlafke-Stelson
1992).
 Medical internal dosimetry 0 A. T. S.-STELSON
ET AL. 779

Table 3. MIRD dose estimate reports.

MIRD
report Journal of Nuclear
no. Authors Radiation absorbed dose from Medicine Reference
1 K. A. Lathrop, R. E. Johnston, M. Blau, E. 0. Se-75-L-selenomethionine. 14:49-50; 1973.
Rothschild, and E. M. Smith.
2 R. J. Cloutier, E. E. Watson, R. L. Hayes, B. Ga-66-, Ga-67, Ga-68, and 14:755-756; 1973.
Nelson, and E. M. Smith. Ga-72 citrate.
3 H. L. Atkins, R. .I.Cloutier, K. A. Lathrop, L. Tc-99m-sulfur colloid i n 16:108A-108B; 1975.
M. Freeman, J. G. McAfee, W. B. Nelp, D. various liver conditions.
D. Patton, and E. M. Smith.
4 R. J. Cloutier, L. M. Freeman, J. G. McAfee, Au-198-colloidal gold in 16:173-174; 1475.
K. R. McCormack, D. D. Patton, L. various liver conditions.
Rosenthal, and E. M. Smith.
5 M. Berman, L. E. Braverman, J. Burke, L. De 1-123, 1-124, 1-125, 1-130, and 16:857- 860; 1975.
Groot, K. R. McCormack, T. H. Oddie, R. 1-13] as sodium iodide.
H. Rohrer, H. N. Wellman, and E. M. Smith.
6 M. Blau, J. G. McAfee, R. H. Rohrer, W. S. Hg-197- and Hg-203-labeled 16.1095-1098; 1975.
Snyder, and E. M. Smith. chlormerodrin.
7 L. M. Freeman, D. D. Patton, L. Rosenthall, G. 1-123, 1-124, 1-126, 1-130, and 16.1214-1 217; 1975.
V. Taplin, and E. M. Smith. 1-131 as sodium rose
bengal.
8 K. A. Lathrop, H. L. Atkins, M. Berman, M. T. Tc-99m as sodium 17:74-77; 1976.
Hays, and E. M. Smith. pertechnetate.
9 H. L. Atkins, J. S. Robertson, B. Y. Croft, B. Radioxenons in lung imaging. 21:459-465; 1980.
Tsui, H. Susskind, J. Ellis, M. K. Loken, and
S. Treves.
10 M. Blau, R. Wicks, S. R. Thomas, and K. A. Albumin microspheres labeled 23:915-917; 1982.
Lathrop. with Tc-99m.
11 J. S. Robertson, R. R. Price, T. F. Budinger, V. Fe-52, Fe-55, and Fe-59 used 24:339-348; 1983.
F. Fairbanks, and M. Pollycove. to study ferrokinetics.
12 S. R. Thomas, H. L. Atkins, J . G. McAfee, M. Tc-99m diethylenetriamine- 25503-505; 1984.
D. Blaufox, M. Fernandez, P. T. Kirchner, pentaacetic acid.
and R. C. Reba.
13 David A. Weber, P. Todd Makler, Jr., Evelyn Technetium-99m-labeled bone 30:1117-1122; 1989.
E. Watson, Jack L. Coffey, Stephen R. imaging agents.
Thomas, and Jack London.
14 Harold L. Atkins, Stephen R. Thomas, Ulrich Technetium-99m-labeled red 31:378-380; 1990.
Buddemeyer, and L. Rao Chervu. blood cells.
15 J. S. Robertson, M. D. Ezekowitz, M. K. Radioindium-labeled 33:777-780; 1942.
Dewanjee, M. G. Lister, and E. E. Watson. autologous platelets.
16 Harold L. Atkins, David A. Weber, Herbert Technetium-99m- 33:1717-1719; 1002.
Susskind, and Stephen R. Thomas. diethylenetriamine-
pentaacetic acid as aerosol.
17 Harold L. Atkins, James S. Robertson, and Inhaled krypton-8lm gas in 34:1382-1384; 1993.
Gamal Mabani. lung imaging.

About the time the MIRD Committee was being
established but before its first publications became avail-
able, a group at ORINS (which later became known as
Oak Ridge Associated Universities) was involved in
training nuclear medicine physicians. They were often
asked to calculate absorbed dose estimates for new
radiopharmaceuticals. As the number of requests in-
creased, the ORINS staff saw a need for a center to
provide this information. Funding for the Radiopharma-
ceutical Internal Dose Information Center (later renamed
Radiation Internal Dose Information Center) was pro-
vided in 1971 by the Food and Drug Administration. The
center, supported by the FDA and the AEC (later ERDA
and DOE), has become a worldwide resource for internal
dose information.lllll’The Center’s staff responds to more
-
than 500 inquiries for internal dose information each
year. Among the Center’s many assets is a data base of
over 40,000 entries referencing articles related to internal
dose.
THERECENTPASTANDTHEFUTURE
This review of internal dosimetry is not intended
to be exhaustive, and ends in 1980 because the 1980’s
and the early 1990’s are too recent to be considered
“history.” However, this period has seen the develop-
ment of computerized tomography (CT), magnetic reso-
nance imaging (MRI), single-photon-computerized to-
mography (SPECT), and positron-emission tomography
(PET). Each of these tools, with its unique ability to

Z. Morgan and Walter S. Snyder established an internal

liliil Karl on radiation exposures to workers from radionuclides in the body. John
dose center at Oak Ridge National Laboratory to provide information Poston and Keith Eckerrnan have also directed this center.
780 Health Physics
provide details about the anatomy of a patient, physio-
logic function, and information about the retention and
distribution of radionuclides, promises to greatly advance
the accuracy of internal dosimetry. The potential now
exists to extend Monte Carlo techniques to patient-
specific dosimetry rather than dosimetry based on math-
ematical models.
Small-scale and microdosimetry may conquer the
problems of calculating the radiation dose from nonuni-
form distributions of activity. The term “small-scale’’ has
been applied to dose calculations for energy emitted by
particles in volumes where the particle ranges are greater
than the boundaries of the volume. Although the term
microdosimetry is not always clearly defined, it is usu-
ally reserved for calculating frequency distributions of
energy in volumes so small that the stochastic behavior
of the particles must be taken into account. These
techniques are being increasingly investigated as the
work of Marinelli, Quimby, Loevinger, and others is
extended and advanced.
Acknowledgments-This work was performed under Interagency Agree-
ment No. FDA 224-75-3016, DOE 0286-0286-A1. Oak Ridge Institute for
Science and Education performs work for the U.S. Department of Energy
under contract DE-AC05-760R00033.
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