Bureau ofMedicine and Surgery

Washington, D.C. 20372-5300 NAVMED P-5055(August 2001)

RadiationHealth

ProtectionManual

DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited.

i

RECORD OF PAGE CHANGESRADIATION HEALTH PROTECTION MANUAL

Page change Date of change Date entered Signature

ii

LIST OF EFFECTIVE PAGESChapter Pages

i through iv1 . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 through 1-72 . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1 through 2-63 . . . . . . . . . . . . . . . . . . . . . . . . . . 3-14 . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 through 4-35 . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 through 5-106 . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1 through 6-87 . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1 through 7-4Appendix A . . . . . . . . . . . . . . . . . . . . . . A-1 through A-13Appendix B . . . . . . . . . . . . . . . . . . . . . . B-1

iii

CONTENTSChapter 1. INTRODUCTION Page

Article1-1 Purpose..................................................... 1-11-2 Scope....................................................... 1-11-3 Policy...................................................... 1-11-4 Responsibilities............................................ 1-11-5 Definitions................................................. 1-31-6 Radiation Health Program Evaluation......................... 1-6

Chapter 2. MEDICAL EXAMINATIONS

Article2-1 Introduction................................................ 2-12-2 Types of Ionizing Radiation Medical Examinations............ 2-12-3 Scope of Examination........................................ 2-22-4 Standards................................................... 2-32-5 Special Documentation Requirements.......................... 2-42-6 Validity Periods and Correction of Deficient Examinations... 2-42-7 Reporting Requirements for the REAB......................... 2-52-8 Documentation Requirements for the REAB..................... 2-5

Chapter 3. SUPPORT FACILITIES

Article3-1 Introduction................................................ 3-13-2 Bioassay.................................................... 3-13-3 Radon Bioassay.............................................. 3-13-4 Internal Monitoring (External Counting)..................... 3-13-5 Assistance for Evaluation and Treatment of Irradiated or

Contaminated Personnel.................................... 3-1

Chapter 4. RADIATION PROTECTION STANDARDS

Article4-1 Introduction................................................ 4-14-2 Members of the Public....................................... 4-14-3 Occupational Exposures ..................................... 4-14-4 Embryo/Fetus................................................ 4-24-5 Minors...................................................... 4-24-6 Emergency Exposure.......................................... 4-24-7 Radiation Protection Guidance for Internal Emitters......... 4-24-8 Radiation Protection Guidance for External Exposure......... 4-3

Chapter 5. EXPOSURE RECORDS

Article5-1 Introduction................................................ 5-15-2 Computerized Exposure Record Systems........................ 5-15-3 Record of Occupational Exposure to Ionizing Radiation

(NAVMED Form 6470/10)..................................... 5-15-4 Record of Occupational Exposure to Ionizing Radiation from Internally Deposited Radionuclides (NAVMED Form 6470/11).. 5-25-5 Cross Checks and Verification............................... 5-35-6 Dose Investigations and Dose Estimates...................... 5-45-7 External Contamination...................................... 5-45-8 Extremity Exposure.......................................... 5-55-9 Eye Exposure............................................... 5-5

iv

Chapter 5. EXPOSURE RECORDS (continued) Page

Article5-10 Embryo/Fetus Exposure....................................... 5-55-11 Termination Letters......................................... 5-55-12 Required Reports............................................ 5-65-13 Retention, Disposition and Release of Information........... 5-95-14 Working copy of NAVMED Form 6470/1.......................... 5-105-15 Control of Radiation Exposure Information for Nuclear

Powered Warships and Operational Prototypes............... 5-10

Chapter 6. PERSONNEL DOSIMETRY

Article6-1 Introduction................................................ 6-16-2 Monitoring.................................................. 6-16-3 Dosimetric Devices.......................................... 6-16-4 Lithium Fluoride (LiF) Thermoluminescent Dosimetry.......... 6-26-5 DT-648/PD Lithium Fluoride (LiF) Thermoluminescent

Dosimetry Monitoring Program.............................. 6-36-6 Environmental and Area Monitoring........................... 6-66-7 Extremity Monitoring........................................ 6-76-8 Accident Dosimeter.......................................... 6-76-9 Battlefield Dosimeters...................................... 6-8

Chapter 7. STORAGE, HANDLING AND DISPOSAL

Article7-1 Introduction................................................ 7-17-2 Surveys..................................................... 7-17-3 Access Control of Areas..................................... 7-17-4 Area Posting Requirements................................... 7-27-5 Labeling of Containers...................................... 7-27-6 Storage and Control of Radioactive Material................. 7-37-7 Transportation, Receipt, and Reporting of Lost Radioactive

Material.................................................. 7-37-8 Waste Disposal.............................................. 7-4

Appendix A. SAMPLE FORMS

NAVMED 6470/10 Record of Occupational Exposure to IonizingRadiation........................................... A-3

NAVMED 6470/11 Record of Occupational Exposure to IonizingRadiation From Internally Deposited Radionuclides... A-5

NAVMED 6470/1 Annual/Situational Report of Exposureto Ionizing Radiation............................... A-7

Standard Form 88 Report of Medical Examination....................... A-9

Standard Form 93 Report of Medical History........................... A-11

NAVMED 6470/3 Radiation Exposure Report........................... A-13

Appendix B. ANNUAL LIMIT ON INTAKE

1-1

Chapter 1INTRODUCTION

ArticlePurpose..................................................... 1-1Scope....................................................... 1-2Policy...................................................... 1-3Responsibilities............................................ 1-4Definitions................................................. 1-5Radiation Health Program Evaluation......................... 1-6

1-1. Purpose

(1) This manual provides the radiationhealth requirements applicable to Navy andMarine Corps radiation protection programs.A radiation protection program may be definedas the sum of all methods, plans, andprocedures used to protect the health andenvironment of personnel from exposure tosources of ionizing radiation. It includesthe radiation health program and radiologicalcontrols program. A radiation healthprotection program is not an end in itself;its purpose is to provide the means topreserve and maintain the health of personnelwhile they accomplish necessary andpurposeful work in or around areascontaminated with radioactive material orareas where they are exposed to ionizingradiation.

1-2. Scope

(1) These regulations are intended forobservance during peacetime by all Navy andMarine Corps activities possessing or usingsources of ionizing radiation which mayaffect the health of personnel. Thesestandards do not apply to the exposure of anindividual to ionizing radiation when usedfor the diagnosis or treatment of medical ordental conditions of that individual.Personnel not employed by the Department ofthe Navy shall comply in all respects withthese regulations when engaged in a Navy-sponsored program or operation. It isrecognized that these regulations may not beapplicable to procedures initiated after anattack in which nuclear weapons are used;however, the provisions of these regulations,insofar as they are feasible, shall remain ineffect after such an attack.

1-3. Policy

(1) Exposure to personnel from ionizingradiation shall be reduced to levels as lowas reasonably achievable (ALARA). Positiveefforts shall be made to fulfill thisobjective without compromising operationaland training efforts.

(2) Personnel engaged in work in whichthey may be exposed to ionizing radiationshall be indoctrinated/trained inradiological controls/radiation safetypractices and protective measures.

(3) Supervisors of personnel working withradioactive materials or devices that produceionizing radiation shall be aware of theirresponsibilities with regard to the executionof safety and protective measures.

(4) Proper protective equipment, andtraining in its use, shall be available toand used by all occupationally exposedpersonnel.

1-4. Responsibilities

(1) General. Federal regulations forradiation protection are issued by theNuclear Regulatory Commission (NRC),Department of Health and Human Services,Department of Labor, Department ofTransportation, and the EnvironmentalProtection Agency. Instructions, manuals andwork procedures are issued by the Departmentof Defense, Chief of Naval Operations, fleetcommanders in chief, systems commanders, typecommanders, and commanding officers.

(2) Chief of Naval Operations (CNO) andthe Commandant of the Marine Corps (CMC).The CNO and CMC shall exercise overallcoordination and policy control of theradiation protection programs under theircognizance in the fields of organization,equipment, safety, personnel qualifications,assignments, and training. (3) Deputy Chief of Naval Operations,Fleet Readiness & Logistics (N4). The DeputyCNO (Fleet Readiness & Logistics) isresponsible for:

(a) Maintaining a NRC SpecificLicense of Broad Scope (License) forregulated sources used by the Navy and MarineCorps.

(b) Maintaining a Naval RadiationSafety Committee to issue RadioactiveMaterial Permits to individual commands andactivities for the use and possession of NRCregulated sources.

(c) Enforcing compliance with NuclearRegulatory Commission regulations relative tothe use of NRC sources and management of theLicense.

(4) Chief, Bureau of Medicine and Surgery(BUMED). BUMED is responsible for approvingand issuing requirements for the radiationhealth protection program applicable to allNavy and Marine Corps activities and formanagement of the Medical Department'sradiation protection program. BUMED isspecifically responsible for:

(a) Developing physical standards forpersonnel.

(b) Applying established radiationprotection standards and guidelines.

(c) Investigating physiologicaleffects of radiation.

(d) Conducting radiation medicalexaminations and providing treatment ofradiation casualties.

(e) Approving personnel dosimetryprograms.

(f) Establishing training programsand qualification standards for MedicalDepartment personnel involved in radiationhealth programs.

(g) Reviewing and approving radiationhealth programs.

1-2

(5) Commander, Naval Sea Systems Command(NAVSEASYSCOM). NAVSEASYSCOM is responsiblefor:

(a) Coordinating Systems Commandfunctions related to the radiologicalcontrols programs in the areas of industrial(Radiological Affairs Support Program) andweapons (Nuclear Weapons RadiologicalControls Program) applications.

(b) Developing procedures andproviding technical support and training inthe area of radiation safety as assigned inNAVSEAINST 5100.18 series.

(c) Developing and procuring RADIACinstruments and systems, i.e., any equipmentused to detect or measure ionizing radiationand specialized equipment used fortest/calibration of radiac equipment.Equipment for nuclear reactor control andinstrumentation is not included.

(d) Establishing procedures forpossession, use and disposal of radioactivematerial other than medical isotopes, weaponsand naval nuclear reactors and associatedequipment.

(e) Managing the Navy Low LevelRadioactive Waste Program. (See Chapter 7.)

(6) Director, Naval Nuclear PropulsionProgram. The Director, Naval NuclearPropulsion Program, per PresidentialExecutive Order 12344 of February 1, 1982, isresponsible for:

(a) Control of radiation andradioactivity associated with naval nuclearpropulsion activities.

(b) Prescribing and enforcingstandards and regulations for these areas asthey affect the environment and the safetyand health of workers, and the generalpublic.

(7) Commanders. Commanders havingcommand jurisdiction over installations andactivities using radiation sources shall:

(a) Take such action as deemednecessary to establish uniform practices andprocedures by subordinate commanders and toassure compliance with and implementation ofFederal Regulations, Department of Defensedirectives, and Department of the Navydirectives.

(b) Conduct periodic inspections toassure compliance with the applicabledirectives.

(c) For installations and activitiesusing sources licensed by the NuclearRegulatory Commission (NRC) and permitted bythe Chief of Naval Operations, ensurecompliance with provisions of the command'sRadioactive Material Permit and with Title10, Code of Federal Regulations in the use ofthese sources.

(8) Commanding Officers and Officers inCharge. Commanding officers and officers incharge of Navy or Marine Corps activitieswhere military and civilian personnel may beexposed to ionizing radiation shall:

(a) Maintain a Radiation HealthProtection Program. The Radiation HealthProtection Program will be administered bythe command's medical department and shall besupervised by the radiation health officer orhis assigned equivalent.

(b) Comply with Federal Regulationsand Department of the Navy directives toensure safety in the procurement, control,storage, handling, use, and disposal ofradiation sources and radioactive material inthe command's custody. Ensure coordination

between the radiation health and radiologicalcontrols aspects of the radiation protectionprogram.

(c) Ensure radiation workers have aradiation medical examination prior to beingoccupationally exposed to ionizing radiation.If it is known a visitor is to perform dutieswhich require a radiation medicalexamination, the individual's parentorganization shall determine the individual'smedical qualification for occupationalexposure to ionizing radiation and shallprovide the facility with the individual'scurrent radiation exposure information.

(d) Ensure that measures areestablished for controlling ionizingradiation sources so that the radiationexposure to individuals under his command orwithin his jurisdiction is as low asreasonably achievable and no greater than thelimits prescribed herein.

(1) Provide and maintain anappropriate radiation monitoring capabilityto verify personnel do not exceed theprescribed exposure limits. Chapter 4provides these limits. Chapter 6 detailsenvironmental, area, and personnel monitoringrequirements.

(2) Ensure appropriate protectiveclothing, respiratory protection, anddecontamination facilities, as necessary, areprovided for personnel handling unsealedradioactive material.

(3) Ensure areas where radioactivematerials are used or stored, radiationareas, high radiation areas, very highradiation areas, airborne radioactivityareas, and contaminated areas are posted perFederal regulations and/or Navy directives.

(e) Ensure that the dosimetry resultsfor radiation workers are provided to thecustodian of the individual's medical recordor to the individual's civilian employer,recorded and reported following therequirements in Chapter 5.

(f) Ensure the health recordcustodian documents all personnel monitoringresults for occupational exposures toionizing radiation in the health records andthat individual health record entries (DDForm 1141 or NAVMED Form 6470/10) and allsupporting records are correct, concise, andin agreement with instructions contained inChapter 5.

(g) Ensure accurate and timelysubmissions of situational and annual reportsto the Naval Dosimetry Center.

(h) At activities holding RadioactiveMaterial Permits under the Navy's NuclearRegulatory Commission (NRC) license, ensurethat a copy of the Radioactive MaterialPermit together with its amendments andrelated correspondence, and such otherrecords as necessary to meet the conditionsof the Permit are maintained.

(i) Ensure personnel receiveradiation protection training commensuratewith their duties and per Federalregulations, Department of the Navydirectives, program radiological controlsmanuals, and this manual.

(9) Naval Dosimetry Center. The Officerin Charge of the Naval Dosimetry Center isresponsible for:

(a) Providing centralized processingand consultation for thermoluminescentdosimeters (the DT-648 dosimeter, the DT-518

1-3

accident dosimeter, and LiF extremitydosimeters) and special purpose dosimeters.The Center shall ensure the above mentioneddosimetry systems meet the appropriatecalibration standards and shall maintainequipment, calibration sources, and a staffcapable of evaluating the various types ofdosimeters.

(b) Providing technical assistancewhen requested on matters regarding personneldosimetry.

(c) Maintaining a repository ofradiation exposure history information forNavy and Marine Corps personnel that allowsretention and retrieval of reported radiationexposure data.

(d) Notifying appropriate authoritiesof irregularities in the reports orindications of an exposure control problem atan activity.

(e) Preparing summary reports of theexposure of Navy and Marine Corps personnel.

(10) Individual. Individuals assignedto duties as radiation workers areresponsible for:

(a) Reporting the following to theirsupervisor or medical department personnel ina timely manner:

(1) Any physical condition whichthey feel affects their qualification toreceive occupational exposure.

(2) Any radiation therapytreatment received.

(3) Any radiopharmaceuticalreceived for diagnosis or treatment.

(4) Any occupational radiationexposure received from secondary or temporaryemployment.

(5) Any open wounds or lesions.(b) Wearing a personnel monitoring

device at all times in any area wheremonitoring is required. The individual isresponsible for loss of, or damage to such adevice while in his possession.

(c) Knowing their current quarter andannual Total Effective Dose Equivalent. Thisinformation may be obtained from the healthrecord custodian or radiation health/safetyofficer.

1-5. Definitions

(1) Absorbed Dose. The energy imparted byionizing radiation per unit mass ofirradiated material. The unit of absorbeddose is the rad.

(2) Activity. The rate of disintegration(transformation) or decay of radioactivematerial. The unit of activity is the curie.

(3) Adult. An adult is an individual 18years of age or older.

(4) Airborne Radioactivity Area. A room,enclosure or area in which airborneradioactive materials exist in concentrationsin excess of the derived air concentrations(DACs) specified in Table I, Column 3 ofAppendix B, Title 10 Part 20 of the Code ofFederal Regulations, or concentrations so anindividual present in the area withoutrespiratory protective equipment couldexceed, during the hours the individual ispresent in a week, an intake of 0.6 percentof the annual limit on intake (ALI).

(5) Annual Limit on Intake (ALI). TheAnnual Limit on Intake (ALI) of radioactivematerials is the smaller amount ofradioactive material taken into the body ofan adult worker by inhalation or ingestion in

a year (40 hours per week for 50 weeks) thatwould result in: a committed effective doseequivalent of 5 rem (0.05 Sv) or a committeddose equivalent of 50 rem (0.5 Sv) to anyindividual organ or tissue. The ALI valuesare based on the intake rate and standardsfor "reference man" as defined inInternational Commission on RadiologicalProtection Report No. 23, 1975.

(6) Background Radiation. Backgroundradiation is radiation from cosmic sources;naturally occurring radioactive materials,including radon in concentrations or levelscommonly found in structures or theenvironment; and global fallout as itcommonly exists in the environment from thetesting of nuclear explosive devices.Background radiation does not includeradiation from source, byproduct, or specialnuclear materials regulated by the NuclearRegulatory Commission.

(7) Calendar Quarter. A calendar quarteris a period of time not less than 12consecutive weeks nor more than 14consecutive weeks. The first calendarquarter shall begin in January or begin withthe dosimetry issue cycle closest to January.Subsequent calendar quarters shall beginwithin 12 to 14 weeks of that date so no dayis included in both quarters or omitted fromeither quarter.

(8) Committed Dose Equivalent (HT,50).Committed Dose Equivalent is the doseequivalent to an organ or tissue that will bereceived from an intake of radioactivematerial by an individual during the 50 yearperiod following the intake, i.e., 50 yearorgan dose (total dose for 50 years frominternal contamination).

(9) Committed Effective Dose Equivalent(HE,50). Committed Effective Dose Equivalentis the sum of the products of the weightingfactors applicable to each of the body organsor tissues that are irradiated and thecommitted dose equivalent to these organs ortissues. (HE,50 = � wTHT,50; see weightingfactor table for wT values).

(10) Controlled Area. Controlled areais an area outside a restricted area butinside the site boundary, access to which canbe limited by the activity for any reason.

(11) Curie (Ci). The unit ofradioactivity. One curie equals 3.7 x 1010nuclear disintegrations per second. (1 Ci =3.7 x 1010 Becquerel)

(12) Declared Pregnant Woman. A womanwho has voluntarily informed her employer, inwriting, of her pregnancy and the estimateddate of conception.

(13) Deep Dose Equivalent (Hd). Deepdose equivalent, which applies to externalwhole-body exposure, is the dose equivalentat a tissue depth of 1 cm (1000 mg/cm2). Deepdose equivalent establishes a standard depthfor specifying the dose from whole bodyexternal exposure.

(14) Derived Air Concentration (DAC).Derived air concentration is theconcentration of a given radionuclide in airwhich, if breathed by the "reference man" fora working year (40 hours per week for 50weeks) under conditions of light work(inhalation rate 1.2 cubic meters of air perhour), results in an intake of one ALI.

(15) Dose. A generic term that meansabsorbed dose, dose equivalent, effectivedose equivalent, committed dose equivalent,

1-4

committed effective dose equivalent or totaleffective dose equivalent.

(16) Dose Equivalent (HT). The productof the absorbed dose (D) and the qualityfactor (Q), where HT=DQ. Its purpose is tohave a single unit, regardless of the type ofradiation, describing the radiation effect onman. The dose equivalent has the unit "rem."The dose equivalent for each type and energyof ionizing radiation shall be determined byusing the following quality factors orneutron fluences unless otherwise approved byBUMED.

(a) For x-ray, gamma or betaradiation, the quality factor will be equalto one.

(b) For neutrons of unknown energyand for protons, the quality factor will beequal to 10.

(c) For neutron fluences with knownenergy distributions, the dose equivalentwill be determined using the table of NeutronFluence per Unit Dose Equivalents in Title10, Part 20 of the Code of FederalRegulations.

(d) For ionizing particles heavierthan protons and with sufficient energy toreach the lens of the eye, the quality factorwill be equal to 20.

(17) Effective Dose Equivalent (HE). Theprobability of a stochastic effect, e.g.,cancer induction or heredity effect, in anytissue is proportional to the dose equivalentto that tissue. The value for theproportionality factors differs among thevarious tissues because of the differences intissue sensitivity. If radiation dose isuniform throughout the body then the totalrisk factor is one. For non-uniformradiation, such as partial body exposure toan external radiation field, or from internalexposure where the isotope concentrates todifferent degrees in the various tissues,weighting factors which are based on therelative susceptibility of the tissues tostochastic effects may be used to calculatean effective dose equivalent. The effectivedose equivalent is the sum of the products ofthe weighting factors applicable to each ofthe body organs or tissues that areirradiated and the dose equivalent to theseorgans or tissues. (HE = � wTHT, seeweighting factor table under the definitionof weighting factor for wT values).

(18) Exposure. Being exposed to ionizingradiation or to radioactive material.

(19) External Personnel Contamination.An area of the body is considered to beexternally contaminated if it contains inexcess of 450 picocuries of beta-gammaemitters by direct frisk or 50 picocuries ofalpha emitting contamination by direct frisk,i.e., 100 counts/minute above background ofbeta-gamma emitting contamination (Cobalt-60equivalent) as measured under the area of aDT-304 probe or 50 counts/minute abovebackground of alpha emitting contamination asmeasured on an AN/PDR-56 with small probe.Different limits may be approved by the NavalRadiation Safety Committee for radioactivematerial used under a Naval RadioactiveMaterial Permit or by Chief, BUMED forradioactive material not under a NavalRadioactive Material Permit.

(20) Extremities. Extremities meanshand, elbow, arm below the elbow, foot, knee,or leg below the knee.

(21) Eye Dose Equivalent. Eye DoseEquivalent applies to the external exposureof the lens of the eye and is taken as thedose equivalent at a tissue depth of 0.3centimeter.

(22) High Radiation Area. Any radiationarea accessible to personnel in which thereexists ionizing radiation at such levels anindividual could receive in excess of 100mrem (1 mSv) in 1 hour at 30 centimeters(approximately 1 foot) from the radiationsource or from any surface the radiationpenetrates.

(23) Ionizing Radiation. Anyelectromagnetic or particulate radiationcapable of producing ions, directly orindirectly, in its passage through matter.Ionizing radiation includes the following:gamma rays, x-rays, alpha particles, betaparticles, neutrons, protons, and otherparticles and electromagnetic waves capableof producing ions.

(24) Ionizing Radiation Sources. Anymaterial, equipment or device which emits oris capable of generating ionizing radiation.This includes naturally occurring andartificially induced radioactive material;special nuclear material; nuclear reactors,particle generators and accelerators; medicalor dental x-ray or fluoroscopic equipment;industrial radiographic equipment; certainelectromagnetic wave generators; and certainanalytical instruments such as x-raydiffraction spectrometers, electronmicroscopes, nuclear moisture density meters,etc.

(25) Members of the Public. Individualswho are not occupationally exposed toionizing radiation shall be consideredmembers of the public. Examples wouldinclude individuals that live and workoutside the perimeter of a base or activity,family members of an employee or crew memberthat live on a base but are outside acontrolled industrial area, and visitors thatdo not normally receive occupationalexposure.

(26) Minimum Detectable Activity (MDA).The minimum detectable activity is the amountof a radionuclide, if present in a sample,that would be detected with a 5 percentprobability of non-detection, while acceptinga probability of 5 percent of erroneouslydetecting that radionuclide in an appropriateblank sample. Minimum detectable activity isthe minimum amount of radioactivity that canbe detected at the 95 percent confidencelevel.

(27) Non-ionizing Radiation. Anyelectromagnetic radiation, includingultraviolet, visible, or infrared light,radio or microwaves, or laser radiation,which generally does not produce ionizationsin its interaction with matter.

(28) Non-stochastic Effect. Non-stochastic effect means health effects, theseverity of which varies with the dose andfor which a threshold is believed to exist.Radiation induced cataract formation is anexample of a non-stochastic effect.

(29) Non-radiation Workers. Non-radiation workers are employees or crewmembers who may receive very low levelradiation exposure incidental to theiremployment at a command or activity but notas an integral part of their skill, trade orwork assignment.

1-5

(30) Occupationally Exposed Personnel.Occupationally exposed personnel areindividuals that receive exposure to ionizingradiation in the course of their employmentor duties. Occupationally exposed personnelinclude both radiation workers and non-radiation workers.

(31) Quality Factor (Q). That factorwhich is multiplied by the absorbed dose (D)to obtain a quantity which equates to acommon scale, the dose equivalent (HT), ofany type of ionizing radiation to which anindividual is exposed (HT = DQ).

(32) Rad (rad). The unit of absorbeddose (D) which is equal to the absorption of100 ergs per gram.

(33) Radiation Area. Any area to whichaccess shall be limited as deemed necessaryby the cognizant authority and in whichappropriate precautionary measures are takento protect personnel from exposure toradiation or radioactive material. A"radiation area" includes any area accessibleto personnel in which there exists ionizingradiation at dose-rate levels so that anindividual could receive a deep doseequivalent in excess of 5 mrem (0.05 mSv) in1 hour at 30 centimeters from the radiationsource or from any surface that the radiationpenetrates.

(34) Radiation Health Officer. A MedicalDepartment Officer or civilian who isqualified by virtue of education, trainingand/or professional experience, to supervisea radiation health program. The officer willnormally function within the medicaldepartment of a ship or station and willnormally not be assigned responsibilities inradiological controls/radiation safety exceptwithin BUMED activities. On ships withoutMedical Service Corps or Medical Corpsofficers attached, the senior enlistedmedical department representative assignedradiation health duties shall be designatedthe radiation health officer. The radiationhealth officer shall plan, supervise, andadminister the radiation health program.

(35) Radiation Health Program. Amedical department responsibility comprisingall methods and procedures designed tomaintain and protect the health of personnelexposed to ionizing radiation or radioactivecontamination. It includes, but is notnecessarily limited to the following:

(a) Detecting and identifyingradiation and contamination hazards.

(b) Determining, evaluating anddocumenting personnel exposures (bothinternal and external).

(c) Performing medical qualificationand surveillance examinations of radiationworkers before, after and during periods ofemployment involving occupational radiationexposure.

(d) Evaluating environmentalmonitoring and radiation control proceduresrelated to radiation health.

(e) Reviewing training andqualification requirements of personnelhandling radioactive material, or working inradiation areas, as applicable to radiationhealth.

(f) Conducting radiation healthtraining for involved personnel as necessary.

(g) Ensuring compliance with BUMEDand other relevant instructions in the areaof radiation health.

(h) Submitting required reports andmaintaining applicable records.

(i) Assisting, as required, in theradiation health aspects of nuclear accidentpreparedness, CBR warfare defense, anddisaster control planning.

(j) Promoting a high state ofawareness and compliance with radiationhealth precepts.

(36) Radiation Workers. Radiationworkers are individuals who receive exposureto ionizing radiation in the course of theiremployment or duties and are identified bytheir command as being occupationallyexposed. Normally, these individuals'routine duties require working directly withsources of ionizing radiation and have asignificant potential for exposure. Theseindividuals receive radiation medicalexaminations. These individuals normallyreceive specialized training as part of aspecific radiological controls program.

(37) Radioactive Contamination. Aradioactive substance dispersed in or onmaterials or places where it is undesirable.Unless a different limit is approved by theNaval Radiation Safety Committee forradioactive material used under a NavalRadioactive Material Permit, or by the Chief,Bureau of Medicine and Surgery forradioactive material not under a NavalRadioactive Material Permit, an object orarea is considered to be contaminated when:

(a) The loose surface radioactivityexceeds 450 picocuries (450 micromicrocuriesor 16.6 becquerel) of beta-gamma activity asmeasured on a dry filter paper wiped over anarea of approximately 100 square centimeters.

(b) The loose surface radioactivityexceeds 50 picocuries (50 micromicrocuries or1.85 becquerel) of alpha activity as measuredon a dry filter paper wiped over an area ofapproximately 100 square centimeters.

(38) Radiological Controls Program. Acommand responsibility comprising allprocedures and techniques which are used tocontrol radiation sources and radioactivematerial to minimize exposure to personneland the environment. It includes control ofall ionizing radiation sources duringstorage, handling, use, shipping anddisposal.

(39) Radiological Controls/RadiationSafety Officer. An individual who shall beappointed by the unit commander to provideconsultation and advice regarding theimplementation of controls for the hazardsassociated with radiation sources and theeffectiveness of these measures. Theindividual shall be responsible to the unitcommander for promulgating and supervisingthe radiological controls/radiation safetyprogram. The individual is directlyresponsible for adequate and effectivecontrols which prevent spread ofcontamination and exposure of personnel.This individual shall be technicallyqualified by virtue of education, trainingand/or professional experience to supervisethe storage, issue, use and disposition ofradioactive sources and shall have a thoroughknowledge of applicable regulationspertaining to the control of radiationsources and radioactive material prior toappointment.

(40) REAB. The Radiation Effects AdvisoryBoard reviews and determines an individual’s

1-6

fitness for radiation work as described inBUMEDINST 6470.21 series.

(41) Rem (rem). The unit of doseequivalent(HT) which is equal to the absorbeddose in rad multiplied by the quality factor.The rem shall be the unit of dose equivalentfor record purposes unless otherwisespecified by BUMED.

(42) Restricted Area. Restricted areameans an area, access to which is limited bythe Command for the purpose of protectingindividuals against undue risks from exposureto radiation and radioactive materials.Restricted Areas may not include areas usedas residential quarters, but separate roomsin a residential building may be set apart asa restricted area.

(43) Roentgen (R). A unit of exposure toionizing radiation. It is that amount of x-ray or gamma radiation which will produce inair 2.58 x 10-4 coulombs of charge perkilogram of air.

(44) Shallow Dose Equivalent (HS).Shallow Dose Equivalent, which applies to theexternal exposure of the skin or anextremity, is taken as the dose equivalent ata tissue depth of 0.007 centimeter (7 mg/cm2)(average depth of the germinal cell layer ofthe skin) averaged over an area of 1 squarecentimeter.

(45) Stochastic Effects. Stochasticeffects means health effects that occurrandomly and for which the probability of theeffect occurring, rather than its severity,is assumed to be a linear function of dosewithout threshold. Hereditary effects andcancer incidence are examples of stochasticeffects.

(46) System International (SI) Units.These units have been established by theInternational Commission on Radiation Unitsand Measurements (ICRU) and are used by manycountries. As such, they may be encounteredin the scientific literature. These unitscompare to the rem, rad and curie, referredto as "traditional units" in the followingmanner:

One gray (Gy) = 100 rad One sievert (Sv) = 100 remOne becquerel (Bq) = 2.7 x 10-11 curie (Ci)

= One disintegration/sec. One rad = One centigray (cGy) = 1 x 10-2 gray (Gy) One rem = One centisievert (cSv) = 1 x 10-2 sievert (Sv) One curie = 3.7 x 1010 becquerel (Bq)

(47) Total Effective Dose Equivalent.Total Effective Dose Equivalent is the sum ofthe deep dose equivalent (external dose) andthe committed effective dose equivalent(internal dose).

(48) Unrestricted Areas. Any area towhich access is neither limited or controlledby the activity and any area used forresidential quarters.

(49) Very High Radiation Area. Any areaaccessible to personnel in which there existsionizing radiation at such levels that anindividual could receive in excess of 500rads (5 grays) in 1 hour at 1 meter from theradiation source or from any surface that theradiation penetrates. Note: At very highdoses received at high dose rates, units ofabsorbed dose (e.g., rad and gray) are

appropriate, rather than units of doseequivalent (e.g., rem and sievert).

(50) Weighting Factors (WT). Theweighting factor for an organ or tissue isthe proportion of the risk of stochasticeffects (random probability effects, e.g.,cancer) resulting from irradiation of thatorgan or tissue to the total risk ofstochastic effects when the whole body isirradiated uniformly. For calculating theeffective dose equivalent, the values are:

ORGAN DOSE WEIGHTING FACTORS

Organ or Tissue FactorGonads 0.25Breast 0.15Red bone marrow 0.12Lung 0.12Thyroid 0.03Bone surfaces 0.03Remainder* 0.30

Whole Body 1.00

* 0.30 results from 0.06 for each of 5"remainder" organs (excluding theskin and lens of the eye) thatreceive the highest doses. Theindividual sections of the GI tract,i.e., stomach, small intestine, upperlarge intestine, and lower largeintestine, are treated as individualorgans.

(51) Whole Body. Whole body means, forpurposes of external exposure, head, trunk(including male gonads), arms above theelbow, and legs above the knee.

1-6. Radiation Health Program Evaluation

(1) To ensure compliance with regulationsand procedures specified in this manual,evaluations of the Radiation Health Programshall be conducted as follows:

(a) For forces afloat andintermediate maintenance activities auditedunder type commander (TYCOM) directives, anaudit shall be conducted at least annually bymedical department personnel from group,squadron, or type commanders, e.g., squadronmedical officers, squadron hospital corpsmen,radiation health officers, etc. For nuclear-powered ships, the ship's executive officershall also be a member of the audit team.The executive officer's participationqualifies this audit as one of the semiannualradiation health audits required by OPNAVINSTC9210-2 series (Engineering Department Manualfor Naval Nuclear Propulsion Plants).

(b) For shore stations, two auditsper year (conducted approximately 6 monthsapart) shall be conducted by personnelknowledgeable in radiation health, but whoare as independent as possible of the localradiation health program.

(c) For naval shipyards with largeradiation health programs, BUMED performsperiodic audits. The BUMED audits are inaddition to the audits required by paragraph1-6(1)(b), and shall not be used to replacethem.

(2) When performing medical recordreviews in conjunction with evaluations ofradiation health programs, auditors shouldfocus only on findings that affect thephysical qualification of the individual to

1-7

receive occupational radiation exposure(i.e., the technical aspects of the physicalexamination). Other findings that are onlyadministrative in nature, such as date andname formatting errors and eyesight anddental data transcription errors, should be

identified to the command, but shall not becited as radiation health recorddeficiencies.

(3) A copy of the audit report shall beretained and be available for review for aperiod of 3 years.

2-1

Chapter 2MEDICAL EXAMINATIONS

ArticleIntroduction ............................................... 2-1Types of Ionizing Radiation Medical Examinations............ 2-2Scope of Examination ....................................... 2-3Standards .................................................. 2-4Special Documentation Requirements ......................... 2-5Validity Periods and Correction of Deficient Examinations .. 2-6Reporting Requirements for the REAB ........................ 2-7Documentation Requirements for the REAB .................... 2-8

2-1. Introduction

(1) Personnel occupational radiationexposure criteria are based upon the conceptthere may be some degree of risk from anylevel of radiation exposure, although medicalknowledge shows the risk from radiationexposure within limits to be small. Noradiation injuries have been documented inman for exposures which were compliant withexisting radiation protection guides.

(2) Radiation workers receive medicalexaminations to establish baseline resultsand evaluate disease states which maymedically disqualify a person from receivingoccupational radiation exposure.

(3) The medical standards are based on:(a) The radiation worker accepting

some small degree of risk which is balancedagainst benefits, based upon competenttechnical appraisal.

(b) A deliberate selection ofradiation worker candidates.

(4) Ionizing radiation medicalexaminations are documented on two forms: (1)Report of Medical Examination (SF-88) and (2)Report of Medical History (SF-93). TheDepartment of Defense is in the process ofreplacing these forms with analogous forms;DD Form 2808 and DD Form 2807.1,respectively. Until BUMED authorizes the DDforms for this specific usage, the SF-88 andSF-93 shall continue to be used to documentionizing radiation medical examinations.

2-2. Types of Ionizing Radiation MedicalExaminations

(1) Preplacement Examination (PE).(a) All personnel who are being

considered for assignment as radiationworkers will be given an ionizing radiationmedical examination, defined as apreplacement examination (PE), prior toassignment or transfer to those duties. Thisincludes individuals who have been radiationworkers at one time or another, received atermination examination and are now beingconsidered for reentry into the program.

(b) Non-radiation workers and membersof the general public, are not required tohave a PE.

(c) Visitors including messengers,servicemen, and delivery men, are notrequired to have a PE.

(d) Emergency response personnel;dentists, dental technicians and other dentalparaprofessionals; nurses and wardpersonnel; explosive ordinance disposal teammembers; and certain crew members oremployees whose exposure is truly sporadic,are not required to have a PE. (See

appropriate radiological controls manuals forspecific program requirements.)

(e) Individuals who are not requiredto have a PE but who exceed 500 mrem (5 mSv)exposure in a calendar year, must have a PEwithin 1 month of the time they exceed 500mrem (5 mSv) or as soon thereafter asoperational requirements permit.

(2) Reexamination (RE). Personnel whoare to be continued in routine duties asradiation workers must have an ionizingradiation medical examination, defined as areexamination (RE), as follows: Periodicitybetween examinations will not exceed 5 yearsup to age 50. After age 50 examinations arerequired every 2 years, e.g., an individualexamined at age 46 would be re-examined at51, an individual examined at age 47, 48, 49or 50 would be reexamined at age 52.Beginning at age 60 the examination isrequired annually. (See Manual of theMedical Department (MANMED) Chapter 15.) Theexamination may be performed earlier than therequired frequency for the purpose of evendistribution of medical examination workload,or to combine the reexamination with amedical examination required for anotherpurpose, or for any other reason. The RE isrequired to be performed no later than onemonth following the anniversary date (monthand year) of the previous radiation medicalexamination or other medical examinationaccepted and documented as a radiationmedical examination, e.g., for an examinationperformed on the 15th of February 1985, thereexamination must be completed by 31 March1990. When constrained by ship operatingschedules, the examination is to be performedat the earliest opportunity.

(3) Situational Examination (SE). Anyindividual who has exceeded the radiationprotection standards for radiation workers asstated in Chapter 4, or has ingested orinhaled a quantity of radioactive materialexceeding 50 percent of an annual limit ofintake (ALI), or as deemed necessary by theresponsible medical officer must be given anionizing radiation medical examination,defined as a situational examination (SE).ALIs are listed in International Commissionon Radiological Protection, PublicationNumber 30 or in Appendix B of Title 10, Part20. ALIs for commonly used isotopes arereprinted for convenience in Appendix B ofthis manual. The medical history must containsummary statements which provide the basisfor performing the examination.

(4) Termination Examination (TE).Reasonable efforts will be made to ensure aradiation worker receives a

2-2

termination examination (TE). If a TE is notcompleted or not performed, e.g., due to lackof employee cooperation, etc., a Form SF-88will be prepared and completed to the maximumextent practicable. The reasons why the formis incomplete will be recorded in thedisqualifying defects block of the SF-88.Radiation workers will be given a TE as nearas practical to but no earlier than 6 monthsprior to satisfying one of the followingconditions:

(a) Upon separation or termination oftheir active duty or employment if theyreceived a PE and have documentedoccupational radiation exposure (includingpersonnel monitored for exposure but whoreceived 00.000 rem).

(b) When permanently removed from theradiation health program.

(c) When permanently removed fromduties as a radiation worker.

(5) Other Examinations. Medicalexaminations other than radiation medicalexaminations and results of consultations forindividuals physically qualified as radiationworkers will be reviewed by a medical officeror medical department representative forfindings or evaluations affecting continuedqualifications as a radiation worker. Thescope of other medical examinations need notbe expanded to cover the requirements of thisarticle unless the examination is to be usedas a radiation medical examination. Medicalexaminations performed outside the Departmentof Defense are not to be requested forroutine review. Individuals may submitmedical information from their privatephysicians for consideration by theresponsible medical officer. In these cases,the Navy remains solely responsible fordetermining whether the medical informationfrom the private physician will be acceptedor rejected.

2-3. Scope of Examination

(1) The examination for active dutymembers shall include the additionalrequirements of the routine active dutyexamination. Examinations for civilianpersonnel are only required to include theitems specific to employment under Office ofPersonnel Management regulations and thoselisted here. (2) The medical examination will placeparticular emphasis on determining theexistence of malignant and premalignantlesions and other conditions which could berelated to radiation exposure. A medicalofficer with knowledge of the potentialbiological effects of ionizing radiation willreview any medical history or presence ofdisease states or abnormalities related tothe following: history of occupationalexposure to ionizing radiation in excess ofthat allowed by current directives; historyof radiation therapy; and, medical conditionswhich may be associated with exposure toionizing radiation. The radiation medicalexamination will include, but not be limitedto, a careful medical history, physicalexamination, complete blood count, urinalysis

and other clinical laboratory studies orprocedures, and bioassays, as indicated.

(a) Medical History. A completemedical history on the SF-93 will beobtained, including all changes in medicalhistory since the last radiation healthexamination. Medical histories will include:

(1) History of accidental oroccupational exposure to ionizing radiationabove Table III limits;

(2) History of cancer orprecancerous lesions;

(3) History of anemia;(4) History of radiation therapy;(5) History of radiopharmaceutical

received for therapeutic or experimentalpurposes;

(6) History of work involving thehandling of unsealed radium sources or otherunsealed sources.

(b) Medical Examination. Theexamination will consist of the itemsdescribed in the clinical evaluation blocksof the SF-88 with the following modificationsfor civilian personnel:

(1) Female pelvic examination isnot required. Breast examinations arerequired for females age 36 or older. Thedigital rectal examination is only requiredfor male examinees age 36 or older. Forpersonnel who are less than 36 the aboveexaminations may be offered but are notrequired. (c) Special Studies. The requiredspecial studies are a CBC and a urinalysis.In addition, the following special studiesmay apply:

(1) Internal Monitoring. Allpersonnel assigned to duties involving thehandling of radioactive material in a form sothat they could reasonably be expected toexceed 10 percent of an annual limit onintake (ALI) in 1 year through inhalation,ingestion or absorption will be evaluated forevidence of a partial body burden before andafter assignment to such duties, e.g., at thestart and completion of a tour involvingthese duties. Periodic monitoring will beconducted as deemed necessary by theresponsible medical officer or radiationhealth officer. Additional requirements toperform internal monitoring due to specificwork environments will be issued inapplicable program radiological controlsmanuals with Chief, BUMED concurrence or asconditions of radioactive material permits.

(2) Radon Breath Analysis orRadium Urine Bioassay. All personnelassigned to duties involving the handling ofradium, or its compounds, not hermeticallysealed so that they could reasonably beexpected to receive 10 percent of an annuallimit on intake (ALI) in 1 year will haveradon breath analysis or radium urinebioassay at the beginning and end of suchassignment or following personnelcontamination incidents involving loosesurface contamination of radium compoundssuch that the individual could have received10 percent of an ALI. Chapter 3 providesguidance for obtaining a radon breath

2-3

analysis or radium urine bioassay. Othermethods of determining internal radiumdeposition may be used if approved by Chief,BUMED.

(3) Bioassay. When deemednecessary by the responsible medical officeror radiation health officer bioassay may beperformed on body tissues, secretions, andexcretions to estimate an exposure frominternal contaminates. If a command lacksthe capability to perform appropriatebioassay, a request will be submitted to oneof the support facilities designated inChapter 3.

(4) Additional requirements toperform special examinations due to specificwork environments can be provided in theapplicable program radiological controlsmanual with Chief, BUMED approval.

2-4. Standards

(1) The general requirements are thosefor active duty in the military service or incivil service employment, as amended by thisarticle. Individuals found not physicallyqualified based upon these requirements maybe reevaluated at a later date. Thefollowing will be cause for rejection ordisqualification unless the condition isreviewed and the individual found qualifiedfor radiation work by the BUMED RadiationEffects Advisory Board (REAB) (refer toArticle 2-7):

(a) History of cancer.(b) History of radiation therapy

which may have compromised bone marrowreserves.

(c) History of polycythemia vera.(d) Cancerous or precancerous

lesions. Exceptions: Adequately treatedactinic keratosis, basal cell carcinoma, andabnormal PAP smear are not disqualifying.

(e) Open lesions or wounds (includinglacerations, abrasions, and ulcerative,eruptive, or exfoliative lesions). These aredisqualifying either on a temporary orpermanent basis, depending on the condition,for individuals who handle radioactivematerial which is not hermetically sealed,until such time as the medical departmentrepresentative or medical officer considersthe wound to be adequately protected fromradioactive contamination.

(f) Abnormal Blood count:(1) Any deviation of the complete

blood count (CBC) outside laboratory normalvalues or the values in Table I if manuallyperformed must be evaluated by a medicalofficer and a determination made whether theindividual is considered disqualified (CD) ornot considered disqualified (NCD). The basisfor a determination of CD/NCD must be givenby the responsible medical officer as acomment in the summary of defects anddiagnosis block.

(2) CBC values, manual orautomated, which persist outside the rangesin Table II will be considered disqualifyinguntil review by the BUMED REAB. The medicalofficer's evaluation of the CBC and his/herrequests for other studies or consultations

must be directed toward the determination ofmalignant or premalignant conditions andhematopoietic system reserve.

(3) Differential white blood cellcount is required when the WBC is outsidelaboratory normal or Table I values asapplicable. The differential shall beevaluated for any gross cell count anomalies.Minor deviations from the normal range whichare not indicative of a cancerous or pre-cancerous condition are not considereddisqualifying; however, all differential WBCcounts outside the normal range requirecomment in the summary of defects anddiagnosis block of the SF-88 with adetermination of CD or NCD.

TABLE IComplete Blood Count Parameters

There are two acceptable laboratorymethods for determining blood countparameters, manual and automated machine.

Blood Parameter Male FemaleHematocrit (Hct) 40-52% 37-47%Hemoglobin (Hgb) 14-18g/dl 12-16g/dl(optional)White Blood Count (WBC) 4,000-12,000/cubic mm

Differential Count

Manual Male & FemaleNeutrophils (N) 40-80%Lymphocytes (L) 20-50%Bands (BF) 0-10%Eosinophils (E) 0-10%Basophils (B) 0-3%Monocytes (M) 0-10%Atypical Lymphocytes (ATL) 0-10%

Some automated machines will providedifferential counts that categorize the whiteblood cells (leukocytes) by the traditionalmanual leukocyte classification, as above.Other machines may use other classifications,which are as acceptable for diagnosis andprognosis, for example:

AutomatedLymphocytes 20.5-51.1%Monocytes 0.0-9.3%Granulocytes (Neutrophils) 42.2-75.1%Large unstained cells less than 4%

Any clinically acceptable automateddifferential white blood count methodsuffices for the needs of the radiationhealth program. However, if the automatedmachine categorization differs from thoseprovided above, the laboratory data sheetmust be filed in the health record or thenormal ranges for the machine must berecorded along with the results of the studyon the SF-88.

2-4

TABLE II

Male & FemaleHematocrit 35-56%Hemoglobin (optional) 11g/dl-19g/dlWhite Blood Count 3,500-14,000/cubic mm

(g) Urinalysis. Urine will be testedfor red blood cells using either a standardclinical dipstick method or microscopic highpower field. Document the results of redblood cell testing in the "microscopic" blockof the physical examination form. Repeattesting for positive results must beperformed by high power field. Red bloodcells in the urine (greater than 5 RBCs perhigh power field) persisting on repeaturinalysis will be considered disqualifying,pending definitive determination of otherthan a malignant condition. Other abnormalurinalysis results may be of clinicalsignificance (e.g., low specific gravity,positive sugar or albumin, WBCs or casts)dictating follow-up evaluation at thediscretion of the examiner; however, they arenot in themselves disqualifying foroccupational exposure to ionizing radiation.Nonetheless, all abnormal urinalysis findingsrequire comment in the SF-88 Summary ofDefects and Diagnosis block and adetermination of CD or NCD.

(h) If an individual has internallydeposited radionuclides associated with anintake of 50 percent of an ALI or more in 1year the individual shall be disqualifiedfrom duties involving occupational radiationexposure pending BUMED review. ALI valuesfor some common isotopes are provided inAppendix B.

(i) Other defects which pose a healthor safety hazard to the individual, co-workers, or degrade the safety of the work-place.

2-5. Special Documentation Requirements

(1) The following specific requirementswill be adhered to in addition to therequirements for completing the Standard Form88 and 93 as listed in Chapters 15 and 16 ofthe Manual of the Medical Department. Localreproduction of these forms and computer-generated SF-88 and SF-93 forms areauthorized; however, these forms must haveall the required technical information.Example forms are provided in Appendix A.

(a) Use of an overprint or rubberstamp on the SF-93 for the requiredsupplemental history questions is acceptable.Instructions in the hospitalization blocks ofthe SF-93 require certain additionalinformation be provided for a "positiveanswer," for the purpose of radiationmedical examinations, the name of the doctor,clinic or hospital is not needed.

(b) All radiation medicalexaminations require a medical officer'ssignature in the reviewing officer block ofthe SF-88. This medical officer isresponsible for reviewing the completemedical examination including laboratory andother information to determine qualification.The reviewing medical officer may be the same

as the examining medical officer. The SF-88reviewing officer block entry will includethe date of final review in the marginimmediately below the signature of thereviewing official.

(c) The medical history will besigned by the examining medical officer.

(d) Records of medical examination(SF-88 and SF-93) performed by a physicianassistant or nurse practitioner must becountersigned by a physician. (e) For the summary of defects anddiagnosis block of the SF-88 and thephysician’s summary block of the SF-93 anyentry concerning an abnormal finding willhave an indication of "NCD" or "CD" perMANMED Chapter 15.

(f) For the purpose of a radiationmedical examination, the term "EssentiallyNegative" or "ESS. NEG." has the same meaningas "Negative."

(g) Non-completion of a radiationmedical examination must be documented in thenotes block of the SF-88 with specificreasons for non-completion.

(h) Radiation medical examinationswill clearly state whether the individual isphysically qualified (PQ) or not physicallyqualified (NPQ) for ionizing radiation work.

(i) The fact that a terminationmedical examination is required will beentered on the front of the individual'shealth record jacket or employee medical fileas "Termination Radiation Medical ExaminationRequired."

(j) Medical examinations conductedfor a purpose other than ionizing radiationwork may be amended per MANMED Chapter 15 andArticle 2-6 at the discretion of theresponsible medical officer. If a previousmedical examination is accepted, the date ofthe required reexamination will be based onthe original date (month and year) of theaccepted examination.

(k) Results of bioassay, internalmonitoring, etc., which document monitoringfor internally deposited radioactivity, willbe documented as required in Chapter 5.

(l) Consultative reports fromspecialists shall be recorded on the SF-513,or on letterhead stationery if the specialistis not a government health care provider.

(m) No radiation medical examinationreport or portion thereof shall be removedfrom an individual's health record.

2-6. Validity Periods and Correction ofDeficient Examinations

(1) A medical examination conducted foranother purpose may be upgraded to aradiation medical examination and will bevalid until the next required medicalexamination (see Article 2-2(2) and MANMEDChapter 15), provided there has been nosignificant change in the member's physicalcondition, and the examination is of theproper clinical scope. Examinations areconsidered deficient in scope when clinicalevaluations unique to the examination aremissing or incomplete.

2-5

(a) If more than 90 days has elapsedthe examination must be upgraded by aninterview with a medical officer orcredentialed provider to include, at aminimum, a review of health record, intervalhistory, and applicable special studies.

(1) If the examination issufficient in clinical scope to meet therequirements of a radiation medicalexamination, then a statement of theadditional purpose and interval history(e.g., "Member examined this date, nosignificant interval history noted. PQ forIonizing Radiation Work") will be made in thenotes block of the SF-88 and signed and datedby the reviewing physician.

(2) If the examination isdeficient in clinical scope, the appropriateclinical studies and procedures will beperformed which satisfy the additionalrequirements. This information will be addedto the above statement in the notes block ofthe SF-88.

(b) If there is insufficient space inthe notes block of the SF-88, then anaddendum SF-88 will be prepared. Thefollowing entry must be made in the bottommargin on the front of the SF-88; "Addendumto Medical Examination dated _______." Thefollowing blocks; name, grade and component,identification number, purpose ofexamination, dates of examination,qualification block, and typed or printedname of the reviewing officer, andappropriate blocks for information beingadded will be completed on the addendum SF-88. Other blocks on the addendum SF-88 may beleft blank. The purpose of the examinationblock and the qualification block mustindicate the new purpose of examination(e.g., Ionizing Radiation Work (RE)).

(c) The addendum SF-88 will be filedimmediately behind the original SF-88 andnumber of attached sheets, if any, to theoriginal SF-88 will be indicated in the spaceprovided opposite the reviewing officerblock.

(d) If a previous medical examinationis accepted by the cognizant examiner, thedate of the next required radiationexamination will be based on the date of theoriginal accepted examination.

(2) The SF-93 may be corrected in afashion similar to that described above,using the physician’s summary block for theadditional information, if consideredappropriate by the examining or reviewingmedical officer. If an addendum SF-93 isrequired, the following blocks; name,identification number, purpose ofexamination, date of examination,individual's signature and date, typed orprinted name of examiner, date and examiner'ssignature, and appropriate blocks for therequired information will be completed.Block 5 must indicate the new purpose ofexamination (e.g., ionizing radiation work(RE)). The following entry must be made inthe bottom margin on the front of the SF-93;"Addendum to Medical History dated _______."

(3) Administrative correction will bemade as described in Chapter 16 of the Manual

of the Medical Department, i.e., single linedrawn through erroneous entry, initialed, andcorrected entry made. Corrected entries maybe made in the Notes block of the SF-88, thephysician’s summary block of the SF-93, or onan addendum.

(4) Exception to the aforementionedvalidity period and correction procedures:Medical examination and health record entrieswill conform to the standards prescribed atthe time of the examination, i.e., clinicallyupgrading or administratively correctingexaminations which were conducted prior toimplementing this change is not required.

2-7. Reporting Requirements for the REAB

(1) The following medical examinationsand supporting medical documents (see Article2-8) must be submitted to Chief, BUMED,Undersea Medicine and Radiation HealthDivision, for review by the Radiation EffectsAdvisory Board (REAB) per BUMEDINST 6470.21series. The board will perform a review anddetermine the individual‘s fitness forradiation work. The transmittal letter mustinclude the reason for submittal, totallifetime exposure of the individual, summaryof the individual's duties, and ifappropriate the current or disqualifyingdiagnosis. Only medical examinations whichare completed and for which all requiredconsultative results are available should besubmitted for review.

(a) Findings on a radiation medicalexamination which disqualify an individualfrom ionizing radiation work.

(b) Findings on a medical history ormedical examination of:

(1) History of ionizing radiationexposure or internal deposition in excess ofthat allowed by Articles 2-4 and 4-3(1)(a).

(2) History of radiation therapy.(3) An intake in excess of 50

percent of an ALI of radioactive material notintentionally administered for medicaldiagnosis or treatment. A description of theanalysis technique must be included with thesubmission.

(c) Any medical examination orcondition which the responsible medicalofficer or commanding officer recommends forChief, BUMED review. Such request for reviewwill not be denied by any member of the chainof command.

(d) All SEs.(e) Allegations or claim by a service

member or employee that his/her physicalcondition was caused by exposure to ionizingradiation.

2-8. Documentation Requirements for the REAB(1) All cases submitted to the BUMED REAB

for review must include the most recentradiation medical examination and supportingmedical documentation directly related to theindividual's medical condition, includinglaboratory and special studies results,consultation reports, and any evaluationsperformed by the individual's private medicaldoctor.

2-6

(2) Cases submitted to the BUMED REAB forreconsideration of an individual previouslyfound not physically qualified by the BUMEDREAB due to a diagnosis of cancer mustinclude a current radiation medicalexamination performed subsequent to theindividual completing all prescribedtreatment. Additionally, supporting medicaldocumentation must include conclusions by thetreating physician and oncologist that the

individual is free of cancer with a goodlong-term prognosis. A discussion of themedical procedures and pathology reports thatsupport this conclusion should be provided.Finally, the treating physician's oroncologist's follow-up plan to ensure theworker remains cancer-free should also beprovided.

3-1

Chapter 3SUPPORT FACILITIES

ArticleIntroduction................................................ 3-1Bioassay.................................................... 3-2

Radon Bioassay.............................................. 3-3Internal Monitoring (External Counting)..................... 3-4Assistance for Evaluation and Treatment of Irradiated or Contaminated Personnel .................................. 3-5

3-1 Introduction

(1) This chapter provides guidance forobtaining assistance from support facilitiesfor the completion of certain items requiredby this manual or program radiologicalcontrols manuals that are not readilyavailable at every activity that employsradiation workers. Specific documentationrequirements with regard to recording resultsare contained elsewhere in this manual andprogram radiological controls manuals.

3-2. Bioassay

(1) When deemed necessary by thecognizant medical officer or radiation healthofficer of a ship, unit, or command whichlacks facilities to perform such analysis, arequest for a bioassay is to be submitted tothe Naval Dosimetry Center, NavyEnvironmental Health Center Detachment,Bethesda, MD, 20889-5614. DSN 295-0142 or295-5410 or Commercial (301) 295-0142 or 295-5410. The Naval Dosimetry Center's PlainLanguage Address for message traffic isNAVENVIRHLTHCEN DET BETHESDA MD. The requestshall include a general description of theevent or circumstance which produced thepossible internal radioactive deposition, theprobable radioisotopes present, the resultsof previous radiochemical analysis, and anyother pertinent information. (2) When it has been determined bioassayare needed, the support facility willinstruct the requesting activity regardingthe collection, preservation, volume andnumber of specimens required. The supportfacility will recommend the appropriateshipment procedures to be used, and willsupply appropriate containers andpreservatives, if necessary.

3-3. Radon Bioassay

(1) All workroom, storage room, controlroom, and breath samples shall be collectedin sampling bags, and 24-hour urine samplesin appropriate containers, obtained onrequest, from the Naval Dosimetry Center.The request for sampling bags, urinecollection containers, and equipment shallspecify the number and types of samples to betaken, and shall include the name andtelephone number of the individual to contactfor shipping information. Instructionsconcerning sample collection and equipmentwill be provided by the laboratory. Allsampling bags, urine collection containers,and equipment shall be shipped to thefacility specified by the Naval DosimetryCenter within a period of approximately 2weeks after receipt.

3-4. Internal Monitoring (External Counting)

(1) Personnel shall have internalmonitoring performed when deemed necessary bythe cognizant medical officer or radiationhealth officer (see Chapter 2), and asrequired by program radiological controlsmanuals. Naval organizations lacking thecapability to perform internal monitoringexaminations may request internal monitoringservices from the nearest BUMED approvednaval organization capable of providinginternal monitoring. BUMED approvedfacilities (organizations) include:

(a) Shipyards, tenders, and submarinebases which perform radioactive workassociated with naval nuclear propulsionplants.

(b) Nuclear-powered surface ships andnaval reactor prototypes.

(c) Naval Dosimetry Center, NavyEnvironmental Health Center Detachment,Bethesda, MD 20889-5614.

(d) Naval Medical Center, San Diego, CA92134-5000.

(e) Naval Nuclear Power School, GooseCreek, SC 29445-6324.

(f) Other organizations specificallyauthorized by BUMED or required as acondition of a Radioactive Material Permit.

3-5. Assistance For Evaluation and Treatmentof Irradiated or Contaminated Personnel

(1) Specific guidance for evaluation,monitoring, care and decontamination ofpersonnel is available in BUMED Instruction6470.10 series. Advice on the significanceof abnormal findings and assistance in theevaluation of personnel suspected ofexceeding radiation exposure limits due toexternal or internal radiation exposure is tobe obtained from: BUMED, telephone DSN: 762-3444, Commercial: 202-762-3444; afterworking hours telephone DSN: 762-3211,Commercial: 202-762-3211.

4-1

Chapter 4RADIATION PROTECTION STANDARDS

ArticleIntroduction ............................................... 4-1Members of the Public ...................................... 4-2Occupational Exposures ..................................... 4-3Embryo/Fetus ............................................... 4-4Minors ..................................................... 4-5Emergency Exposure ......................................... 4-6Radiation Protection Guidance for Internal Emitters...... .. 4-7Radiation Protection Guidance for External Exposure......... 4-8

4-1. Introduction

(1) General. Every effort shall be madeto maintain personnel radiation exposures asfar below Navy radiation protection standardsas practicable. Current Navy radiationprotection standards are consistent with ormore stringent than those of theEnvironmental Protection Agency, NuclearRegulatory Commission and the OccupationalSafety and Health Administration.

(2) Scope. The standards prescribedherein are adopted for the control ofionizing radiation exposure to personnelwithin the naval establishment during peace-time and noncombatant operations, and do notinclude radiation exposure of an individualincident to medical or dental diagnostic ortherapeutic procedures or to exposure frombackground radiation. These standards do notapply after an attack in which nuclearweapons are used, for combat operations, orduring war; however, the provisions of theseregulations insofar as they are feasible,shall remain in effect. Any and allexceptions to the following standards must beapproved by the Chief, Bureau of Medicine andSurgery.

4-2. Members of the Public

(1) Radioactive material and othersources of radiation shall not be used,maintained, or transferred in such a mannerto cause:

(a) the dose in any unrestrictedarea, from external sources, to exceed 2 mrem(0.02 mSv) in any one hour.

(b) an individual member of thepublic to receive a total effective doseequivalent in excess of 100 mrem (1 mSv) in acalendar year, exclusive of the dosecontribution from disposal of radioactivematerial into sanitary sewerage per aradioactive material permit.

(2) Exposure limits for members of thepublic shall continue to apply when themember enters a controlled area. (3) Exposure limits for members of thepublic apply to unrestricted areas andberthing spaces.

(4) It must be locally documented, bymeasurement, calculation or both, that due tolimited occupancy or transient situations:

(a) The maximum exposed individual'stotal effective dose equivalent fromoccupancy in all unrestricted areas would not

be expected to exceed 100 mrem (1 mSv) percalendar year; or,

(b) The annual average concentrationsof radioactive material released in gaseousand liquid effluents at the boundary of theunrestricted area do not exceed the valuesspecified in Table 2 of Appendix B to Title10 Part 20; and, if an individual werecontinually present in an unrestricted area,the dose from external sources would notexceed 2 mrem (0.02 mSv) in an hour and 50mrem (0.5 mSv) in a year.

4-3. Occupational Exposures

(1) Radiation Workers.(a) Radioactive material and/or other

sources of radiation shall not be used insuch a manner to cause an adult to receivethe more conservative of the radiation dosesspecified in Table III.

TABLE III

Radiation Exposure LimitsTotal Effective Dose Equivalent(Whole Body)............... 03.000 rem/qtr yrTotal Effective Dose Equivalent(Whole Body)................... 05.000 rem/yrShallow Dose Equivalent(Extremities).................. 50.000 rem/yrShallow Dose Equivalent(Skin)......................... 50.000 rem/yrEye Dose Equivalent(Eyes)......................... 15.000 rem/yrSum of Deep Dose Equivalent and CommittedDose Equivalent for any organ or tissueother than the Lens of the eye(Organ Dose)................. 50.000 rem/yr

(b) For radiation workers whose priorcurrent year exposure is unknown, the annuallimits shall be reduced by one-quarter foreach quarter of the current year for whichrecords of exposure are unavailable orincomplete. For example, if new employeesare hired in June and state they were exposedat their previous job earlier in the year butrecords are unavailable, then the annualexposure limits for the new employees must bereduced by one-quarter for the first andsecond quarters of the year, i.e., reducedfrom 5 rem (0.05 Sv) to 2.5 rem (0.025 Sv),from 50 rem (0.5 Sv) to 25 rem (0.25 Sv) forshallow dose, 15 rem (0.15 Sv) to 7.5 rem(0.075 Sv) for eye dose and from 50 rem (0.5Sv) to 25 rem (0.25 Sv) for the sum of deepdose equivalent and committed dose equivalent

4-2

for any organ or tissue other than the lensof the eye.

(2) Nonradiation Workers. Radioactivematerial shall not be used in such a mannerto cause any nonradiation worker to exceed atotal effective dose equivalent of 500 mrem(5 mSv) per year considering occupancyfactors and source usage. It must be locallydocumented that due to limited source usage,occupancy or transient situations theindividual's total effective dose equivalentis not expected to exceed 500 mrem (5 mSv)per year.

4-4. Embryo/Fetus

(1) Once a woman monitored foroccupational exposure notifies her command inwriting of her pregnancy, exposure to theembryo/fetus shall not exceed 500 mrem (5mSv) for the term of the pregnancy and shallnot exceed 50 mrem (0.5 mSv) per month in anymonth for the remainder of the pregnancy.

(a) The dose to the embryo/fetusshall be taken as the sum of the deep doseequivalent to the declared pregnant woman andthe dose to the embryo/fetus fromradionuclides in the embryo/fetus anddeclared pregnant woman.

(b) If the dose to the embryo/fetusis found to have exceeded 500 mrem (5 mSv) oris within 50 mrem (0.5 mSv) of this dose, bythe time the woman declares the pregnancy,the activity shall be deemed to be incompliance with the limit if the additionaldose to embryo/fetus does not exceed 50 mrem(0.5 mSv) during the remainder of thepregnancy.

4-5. Minors

(1) No individual under 18 years of ageshall receive an occupational exposure toionizing radiation in excess of 10 percent ofthe exposure limits for radiation workers.

4-6. Emergency Exposure

(1) In an emergency it may be necessaryfor fire fighters or other workers to exceedlimits prescribed in Table III to save lifeor valuable property. In such situations,the probable risk of high exposure to therescuer must be weighed against the expectedbenefits. In emergency situations:

(a) Which require personnel to searchfor and remove injured personnel or whichrequire entry to prevent conditions thatwould probably injure numbers of people, theplanned total effective dose equivalentshould not exceed 100 rem (1 Sv).

(b) Where it is desirable to enter ahazardous area to protect facilities,eliminate further escape of contamination, orto control fires, the planned total effectivedose equivalent should not exceed 10 rem (0.1Sv).

(c) The above emergency exposureguidance is based on criteria set forth inNational Council on Radiation Protection andMeasurements Reports Number 39 and 91. Whenan individual has been exposed to more than 3rem (0.03 Sv) during the calendar quarter, or5 rem (0.05 Sv) in a calendar year as aresult of an emergency, he shall be

restricted from any additional occupationalexposure as a radiation worker to radiationpending BUMED review; and, his exposure shallbe reported as an overexposure following therequirements of Chapter 5.

4-7. Radiation Protection Guidance forInternal Emitters

(1) If radioactive material is inhaled,ingested, or absorbed through the skin, itmay be deposited in various organs or systemsof the body. It then acts as a radiationsource within the body and will continue toirradiate the cells of the body until it hasbeen eliminated by biological processesand/or by radioactive decay. The amount ofradioactive material retained in the body islimited by controlling the rate of intake ofsuch material. This is accomplishedprimarily by limiting the concentration ofradioactive materials on surfaces, in the airand water in the occupational environment.Risk of internal exposure is reduced by goodhousekeeping procedures, e.g., cleanliness,containment, protective clothing andappropriate exhaust ventilation.

(2) Intake of an ALI or exposure at thelevel of the DAC for 40 hours per week for a50-week year should result in a committedeffective dose equivalent of 5 rem (0.05 Sv)or 50 rem (0.5 Sv) to an organ or tissue,whichever is the more limiting. Appendix Blists ALIs, and DAC values which will resultin an intake equal to an ALI for some of theisotopes used in the Navy. Tables of the ALIand DAC values for other radionuclides arepublished in Table I of Appendix B, Title 10,Part 20 of the Code of Federal Regulations.

(3) Personal protective measures may beaccomplished by:

(a) Avoiding Inhalation.(1) Personnel shall not work in an

environment whenever 10 per cent of an annuallimit on intake of radioactivity is likely tobe exceeded without some action being takento minimize the intake. Personnel shall notroutinely work (2,000 hours expected) in anenvironment whenever 10 per cent of a DAC islikely to be exceeded without some actionbeing taken to minimize the intake. Actionsmay include process or engineering controls,e.g., containment or ventilation, to minimizethe concentration in the air or othercontrols, e.g., respirators, access control,limitation of exposure times, etc., tocontrol and minimize the exposure ofpersonnel.

(2) The commanding officer mayauthorize work without respiratory protectionin environments where 10 per cent of a DACmay be exceeded for short periods of time,provided the exposure time during any 7consecutive days is decreased proportionatelyfrom the 40-hour time limit. For example, ifwork is for 8 hours, the concentration levelsmay be 5 times 10 per cent of the DAC valueslisted in Appendix B of this manual or TableI of Appendix B, Title 10, Part 20 of theCode of Federal Regulations. Conversely, ifa worker works more than 40 hours during any7-consecutive day period and the number ofhours of exposure is more than 40, the airconcentration limits (DACs) shall be loweredproportionately. For example, if work is for

4-3

48 hours the air concentration values forwork without respiratory protection are 5/6of 10 per cent of those listed in Appendix Bor Table I of Appendix B, Title 10, Part 20of the Code of Federal Regulations.

(3) Personnel may work in anenvironment where 10 per cent of the DAC isexpected to be exceeded provided the workersuse respiratory equipment and protectiveclothing as appropriate; or, if the particlesize and chemical or physical state of theradionuclide is so that it is unlikely thatthe workers will exceed 10 per cent of anALI; or, if containments, glove bags,ventilation hoods or barriers are used suchthat 10 per cent of a DAC in the breathingzone is not likely to be exceeded.

(4) Respiratory protection frominhalation of radioisotopes is not requiredduring decontamination or showering of acontaminated person unless it is expected theindividual or the attendants will exceed 50per cent of an ALI. Resuspension andredistribution factors may be used tocalculate levels of activity necessary topose a risk of exceeding 50 per cent of anALI. (For cobalt 60, approximately 100 mCiwould need to be present. This amount wouldgive an external exposure rate ofapproximately 100 mrem (1 mSv) per hour atone meter from the contaminated person.)

(b) Avoiding ingestion. No ediblematerial of any kind including chewing gum,candy, food, beverages, tobacco or smokingequipment shall be allowed in a contaminatedarea or stored in an area containing liquidor unsealed radioactive sources. Surfacecontamination levels will be minimized topreclude hand to mouth transfer of activity.Upon leaving a contaminated area personnelshould not be permitted to handle ediblematerials until they have been carefullymonitored and decontaminated if necessary.

(c) Avoiding absorption. Personnelshould be provided, trained in the use of,and required to wear appropriate protectiveclothing in a contaminated area. Worksurfaces (bench tops) where liquidradioactive material is used should becovered with absorbent paper or othermaterial to minimize the potential for handcontact with any spilled liquid.

(4) If an individual receives an internaldeposition or uptake of radionuclidesdetermined by internal monitoring or bioassayas a result of his duties (occupationalexposure), the committed effective doseequivalent will be calculated by a BUMEDapproved facility. (See Chapters 3 and 5.)

4-8. Radiation Protection Guidance forExternal Exposure

(1) When the source of ionizing radiationis located outside the body, the followingmethods of control are applicable:

(a) Time. Reducing an individual'sworking time in a radiation field is thesimplest way to limit his exposure. Sincethe amount of radiation exposure received isequal to the dose rate multiplied by time ofexposure, decreasing exposure time results ina proportional decrease in total exposure.

(b) Distance. Radiation intensityvaries inversely as the square of thedistance from a point source (i.e., a sourceconcentrated in a small volume). Therefore,if a worker doubles the distance betweenhimself and the source, his exposure isreduced to one-fourth; increasing thedistance threefold reduces his exposure toone-ninth. Remote handling devices use thisprinciple to reduce exposure.

(c) Shielding. Shielding materialsabsorb a part or all of the energy of thevarious types of radiation. Interposing ashield between the individual and theradiation source reduces the amount ofradiation exposure.

(d) Radioactive Decay. Allradioactive materials decay exponentially ata fixed time rate. The time required for aradioactive substance to decrease to one-halfits original activity is called the half-lifeof that particular substance. Thus, allowingthe radioactive material to decay for aperiod of time will reduce the amount ofexposure received when the material ishandled.

5-1

Chapter 5EXPOSURE RECORDS

ArticleIntroduction ............................................... 5-1Computerized Exposure Record Systems........................ 5-2Record of Occupational Exposure to Ionizing Radiation(NAVMED Form 6470/10)................... 5-3Record of Occupational Exposure to Ionizing Radiation from Internally Deposited Radionuclides(NAVMED Form 6470/11)... 5-4Cross Checks and Verification........................... ... 5-5Dose Investigations and Dose Estimates...................... 5-6External Contamination...................................... 5-7Extremity Exposure.......................................... 5-8Eye Exposure................................................ 5-9Embryo/Fetus Exposure....................................... 5-10Termination Letters......................................... 5-11Required Reports ........................................... 5-12Retention, Disposition and Release of Information........... 5-13Working copy of NAVMED Form 6470/1 ......................... 5-14Control of Radiation Exposure Information for Nuclear Powered Warships and Operational Prototypes....... 5-15

5-1. Introduction

(1) All personnel monitoring foroccupational exposure to ionizing radiationmust be documented to establish individualradiation exposure histories. Thesehistories have medical, epidemiological andlegal significance since they record theamounts of exposure as well as dates andlocations at which exposures were received.Additionally, they serve as evidence thatoccupational exposure limits were or were notexceeded. This chapter contains therecording and reporting procedures the Chief,Bureau of Medicine and Surgery considersnecessary and adequate for radiation exposuredocumentation. Reporting requirementscontained herein have been approved by theChief of Naval Operations.

(2) Monitored exposure to ionizingradiation is normally recorded on NAVMED Form6470/10, Record of Occupational Exposure toIonizing Radiation and NAVMED Form 6470/11,Record of Occupational Exposure to IonizingRadiation From Internally DepositedRadionuclides. The predecessor to these formswas the DD Form 1141. NAVMED Forms 6470/10and 6470/11 and DD Form 1141 are to be filedand maintained in the health record and in noother location.

(3) For activities holding RadioactiveMaterial Permits, the NAVMED Form 6470/10 andNAVMED Form 6470/11 shall be used in lieu ofNRC Form 4, Occupational External RadiationHistory and NRC Form 5, Current OccupationalExternal Radiation Exposure.

5-2. Computerized Exposure Record Systems

(1) Computerized exposure record systemsare required. Request for exceptions to thisrequirement will be forwarded to BUMED (MED-21). The Naval Dosimetry Center willprovide, upon request, a personal computer(PC) program for automation of exposurerecords and reports required by this manual.Locally prepared or other programs may beused if approved by Chief, BUMED. Locallyprepared or other programs must be compatiblewith the databases used by the NavalDosimetry Center if reports are to be

transmitted on magnetic media. (The ShipyardARCMIS and the Shipboard Non-tactical ADPProgram (SNAP) Automated Medical System(SAMS), and the Radiation Health Assistant(RHA) supported by the Naval Dosimetry Centerare approved programs.)

(a) Personnel exposure informationwill be entered in the computerized databaseat least once a quarter.

(b) The computer generated NAVMEDForms 6470/10 and 6470/11 printouts are to befiled at least annually in the individual'smedical record.

(c) A back-up copy (separate disk ormagnetic tape) of the exposure informationdatabase must be made at least quarterly andretained for two quarters.

(d) Requests for exceptions to therequirement to submit reports via magneticmedia and maintain computerized exposurerecord systems will be forwarded to Chief,BUMED, explaining the reason submission needsto be on a manually prepared report.

5-3. Record of Occupational Exposure toIonizing Radiation (NAVMED Form 6470/10)

(1) General. The custodian of theindividual's health record shall prepare andmaintain a NAVMED Form 6470/10, for eachperson monitored for exposure to ionizingradiation.

(2) Initial Determination. For theinitial preparation of NAVMED Form 6470/10reasonable effort should be made to obtaincomplete reports of all previous exposuresbased upon recorded personnel dosimetry.This shall be accomplished by correspondencewith previous commands, employers and/or theNaval Dosimetry Center.

(a) For each period in which theindividual was monitored for occupationalexposure to ionizing radiation and no recordor an incomplete record of the exposureduring the period can be obtained, an entrywill be made indicating exposure data wasincomplete or not available. An estimate ofprior Lifetime Total Effective DoseEquivalent may be made based on partial

5-2

records, exposure of others performingsimilar work, and statements from theindividual. If an estimate is made, thebasis for the estimate will be explained inthe remarks section. (b) When an individual was previouslyexposed at more than one facility, theexposure from each facility shall beseparately recorded in items 7 through 14, asappropriate.

(c) If an individual has beenoccupationally exposed at any activitypossessing a Nuclear Regulatory CommissionLicense, and his exposures have been recordedon NRC-4 and NRC-5 forms, the cumulativeexposure obtained from those forms shall berecorded on the NAVMED Form 6470/10 in items7 through 14, as appropriate, and a statementregarding the source of that informationshall be entered in the remarks section ofthe NAVMED Form 6470/10.

(3) Current Record. Appropriate entrieson each individual's NAVMED Form 6470/10 oran update of the individual's computerizedexposure database which can generate thisform shall be made at least quarterly forthose personnel monitored for exposure.

(a) Entries on the NAVMED Form6470/10 are to be completed per the guidanceprovided below and the instructions on theback of the form. The method of monitoringis presumed to be by TLD after 1 October 1989and no entry explaining the type of dosimeteris required in the Remarks section unless themethod of monitoring is not a TLD.

(b) All previous copies of NAVMEDForm 6470/10 and DD Form 1141, Record ofOccupational Exposure to Ionizing Radiationfiled in the individual's medical recordshall be retained in the individual's medicalrecords.

(c) The instructions on the NAVMEDForm 6470/10, items 7 and 8 require theentering of the period of exposure (beginningand end). Items 9 through 13, require theentering of the radiation dose received forthe period of exposure. For calcium fluorideTLDs used by forces afloat, the period ofexposure and the radiation dose for theperiod entered on the NAVMED Form 6470/10shall be the same as the issue period(beginning and end) recorded in blocks 6/7and 11 of the exposure record card (SubgenForm 9890/30). The radiation dose receivedfor the period shall be the same as thecumulative total of radiation doses recordedin block 10 of the exposure record card.Multiple entries on the NAVMED Form 6470/10,to document periods of leave etc., whichoccur routinely during any given issueperiod/period of exposure are not necessary.

(d) Personnel exposure data shall beobtained and properly recorded on the NAVMEDForm 6470/10. Entries should identify thedates of the exposure and either theinstallation where the individual ispermanently assigned or if exposed while ontemporary duty assignment, the activity wherethe exposure was received. Use of hullnumbers for identification is consideredappropriate for afloat commands.

(e) When an individual is monitoredfor exposure to ionizing radiation at a navalinstallation or activity, other than wherehis medical records are maintained, the

commanding officer, or officer in charge ofthat installation or activity shall ensurethe personnel exposure information isfurnished to the custodian of theindividual's medical record. This exposureinformation shall be forwarded to the healthrecord custodian at least quarterly or within30 days of receipt of final personnelexposure information. Exposures received byvisiting or temporary duty personnel whoseexposures are not reported annually by theirparent activities, shall be submitted to theNaval Dosimetry Center, Navy EnvironmentalHealth Center Detachment, Bethesda, MD 20889-5614 on a Situational Report, NAVMED Form6470/1 by the command where the exposureoccurred.

(f) When an individual is monitoredfor exposure to ionizing radiation at aninstallation outside the jurisdiction of theDepartment of the Navy, the individual shallensure the exposure data is furnished to thecustodian of his medical record for entry onthe NAVMED Form 6470/10, and submission on aNAVMED Form 6470/1, Annual or SituationalReport.

(g) Annual verification of theLifetime Total Effective Dose Equivalent(column 14 of the NAVMED Form 6470/10) isrequired if the entries are preparedmanually. If the NAVMED Form 6470/10 isgenerated using an approved computer program,that has not been modified since approval,annual verification of the total effectivedose equivalent is not required.

5-4. Record of Occupational Exposure toIonizing Radiation from Internally DepositedRadionuclides (NAVMED Form 6470/11)

(1) Results of all internal monitoringincluding baseline measurements shall berecorded on a NAVMED Form 6470/11 and theresults reported in the Committed EffectiveDose Equivalent column of the NAVMED Forms6470/10 and 6470/1, Annual or SituationalReport of Exposure to Ionizing Radiation.Instructions are provided on the back of theforms.

(a) The results of internalmonitoring shall include the followinginformation: date of monitoring, the system'sminimum detectable activity (MDA), theisotope(s) for which monitoring wasperformed, activity (in units of nanocuries)present and the anatomical locationsmonitored. Additionally, the equipment typeand serial number will be recorded in thosecases where an individual has been exposed toairborne radioactivity above the limits ofthe applicable program radiological controlsmanual, or greater than minimum detectableactivity (MDA) is identified during internalmonitoring. If a series of monitoringmeasurements are performed within one weekfollowing an occupational exposure whichresulted in internal contamination, then thetime as well as the date of each monitoringshall also be recorded. In this case, thecommitted effective dose equivalent iscalculated based on intake and retentiondetermined from the series of measurements,and a single entry is made in column 12 ofthe NAVMED Form 6470/11 for the series of

5-3

measurements. Only one committed effectivedose equivalent entry will be made perinternal contamination. If nonnaturallyoccurring, or abnormal amounts ofradioisotopes not related to an occupationalexposure are detected, e.g., isotopesadministered for medical purposes, cesium-137from consuming venison, etc., the detectionshall be noted in the remarks section of theNAVMED Form 6470/11.

(b) If internal monitoring isperformed on an individual during an issueperiod where the individual is monitored fordeep dose (photon or neutron) the committedeffective dose equivalent entry in column 12of the NAVMED Form 6470/11 will betranscribed to column 12 of the NAVMED Form6470/10 for that issue period. For example,if the external monitoring period is 1February 1992 to 28 February 1992 and theinternal monitoring is performed on 5February 1992 then a committed effective doseequivalent entry would be made for the 1February 1992 to 28 February 1992 monitoringperiod. If internal monitoring is completedand the individual is not being monitored fordeep dose then the committed effective doseentry on the NAVMED Form 6470/11 will betranscribed to the NAVMED Form 6470/10 andthe issue period ("From" and "To") will bethe date the internal monitoring wasperformed.

(2) Results of internal monitoringmeasurements which show internalcontamination from occupational exposuregreater than the MDA of the countingequipment shall be forwarded to the NavalDosimetry Center or authorized facility forcalculation of the committed effective doseequivalent. The results will be returned tothe submitting activity for incorporation onthe NAVMED Forms 6470/10, 6470/11 and 6470/1.

(a) Local activities may calculatethe committed effective dose equivalent ifspecifically authorized by Chief, BUMED.Activities requesting authorization mustsubmit their procedures to Chief, BUMED forreview and approval. However, all calculatedcommitted effective dose equivalent shall bereviewed by Chief, BUMED (MED-21) prior toentry into an individual’s exposure record.

(b) Naval shipyards are authorized tocalculate the committed effective doseequivalent.

(c) The committed effective doseequivalent is calculated by:

(1) Following the methodologyrecommended by the International Commissionon Radiological Protection (ICRP) in ICRPReport Number 30. Calculations should bebased on activity measurements determined atleast 24 hours after the exposure event.Total exposure may be based on the retentionrates in ICRP 30 or on measured retentionrates as observed for the exposed individual,or;

(2) Comparing the measured airconcentration values and exposure time withthe DAC limits (40 hours per week, 50 weeksper year exposure to yield 5 rem (0.05 Sv))and calculating the committed effective doseequivalent.

(3) Internal monitoring measure-ments which are less than the minimumdetectable activity (MDA) of the countingequipment shall be recorded on the NAVMED

Form 6470/11 as less than MDA (<MDA) and thecommitted effective dose equivalent will beentered as 00.000 rem.

(4) For internal monitoring oforgans where the organ dose limit is morelimiting than the committed effective doseequivalent, e.g., thyroid monitoring foriodine uptake, a separate NAVMED Form 6470/11will be maintained. At the top and bottom ofthe form the name of the organ should bewritten. For example, for thyroid monitoringthe words "Thyroid Monitoring" will bewritten or typed at the top and bottom of theform. The word "Effective" in the headingfor column 12 will be lined out so theheading reads "Committed Dose Equivalent."Internal monitoring measurements which areless than the MDA of the counting equipmentshall be recorded on the NAVMED Form 6470/11as less than MDA (<MDA) and the committeddose equivalent entered as 00.000 rem.Results of internal monitoring measurementsgreater than the MDA of the countingequipment for the isotope(s) of concern shallbe forwarded to the Naval Dosimetry Center orauthorized facility (see Article 5-4(2)) forcalculation of the organ committed doseequivalent. To determine compliance with theorgan dose limits of Chapter 4, the deep doseequivalent from external exposure must beadded to the committed dose equivalent. Thecommitted dose equivalent is multiplied bythe organ weighting factor to give thecommitted effective dose equivalent.

5-5. Cross Checks and Verification (1) To ensure accurate transcription andrecording of dosimetry information a randomsampling of the exposure data in the data-base, or on printed computer formatted NAVMEDForms 6470/10 and 6470/11, or on manuallyprepared NAVMED Forms 6470/10 and 6470/11shall be cross checked against appropriaterecords, e.g., exposure record cards, NAVMEDForm 6470/3, Radiation Exposure Reports, orcomparable records. This cross check shallbe performed semiannually on 1 percent of theindividual records in the computerizeddatabase or no less than five of theindividual records. If errors are found, alarger percentage of the records should bechecked. The cross check shall be noted bymaking an entry in the remarks section of thedatabase for the audited NAVMED Forms 6470/10and 6470/11 or by signing and dating astatement in the remarks section of theprinted NAVMED Forms 6470/10 and 6470/11 thatentries have been verified.

(1) Manually prepared NAVMED Forms6470/10 and 6470/11 shall be individuallyverified on an annual basis normally inconjunction with preparation of the annualreport. This verification will consist of anaudit of the past year's exposure entries toverify correct addition. If the NAVMED Forms6470/10 and 6470/11 are generated using anapproved computer program that has not beenmodified since approval, annual verificationis not required.

(3) If erroneous entries have been madeon manually prepared NAVMED Forms 6470/10 or6470/11, they shall not be stricken out. Anew entry which corrects the error(s) shall

5-4

be made. An explanation of the error and thecorrection shall be briefly documented by adated entry in the remarks section. Anasterisk (*) or footnote number shall beneatly entered in the block containing theerroneous entry. This procedure forcorrecting erroneous entries on the NAVMEDForms 6470/10 and 6470/11 supersedes therequirements of Chapter 16 of the Manual ofthe Medical Department for correction ofmedical record entries.

5-6. Dose Investigations and DoseEstimates

(1) When a primary dosimetric device,(e.g., a thermoluminescent dosimeter) islost, damaged, or destroyed, the medicalofficer, radiation health officer, or medicaldepartment representative, as applicable,shall be notified and doses shall beestimated based on:

(a) Exposure time and radiationlevels;

(b) Dose of other personnelperforming similar work, or the individual'spreviously recorded dose while performingsimilar work;

(c) Pocket dosimeter measurements, ifavailable.All of the above procedures for estimatingdose shall be used and recorded in aninvestigation report, contingent on theavailability of data. The investigationreport shall include a description of how thedosimetric device was lost, damaged, ordestroyed, the dose estimate, the periodcovered by the estimate, work performed bythe individual during this period, adescription of the investigation, resultsfrom each estimating procedure, andapplicable supporting documentation (e.g.,any calculations performed, copies ofradiation survey records, or copies ofabnormal thermoluminescent dosimeter glowcurves). The dose assigned, based on theinvestigation, shall be the "best estimate"of the dose received as opposed to "worstcase" or "most conservative" estimate. Theinvestigation report shall be approved inwriting by the medical officer or theradiation health officer. For commands nothaving a medical officer or a radiationhealth officer, the investigation reportshould be approved by the medical departmentrepresentative and the executive officer.The investigation report shall not be enteredin the individual's health record. Theinvestigation report shall be retainedindefinitely.

(1) A dose estimate shall also beperformed when the results of the primarydosimetric device are considered suspect. Ifthe investigation concludes the results arenot suspect, an estimate is not required.For example a dose estimate shall beperformed when:

(a) An abnormal glow curve isobserved for a thermoluminescent dosimeter.

(b) The measurement of gamma or x-rayradiation by the whole body primarydosimetric device, e.g., a thermoluminescentdosimeter, differs significantly from themeasurement by the whole body secondary

dosimetric device, e.g., a pocket dosimeter,and both devices have been worn together atthe same body location. Examples of"significant differences" are provided below.

(1) Primary and secondarydosimetric device measurements differ by 30percent or more and the primary dosimetricdevice measurement is greater than or equalto 100 mrem.

(2) Primary and secondarydosimetric device measurements differ by 30mrem or more and the primary dosimetricdevice measurement is less than 100 mrem.

(3) Primary and secondarydosimetric device measurements differ by 100mrem or more and the secondary device is anintermediate range pocket dosimeter (IM-181/PD).

(4) Primary and secondarydosimetric device measurements differ by 300mrem or more and the secondary device is ahigh range pocket dosimeter (IM-135/PD).

(5) Primary and secondarydosimetric device differ by more than thecriteria established in the applicabletechnical manual for nonstandard secondarydosimetric devices, e.g., RADSTAR or otherelectronic dosimeters.

(c) The measurement of neutronradiation by the primary dosimetric devicediffers significantly from the expected dose.Examples of "significant difference" areprovided below:

(1) Primary and expected dosesdiffer by 100 percent or more and the primarydosimetric device measurement is greater thanor equal to 30 mrem of neutron dose.

(2) Primary and expected dosesdiffer by 30 mrem or more and the primarydosimetric device measurement is less than 30mrem of neutron dose. (3) The reason why the dose estimate wasperformed, the dose estimate, the basis forthe dose estimate, and the period covered bythe estimate shall be recorded in the"Remarks" section of the NAVMED Form 6470/10or on an addendum to the NAVMED Form 6470/10.A description of how the dosimetry device waslost, damaged, or destroyed shall not berecorded on the NAVMED Form 6470/10 or on anaddendum to NAVMED Form 6470/10. The entrymust be concise and will normally be limitedto a few summary statements. If the entry ismade on an addendum to NAVMED Form 6470/10,the entry shall not exceed one page inlength. Summary statements of less than 600spaces concerning a dose estimate shall betranscribed to the NAVMED Form 6470/1 uponsubmission of the annual or situationalreport of personnel exposure to ionizingradiation or as a footnote if submitted incomputer format.

5-7. External Contamination

(1) Results of all cases of externalpersonnel contamination shall be recorded inthe remarks section of the individual'sNAVMED Form 6470/10, Record of Exposure toIonizing Radiation, and reported in theremarks section of a situational report or onthe annual report, NAVMED Form 6470/1.

(a) The results shall include thefollowing minimum information: date of

5-5

monitoring, isotope(s) monitored, activity(in units of microcuries or nanocuries)present, and the anatomical location of thecontamination.

(b) A form covering this informationmay be marked as "Addendum to NAVMED 6470/10"and incorporated with the NAVMED Form 6470/10in the health record.

5-8. Extremity Exposure

(1) For individuals who are monitored forexposure to the extremities, as defined inChapter 1, a separate NAVMED Form 6470/10 forextremity exposure shall be maintained. Thewords "Extremity Monitoring" will be writtenor typed at the top and bottom of the NAVMEDForm 6470/10. The highest measured exposurewill be recorded as the extremity exposurewhen multiple extremities are monitored.Extremity exposures will be recorded incolumn 9, Shallow Dose. Columns 10 through14 will be left blank. Do not transfer thisentry to column 9 of the whole body NAVMEDForm 6470/10. Extremity shallow doseequivalent shall be maintained separately,and shall be reported to the Naval DosimetryCenter in either the remarks section or on aseparate page or pages of the annual orsituational report of personnel exposure toionizing radiation, NAVMED Form 6470/1. Thereported doses shall be clearly annotated asextremity doses.

5-9. Eye Exposure

(1) For individuals who are monitored forexposure to the eyes, a separate NAVMED Form6470/10 for eye exposure shall be maintained.The words "Eye Monitoring" will be written ortyped at the top and bottom of the NAVMEDForm 6470/10. The word "Shallow" in column 9will be lined out and replaced with the word"Eye." Eye exposures will be recorded incolumn 9. Columns 10 through 14 will be leftblank.

5-10. Embryo/Fetus Exposure

(1) In order for the embryo/fetusexposure limits of Chapter 4 to apply a womanmonitored for radiation exposure must informher command, in writing, of her pregnancy.To ensure its documentation and retention,the written declaration shall be made on aStandard Form 600, Chronological Record ofMedical Care (SF-600), and placed in thewoman's health record. The following SF-600entry shall be completed, dated and signed bythe woman and witnessed by a representativeof the medical department:

"I hereby make notification I ampregnant. My estimated date ofconception is ___________. I understandby declaring my pregnancy, myoccupational exposure to ionizingradiation will be controlled so that thedose to my unborn child does not exceedthe limits prescribed in Chapter 4 ofNAVMED P-5055, the Navy RadiationHealth Protection Manual."

(2) When the woman declares her pregnancythe exposure to the embryo/fetus from theestimated date of conception will becalculated. Future exposure to the womanwill be carefully monitored to ensure theexposure limits in Chapter 4 for theembryo/fetus are not exceeded. When theexposure to the embryo/fetus ends, either bytermination of pregnancy or termination ofemployment of the declared pregnant woman,the Total Effective Dose Equivalent to theembryo/fetus shall be calculated based on theconception date and entered in the Remarkssection of the woman's NAVMED From 6470/10.

(3) At the conclusion of her pregnancy,the woman must notify her command of the datethe pregnancy ended so that the TotalEffective Dose Equivalent to the embryo/fetuscan be calculated and her exposure limit canbe modified back to her whole body limit. Anentry shall be made on a Standard Form 600(SF-600) and placed in the woman’s healthrecord documenting the date the declaredpregnancy ended.

5-11. Termination Letters

(1) If radiation workers are released,retired or terminate employment and request acopy of their exposure information, theyshall be provided with a statement of theirtotal occupational radiation exposurereceived during their period of employment orservice with the Navy or Marine Corps. Thetermination letter shall be submitted within30 days of the receipt of the individual'sfinal exposure information or finaldetermination the individual will no longerbe monitored for exposure to ionizingradiation. The termination letter shallinclude:

(a) Name, social security number, anddate of birth of the individual.

(b) Exposure Information. Exposureinformation from all NAVMED Form 6470/10s andDD Form 1141s shall be extracted andsummarized for all categories of monitoredexposure. The current year's exposure shallbe listed by quarter year. For prior yearsthe exposures shall be listed by command andlocation or hull number, period monitored atthat command, and cumulative Navy exposureduring that time period. The periodmonitored shall be in day, month, year formatfrom the date first monitored to the datelast monitored at the command, inclusive.Exposures received prior to January 1992 maybe listed as whole body exposures withinternal monitoring listed separately aslisted on the DD Form 1141 or may beconverted to effective dose equivalents. Toconvert prior DD Form 1141 exposures toshallow dose equivalent, shallow doseequivalent to the extremities, eye dose, deepdose equivalent, total effective doseequivalent and lifetime total effective doseequivalent:

(1) Shallow Dose Equivalent. Ifmonitored for skin exposure, shallow dosewill be entered as equal to the numeric valueof the skin dose (column 9), of the DD Form1141 for the periods monitored. If notmonitored, leave this column blank.

(2) Deep dose equivalent, photonwill be entered as equal to the value of the

5-6

gamma and x-ray dose (column 10) of DD Form1141.

(3) Deep dose equivalent, neutronwill be entered as equal to the value of theneutron dose (column 11) of the DD Form 1141.

(4) Committed Effective DoseEquivalent. If internal monitoring wasconducted and the results indicated apositive uptake the committed effective doseequivalent shall be calculated by a BUMEDapproved facility (see Article 5-4(2)) usingthe ICRP methodology. Internal monitoringresults less than the system's MDA shall berecorded as 00.000 rem committed effectivedose equivalent. If no internal monitoringwas performed, leave this column blank.

(5) Total effective dose equiv-alent will be entered as the sum of deep doseequivalent, photon, deep dose equivalent,neutron and committed effective doseequivalent.

(c) The following statements shall beincluded on the form or letter provided tothe individual: (1) "This report is per NAVMED P-5055, Radiation Health Protection Manual."

(2) "You should preserve this reportfor future reference. If you should seekfuture employment involving occupationalexposure to ionizing radiation, your employerwill want this information. As a point ofreference to the significance of yourexposure, the average exposure to a member ofthe United States population is approximately300 mrem (3 mSv) per year from naturalbackground radiation. Federal radiationexposure limits are 5 rem (0.05 Sv) per year,total effective dose equivalent. No adverseobservable effect is expected at exposurelevels below the Federal limits." 5-12. Required Reports

(1) Annual Report of Personnel Exposureto Ionizing Radiation to the Individual.Annually, any installation, activity, ship orunit at which personnel are monitored forexposure to ionizing radiation, shall provideall monitored individuals currently onboarda written report of their dose for theprevious calendar year. This annual reportshall be provided prior to 1 April eachyear. If valid operational commitments(e.g., SSBN patrol cycle) delay receipt offinal personnel exposure information for theprevious year until after 1 March, the reportshall be provided within 30 days of the dateof receipt of final personnel exposureinformation.

(2) Annual Reports of Personnel Exposureto Ionizing Radiation.

(a) Annually, any installation,activity, ship or unit at which personnel aremonitored for exposure to sources of ionizingradiation, shall submit an annual report ofpersonnel exposure to ionizing radiation onNAVMED Form 6470/1, report of personnelexposure to ionizing radiation, in magneticmedia format to the Naval Dosimetry Center.Acceptable submission will be on 3.5 inchdiskettes and will include a printed copy of

the tabulated report. This annual reportshall be submitted prior to 1 April eachyear. If valid operational commitments(e.g., SSBN patrol cycle) delay receipt offinal exposure information for the previousyear until after 1 March, the annual reportshall be submitted within 30 days of the dateof receipt of final personnel exposureinformation. These reports shall besubmitted to:

Officer in ChargeNaval Dosimetry CenterNavy Environmental Health Center DetachmentBethesda, MD 20889-5614

(b) This report shall include thosepersonnel on board 31 December who have beenmonitored for exposure to ionizing radiationduring the previous calendar year whileassigned to the reporting activity.Dosimetry readings of 00.000 rem are requiredto be reported. If the individual was notmonitored for a given type of radiation or ifthe individual did not receive monitoring forinternal contamination leave the appropriatecolumn(s) blank.

(c) For badging periods that span 1January, the year in which the mid-point ofthe exposure period occurs shall be the yearin which the entire exposure for that periodis reported.

(3) Situational Report of PersonnelExposure to Ionizing Radiation.

(a) If a monitored individual istransferred, retires or terminatesemployment, prior to 31 December, aSituational Report of Personnel Exposure toIonizing Radiation shall be submitted onNAVMED Form 6470/1 in magnetic media formatby the individual's activity to the NavalDosimetry Center within 30 days of detachmentof the individual from the command, or within30 days of receipt of the individual's finalexposure information, whichever is later.Acceptable submission will be on 3.5 inchdiskettes and will include a printed copy ofthe tabulated report. (b) If a visitor at a naval facilityor an individual on temporary duty from anactivity which does not submit annual orsituational reports of personnel exposure toionizing radiation, is monitored for exposureto ionizing radiation, a situational reportof personnel exposure to ionizing radiation,submitted in magnetic media format, shall beprepared and forwarded to the Naval DosimetryCenter by the activity at which the exposurewas incurred, within 30 days of departure ofthe individual from the command or receiptof the individual's exposure information.

(c) The exposure reported on asituational report of personnel exposure toionizing radiation for an individualterminating or transferring shall be onlythat exposure for the year in which transferor termination occurs. Do not summarize theindividual's complete exposure history on asituational report.

5-7

(4) Situational Report of PersonnelExceeding Radiation Exposure Limits. Thisreport shall be submitted to Chief, BUMED,Attention: Undersea Medicine and RadiationHealth Division, as follows:

(a) If any individual (adultradiation worker, nonradiation worker, minor,declared pregnant woman, or member of thegeneral public) receives a total effectivedose equivalent in excess of the limitsspecified in Chapter 4, this report shall beforwarded on NAVMED Form 6470/1 within 30days from the determination of such exposure.Details explaining how the exposure wasreceived will be entered in the remarkssection of the form or as an attachment tothe report. The report may be submitted in amanual format. The report shall include:

(1) The individual's dose; and,(2) The levels of radiation and

concentrations of radioactive materialinvolved; and,

(3) The cause of the elevatedexposures, dose rates, or concentrations;and,

(4) The corrective actions takenor planned to ensure against a recurrence.

(b) If any individual receives atotal effective dose equivalent of more than5 rem (0.05 Sv), eye dose equivalentexceeding 15 rem (0.15 Sv), or a shallow doseequivalent of 50 rem (0.5 Sv) in a singleincident, BUMED, Undersea Medicine andRadiation Health Division, shall be notifiedimmediately by telephone and/or "IMMEDIATE"message. During "MINIMIZE," electricaltransmission by priority message isauthorized. A follow-up written report shallbe forwarded on NAVMED Form 6470/1 within 24hours from the determination of suchexposure. The Report may be submitted in amanual format.

(c) If an individual receives a totaleffective dose equivalent of more than 25 rem(0.25 Sv) or an eye dose equivalent of 75 rem(0.75 Sv), or a shallow dose equivalent of250 rad (2.5 Gy) in a single event, BUMED,Undersea Medicine and Radiation HealthDivision, shall be notified immediately bytelephone and/or "IMMEDIATE" message. During"MINIMIZE," electrical transmission bypriority message is authorized. A detailedSituational Report of Personnel ExceedingRadiation Exposure Limits furnishing allinformation available on the exposure, thereason for such exposure, the general statusof health and physical condition of theindividual and a summary of treatmentrendered or recommended, shall be submittedto BUMED, Undersea Medicine and RadiationHealth Division, at the earliest practicabletime following the exposure. In any event,this amplifying report must be submittedwithin 15 days after exposure. A copy ofthis report shall be placed in theindividual's health record as an addendum tothe NAVMED Form 6470/10.

(5) Instructions for Completion of NAVMEDForm 6470/1, Radiation Exposure Report inComputer Format. Data will be preparedaccording to the following specifications andformat:

(a) Three and a half inch (720kilobytes or 1.44 megabyte) diskettes usedfor submission shall be in PC format. Thediskette label shall include the followinginformation:

1) ANNUAL REPORT OF PERSONNELEXPOSURE TO IONIZING RADIATION

orSITUATIONAL REPORT OFPERSONNEL EXPOSURE TO IONIZINGRADIATION

(2) Name of Command, UIC(3) Command Point of Contact

(4) Telephone Number ifappropriate.

(b) Data submitted on magnetic mediawill be formatted in records of 113 characterlength. Each record is terminated with acarriage return and line feed. The data willbe arranged in each record according to theformat listed below:

Field1 Character columns 1 through 4

shall be blank.

2 Unit Identification Code: Enterthe 5 digit unit identificationcode of the reporting command incolumns 5 through 9.

3 Name: Enter the name as lastname, first name and middleinitial placing 1 space betweeneach and omitting any punctuationmarks, in columns 10 through 49.If necessary, limit the name to40 columns by truncation.

4 Social Security Number: Entereach individual's 9 digit SSN,without hyphens, in columns 50through 58. For personnel notpossessing a United States SocialSecurity Number, enter a pseudoSSN as: 800 for the first threedigits, the year, month, and dayof birth (i.e., 800-YY-MMDD).

5 Date of Birth: Enter theindividual's 4-digit year ofbirth in columns 59 through 62.Enter the month of birth incolumns 63 and 64. Use a leadingzero in any single digit entry,e.g., June 1956 would be enteredas 195606.

6 Occupational Code: Whereapplicable, enter the 2-digitoccupational code as described onthe reverse side of NAVMED Form6470/1 in columns 65 and 66.Individuals receiving exposurefrom more than one program shouldbe assigned the occupational codewhich represents their primarysource of exposure.

10: Nuclear Propulsion (Radiation Worker)11: Nuclear Propulsion (Non-

radiation Worker.)

5-8

12: Nuclear Propulsion (Visitor, not included in other Nuclear Propulsion Programs)

20: Nuclear Weapons (Radiation Worker)

21: Nuclear Weapons (Non-radiationWorker)

22: Nuclear Weapons (Visitor) 30: Diagnostic Radiology 31: Dental

32: Nuclear Medicine33: Radiation Oncology

40: Gamma Radiography 41: X-ray Radiography and

Accelerators of energies less than 10 MeV

42: Accelerators of energies greater than 10 MeV

43: RADIAC Calibration44: General Industrial sources

(moisture density meters, analytical x-ray sources, depleted uranium, electron microscopes, etc.)

50: Research 51: Research (Radioisotope) 90: Other

7 Exposure Date: Enter the year,month, and day, on which exposurebegan as follows: 4 digit yearin columns 67 through 70, monthin columns 71 and 72, and day incolumns 73 and 74, using aleading zero in any month or dayentry that is only a singledigit. In the same order andmanner, enter the year, month,and day exposure ended in columns75 through 82.

8 Shallow Dose Equivalent: Enterthe individual's shallow doseequivalent in mrem in columns 83through 87. This entry is skinshallow dose equivalent. Do notreport extremity shallow doseequivalent in this field. A 5digit format, excluding anydecimal point will be used. Useleading zeros to fill the entirefield. If not monitored, leavethe field blank. Zero exposuresmust be recorded.

9 Deep Dose Equivalent, Photon:Enter the individual's deep doseequivalent, photon using theabove described dose format, incolumns 88 through 92. If notmonitored, leave the field blank.Zero exposures must be recorded.

10 Deep Dose Equivalent, Neutron:Enter the individual's deep doseequivalent, neutron using theabove described dose format, incolumns 93 through 97. If notmonitored leave the field blank.Zero exposures must be recorded.

11 Committed Effective DoseEquivalent: Enter the

individual's committed effectivedose equivalent using the abovedescribed dose format, in columns98 through 102. If notmonitored, leave the field blank.Zero exposures must be recorded.

12 Total Effective Dose EquivalentThis Period: Enter the total offield 9, (deep dose equivalent,photon), field 10 (deep doseequivalent, neutron) and field 11(committed effective doseequivalent) using the abovedescribed dose format, in columns103 through 107. If notapplicable, leave the fieldblank. Zero exposure must berecorded.

13 Lifetime Total Effective DoseEquivalent: Enter the lifetimetotal effective dose equivalentof the individual as of the endof the reported period. A 6digit format excluding anydecimal point will be used.Leave the hundreds place blankfor exposures less than 100.000rem (1.0 Sv). Use the abovedescribed format in columns 108through 113 .

(6) Instructions for Completion of NAVMEDForm 6470/1, Report of Personnel Exposure toIonizing Radiation in Manual Format.

(a) In the heading of the form, checkthe two appropriate boxes to indicate whetherthe report is an annual report or asituational report and, whether it is areport of personnel exposure to ionizingradiation, or a report of personnel exceedingradiation exposure limits.

(b) Items 1 through 17.1 Enter name and address of

reporting activity.2 Enter UIC. Enter the 5 digit

Unit Identification Code ofthe reporting command. It isextremely important the UIC becorrect. The Naval RadiationExposure Registry is a UICbased database.

3 Enter calendar year reported.4 Enter date prepared.5 Enter name as currently

carried on rolls last name,first and middle initial, asappropriate. If necessary,limit the name to 40 columnsby truncation.

6 Enter individual's SSN. Forpersonnel not possessing aUnited States Social SecurityNumber, enter a pseudo SSN as:800 for the first threedigits, the year, month, andday of birth (i.e., 800-YY-MMDD).

7 Enter individual's year andmonth of birth. Enter theyear as 4 digits and the monthas 2 digits. For the monthof birth use the appropriate

5-9

digits from 01 for Januarythrough 12 for December. Forexample, an individual born inApril 1980 would have theentry 198004.

8 Enter the individual'soccupational code in which themajority of exposure occurred.

9 Enter year, month, and dayexposure was considered tohave started since lastreport, i.e, 19990101.

10 Enter year, month and dayexposure was considered tohave ended, i.e., 19991231.

11-16 Enter radiation doseequivalents received to threedecimal places, i.e., 03.450.Enter dose equivalentsevaluated as "zero" as 00.000.Do not use "Xs" or term"minimal." If the individualwas not monitored for aspecific type of radiationexposure (e.g., neutron),leave the field blank.

11 Enter skin shallow doseequivalent in rem. Do notreport extremity shallow doseequivalent in this field.Report extremity shallow doseequivalent in the remarkssection, block 17, or on aseparate page of the 6470/1.Clearly annotate as extremitydose.

12 Enter deep dose equivalent,photon, in rem.

13 Enter deep dose equivalent,neutron in rem.

14 Enter committed effective doseequivalent in rem.

15 Enter total effective doseequivalent for this period;sum of items 12, 13 and 14.This entry should normally beonly for the current calendaryear. Previous year'sexposure should have alreadybeen reported on prior annualreports.

16 Enter total lifetime doseequivalent in rem, enter to 6digits only if exposure isgreater than 99.999 rem.

17, 18, 19 Selfexplanatory.

(7) Naval Exposure Registry SummaryReport. By the end of the second quarter ofeach year the Naval Dosimetry Center shallprepare a summary report of the exposuresreceived from Navy and Marine Corps sourcesand forward the report to Chief, BUMED. Thereport shall include the total person-rem,exposure profiles in 100 mrem increments(number of people exposed per exposureincrement), and an exposure trend analysisfor Navy as a whole and by occupational code.The report shall also include the totalnumber of people exposed, the total number ofactivities reporting exposure and a narrativesummary of any exposures exceeding theexposure limits.

5-13. Retention, Disposition and Release ofInformation

(1) The DD Form 1141 and NAVMED Forms6470/10 and 6470/11 are permanent componentsof the individual's health record and shouldbe safeguarded as such; however, commandingofficers, authorized inspecting officials,and supervisors of persons occupationallyexposed to ionizing radiation or theindividual concerned may review the DD Form1141s and NAVMED Forms 6470/10 and 6470/11with the medical records custodian uponrequest. The medical records custodian mayexchange exposure data with installationsoutside the jurisdiction of the Department ofthe Navy for any persons occupationallyexposed at the installation upon writtenrequest, provided a release authorizationsigned by the exposed individual is forwardedwith the request.

(2) When a civilian employee is notincluded in a Federal civilian employeehealth care service, DD Form 1141 and NAVMEDForms 6470/10 and 6470/11 shall be maintainedas a permanent document in the employee'sofficial personnel folder.

(3) All available dosimetry results shallbe entered on NAVMED Forms 6470/10 and6470/11 as appropriate prior to transfer ofmilitary personnel. Dosimetry results notrecorded as of the date of transfer shall beforwarded to the individual’s next dutystation within 30 days of receipt of finalpersonnel exposure information.

(4) The DD Form 1141, and NAVMED Forms6470/10 and 6470/11 shall be permanentlyretained in the retired medical records of aservice member who has been monitored forexposure to ionizing radiation during hisservice. When a member is released fromactive duty or retires prior to his/herexposure information being entered in his/herhealth record, a dose transmittal withinstructions to enter the information in themedical record shall be forwarded forincorporation in the member's health record.For Navy and Marine Corps personnel, thedose transmittal should be forwarded to:

Department of Veterans AffairsVARMCP.O. Box 5020St. Louis, MO 63115-8950Tel: 1-800-827-1000/314-538-4500

(5) Copies of completed NAVMED Form6470/1, Situational and Annual Reports ofPersonnel Exposure to Ionizing Radiationshall be retained indefinitely.

(6) Exposure investigation reports shallbe retained indefinitely.

(7) Copies of Termination Letters shallbe retained for 5 years.

(8) Copies of NAVMED Form 6470/3 shall beretained for 5 years.

(9) Retain and dispose of other radiationhealth program documents per SECNAVInstruction 5212.5 series and applicableprogram radiological controls manuals.

5-10

5-14. Working Copy of NAVMED Form 6470/1.

(1) To maintain accurate NAVMED Form6470/10s and to submit accurate NAVMED Form6470/1s, a reliable record system isessential. It is suggested each activity'srecord system contain a working copy ofNAVMED Form 6470/1 on which is transcribedall required data from DD Form 1141 or NAVMEDForm 6470/10 on any persons transferred,terminated or retired during the month.Computer generated records are satisfactoryprovided either the source documents or aback-up copy exists. This data shall beupdated when the personnel dosimetry isprocessed and used to prepare the situationalreport. The working copy of the NAVMED Form6470/1 should be destroyed when the requiredsituational report is submitted.

5-15. Control of Radiation ExposureInformation for Nuclear Powered Warships andOperational Prototypes

(1) Selected forms and reports containingaggregated (more than one individual)radiation exposure for crews of nuclearpowered warships or operational prototypesgenerated on or after 01 January 1999 must bemarked as NOFORN and handled as unclassifiednaval nuclear propulsion information perNAVSEA Instruction C5511.32 series. Reportsincluded under this requirement are thesituational report (Form 6470/1), annualreport (Form 6470/1), and radiation exposurereport (Form 6470/3) when completed withexposure information.

(a) For SSN/SSBN platforms, all formsand reports containing aggregated radiationexposure information shall be handled asunclassified NNPI.

(b) For CVN platforms only, reportscontaining aggregated radiation exposureinformation for crewmembers involved inpropulsion plant operations shall be handledas unclassified NNPI. Forms and reports forcrewmembers not involved in propulsion plantoperations (e.g., medical and radiographypersonnel) remain unclassified and are not tobe controlled as NOFORN. Splitting reportsto create separate NOFORN and uncontrolleddocuments is not required or desired.

(2) Applicable forms and reports,including disk labels when forwardingelectronic copies, shall be marked andhandled per NAVSEA Instruction C5511.32series.

(3) Corrective action to mark hard copiesof forms and reports accumulated prior to 01January 1999 is not required. However, thismaterial should be otherwise safeguarded asNOFORN per NAVSEA Instruction C5511.32series.

(4) Forms and reports for specificindividuals only (6470/10 and 6470/11 formsin medical records and termination letters toindividuals), reports from non-nuclearpowered ships (including tenders), non-shipand non-prototype activities (e.g., shipyardsand IMAs), and reports that provide acompilation of exposure data without ship-specific identifiers, remain unclassified andare not to be controlled as NOFORN.

6-1

Chapter 6PERSONNEL DOSIMETRY

ArticleIntroduction .................................................... 6-1

Monitoring ...................................................... 6-2 Dosimetric Devices .............................................. 6-3 Lithium Fluoride (LiF) Thermoluminescent Dosimetry .............. 6-4

DT-648/PD Lithium Fluoride (LiF) Thermoluminescent Dosimetry Monitoring Program ............................................ 6-5Environmental and Area Monitoring ............................... 6-6Extremity Monitoring ............................................ 6-7Accident Dosimeter .............................................. 6-8Battlefield Dosimeters .......................................... 6-9

6-1. Introduction

(1) Personnel dosimetry is a techniquefor detecting and measuring an individual'sexposure to ionizing radiation. The Bureauof Medicine and Surgery requires navalactivities to maintain a dosimetry programfor personnel who receive occupationalexposure to ionizing radiation. Personneldosimetry is used to measure an individual'sradiation exposure and to aid in minimizingexposure. Personnel dosimetry has medical,epidemiological and legal significance andmust be conscientiously practiced by trainedpersonnel under competent supervision.

6-2. Monitoring

(1) Environmental Monitoring.Environmental monitoring shall be performedin areas accessible to the general public toverify members of the general public are notlikely to exceed a total effective doseequivalent of 100 mrem (1 mSv) per year andthe dose in any unrestricted area fromexternal sources does not exceed 2 mrem (0.02mSv) in one hour.

(2) Area Monitoring. Area monitoringshall be performed in areas accessible tonon-radiation workers to ensure nonradiationworkers do not exceed 500 mrem (5 mSv) peryear considering occupancy factors and sourceusage.

(3) Personnel Monitoring. Personnelmonitoring devices shall be worn by:

(a) All adult personnel who couldpotentially receive from sources external tothe body a dose in excess of:

Total Effective Dose Equivalent(Whole Body)................... 00.500 rem/yrShallow Dose Equivalent(Extremities).................. 05.000 rem/yrShallow Dose Equivalent(Skin)......................... 05.000 rem/yrEye Dose Equivalent(Eyes)..........................01.500 rem/yr

Sum of deep dose equivalentand committed dose equivalentfor any organ or tissue otherthan the lens of the eye(organ dose)....................05.000 rem/yr

If the dose to the eye is expected to be lessthan or approximately equal to the deep doseequivalent, then whole body monitoring may beused in lieu of a special device formonitoring the eye dose. For example, in

fluoroscopy a deep dose monitoring deviceworn at the collar to control deep dose bodyexposure will suffice to control the eyeexposure.

(b) All personnel entering a highradiation area (i.e., an area where theexposure rate is greater than 100 mrem (1mSv) per hour).

(c) Declared pregnant women who couldpotentially receive, from sources external tothe body, a dose in excess of 50 mrem (0.5mSv) to the embryo/fetus during the entirepregnancy.

(d) Minors who could potentiallyreceive in 1 year from sources external tothe body a dose in excess of 50 mrem (0.5mSv).

(e) Radiographers and radiographers'assistants as defined in Title 10, Part 34 ofthe Code of Federal Regulations in additionto a self indicating and alarming dosimeter.

(f) Any other personnel deemednecessary.

(4) Internal Monitoring. Internalmonitoring shall be performed on thefollowing personnel:

(a) Adults whose duties are expectedto exceed 10 percent of an ALI.

(b) Minors whose duties areexpected to exceed a committed effective doseequivalent of 50 mrem (0.5 mSv) in 1 year.

(c) Declared pregnant women whoseduties are expected to exceed a dose of 50mrem (0.5 mSv) to the embryo/fetus fromsources internal to the body during thecourse of the pregnancy.

6-3. Dosimetric Devices

(1) The type of dosimetric device ordevices used to measure personnel exposureshall be specified by the commanding officerand approved by Chief, BUMED. Unless othertypes of dosimetry are approved by Chief,BUMED, the dosimetry program shall be basedon dosimetry as described in this Chapter,and its use shall be under the cognizance ofthe designated radiation health/safetyofficer or senior medical representativepresent if no radiation health/safety officeris designated. Acceptable dosimetric devicesinclude: (1) personnel dosimeters, DT-526 orDT-648; (2) wrist badges, DT-526 or DT-648;(3) EXT RAD-100 finger ring dosimeter; singleLiF chips; (4) pocket dosimeters, IMSeries/PD; electronic dosimeter; (5)environmental and area monitoring dosimeters,DT-526, DT-648, DT-648 TLD cards in a BUMED

6-2

Area Monitor (BAM); (6) accident dosimeters,DT-518, DT-526, DT-648; and (7) battlefielddosimeters, DT-60 or DT-236. Organizationsassociated with the Naval Nuclear PropulsionProgram will perform dosimetry following theappropriate NAVSEA Radiological ControlsManual.

(2) Personnel Dosimeters. Personneldosimeters are used to monitor deep andshallow dose. Personnel dosimeters arenormally worn at the waist or chest. Inunique situations where an individual isexposed in a high gradient field or anindividual is expected to receive a partialbody exposure, the monitoring device shouldbe worn on or at the part of the body, e.g.,head, neck, upper arm or thigh, expected toreceive the highest exposure. Personneldosimeters provide a very sensitive, accurateand dependable indication of the exposure toan individual. Because of their sensitivity,accuracy, and dependability, these arereferred to as primary dosimetric devices.Lithium fluoride and calcium fluoridethermoluminescent materials are the sensitiveelements of the two primary Navy personneldosimeters, the DT-648 and DT-526respectively. Thermoluminescent dosimetry isbased on the measurement of radiation using acrystalline substance sensitive to radiationthat, when heated, produces light output thatis proportional to the amount of radiationexposure.

(3) Wrist Badges and/or Finger Rings areused to monitor extremities in specialsituations where a relatively high localexposure is expected. For certain specialsituations involving high level exposures,the wearing of wrist badges or finger ringscontaining thermoluminescent chips to measureradiation exposure to the extremities may berequired. (4) Pocket Dosimeters/ElectronicDosimeters. Pocket dosimeters are selfindicating devices used to monitor exposureto gamma or x-ray radiation in situationswhere an immediate indication of the exposureis desirable. Pocket dosimeters are pencilshaped devices containing a small ionizationchamber. These devices provide verysensitive and accurate indications of theexposure of the individual, however they aresusceptible to shock, dirt, moisture andother environmental factors which may producea false overresponse. Consequently, they areused as secondary dosimetry devices. Analternative to the pocket dosimeter is theelectronic dosimeter which is normallybattery powered, has a digital display ofintegrated dose and can be set to alarm at apreset dose or dose rate. Electronicdosimeters are used as secondary dosimetricdevices.

(5) Environmental and Area MonitoringDosimeters. Environmental and areamonitoring dosimeters are used at theperimeter of radiation areas or inuncontrolled spaces in conjunction withoccupancy factors to verify members of thegeneral public and nonradiation workers arenot exposed in excess of the limitsestablished in Chapter 4. They should not beposted in known high radiation areas or anyother restricted area. Specific program

requirements are in program radiologicalcontrols manuals.

(6) Accident Dosimeters. Accidentdosimeters are used to monitor areas orpersonnel in situations where very highexposure may occur as the result of anaccident. These dosimeters are less accuratethan personnel dosimeters but have a muchhigher range.

(7) Battlefield Dosimeters. Battlefielddosimeters are used to medically triagepersonnel to maximize viable personnelassets. These dosimeters are less accuratethan personnel dosimeters but have a muchhigher range.

(8) Special Purpose Dosimetry. Specialpurpose dosimetry is used to measure theexposure from unique or special sources,e.g., low energy x-rays, high energy protons,high energy heavy particles, very low or highintensity sources, etc., or to measurespecial radiation fields in unique or specialsettings. Dosimetry for special or uniquesituations may be obtained from the NavalDosimetry Center.

(9) For further information orclarification, technical or administrative,concerning naval personnel dosimetry contactthe Naval Dosimetry Center by telephone,letter or message:

Officer in Charge Naval Dosimetry Center Navy Environmental Health Center Detachment Bethesda, MD, 20889-5614

The Naval Dosimetry Center's Plain LanguageAddress for message traffic is:

NAVENVIRHLTHCEN DET BETHESDA MD.

The telephone numbers are:DSN: 295-0142/ 0403/ 6164

Commercial:(301)295-0142/0403/ 6164

TeleFax: (301)295-5981; DSN 295-5981

6-4. Lithium Fluoride (LiF) ThermoluminescentDosimetry

(1) General. Thermoluminescent dosimetryis the measure of radiation using acrystalline substance sensitive to radiation,that when heated, produces light output thatis proportional to the amount of radiationexposure. Ionizing radiation imparts energyto the substance that creates free electronsand hole pairs in impurities in the crystalstructure. When the irradiated substance isheated in a controlled manner, the electronsdeexcite and give off energy in the form ofvisible light. The total amount of light isproportional to the energy absorbed from theionizing radiation. (2) Lithium Fluoride Dosimeters. Thelithium fluoride thermoluminescent dosimeter,referred to as the LiF TLD, is capable ofdetecting beta, gamma, x-ray, and neutronradiation. LiF is extremely sensitive to lowlevel radiation exposure, includingbackground radiation.

6-3

6-5. DT-648 Lithium Fluoride (LiF)Thermoluminescent Dosimetry MonitoringProgram

(1) General. The DT-648 LiF TLD Dosimeteris designed to detect beta, gamma, x-ray andneutron radiation. This system has four LiFTLD chips on a card and is used with a blackbadge holder. The following paragraphsdescribe the use of the DT-648 for monitoringpersonnel and areas for ionizing radiation.The DT-648 is authorized for monitoringgamma, x-ray, beta, and neutron radiation.For neutron radiation monitoring with the DT-648, default energy correction factorsprovide a conservative dosimetry value andshould normally be applied. For situationswhere refined dosimetry values are needed,specific neutron energy spectra correctionfactors can be obtained from the NavalDosimetry Center.

(2) Initiation. To initiate personneldosimetry services, submit a letter requestto the Naval Dosimetry Center. The requestshould state the number of individuals to bemonitored, the source(s) and type(s) ofradiation to be monitored, the activity'sunit identification code (UIC), a desiredstarting date for dosimetry services, acomplete mailing address and name andtelephone number of a point of contact.Activities shall send requests via theirchain of command. Upon approval of therequest, the Naval Dosimetry Center willforward a package containing the necessaryequipment for initiating the program.

(3) Implementation and Use. Upon requestby an activity and approval by the NavalDosimetry Center, the following items will besent to the activity.

(a) A set of TLDs-quantity determinedper the activity's request;

(b) Twice the number of card holdersas TLDs-one set to wear, and one set to workwith when changing out the TLDs;

(c) Card holder openers;(d) Optional identification and

security stickers for the card holders;(e) Optional card holder clips;(f) A pad of report forms, "Radiation

Exposure Report, NAVMED Form 6470/3”;(g) External warning labels for TLD

card shipment containers;(h) 3.5 inch floppy computer disk;(i) A shipping list, and;(j) The Radiation Health Assistant

Program (RHA) on a set of computer disks.(4) The DT-648 Card. The TLD card

consists of four LiF:Mg, Ti TL elements ofdifferent thickness and composition mountedbetween two teflon sheets on an aluminumsubstrate. The TLD card holder covers eachTL chip with a filter providing differentradiation absorption thicknesses to allowevaluation of deep and shallow doseequivalents. Chips 1, 2 and 3 are Li-7,which is sensitive to photon and betaradiation. Chip 4 is Li-6, which issensitive to photon, beta and neutronradiation. The card also has a bar codeidentification label across the face. Thiscard, with four chips and bar codeidentification, shall be used only in theblack card holder for personnel monitoring;no other holder is authorized. See Figure 1.

(5) Factors affecting accuracy. The LiFTLD is not overly sensitive to environmentalextremes, and does not require cold storage.However, to achieve the most accurateresults, the following factors must beconsidered:

(a) LiF TLD cards should be keptclean. Spurious dose readings can result ifthe card is soiled or chemically stained.Each TLD card shall be carefully inspectedupon collection, and soiled cards cleanedprior to their return for processing. Cardsmay be cleaned locally using a soft spongemade damp with mild detergent and water, andthen rinsed with a clean, water dampenedsponge. Do not use chemical solvents orcleaning fluids on LiF TLD cards. Do notmark, write, or put tape on either side ofthe card. (b) Damaged cards, such as bent,broken, missing components, permanentlysoiled or stained, should be noted by acomment in the remarks section of thedosimetry report. The Naval Dosimetry Centercan repair most types of damage andaccurately evaluate the TLD provided thedamage is recognized before the card isprocessed.

(c) Sunlight and fluorescent lightcan, after prolonged exposure, induce falseTLD readings of up to 20 mrem (0.2 mSv).This is reported to occur if the TLD card isexposed to light for several hours whileremoved from the holder. Thus, bare LiF TLDcards should be stored in the dark when notin use.

(d) Static electricity or electricaldischarge has been reported to have causedspurious dose readings on LiF TLD cards. Thisoccurs only if the bare cards are subject tosuch treatment while removed from the holder.If it is suspected, include a comment in theremarks section of the dosimetry report.

(e) High ambient temperatures (over115 degrees F) can cause reduced sensitivityof the LiF TLD and may result in doseevaluations being as much as 25% low. If aLiF TLD is used where the ambient temperatureexceeds 115 degrees F on one or more daysduring the issue period, note in the remarkssection of the dosimetry report "TLD#____________ exposed for ____________ days totemperatures above 115 degrees F".

Figure 1: DT-648 Open holder with TLDcard inside

6-4

(f) The integrity of the card holderis critical to ensuring an accuratemeasurement. If a holder is damaged in a waythat compromises its ability to protect theTLD card (for example, if the mylar window istorn), it can allow the TLD card inside to bedamaged, exposed to light, or collect dirt.Each TLD holder shall be carefully inspectedprior to issue and upon collection. Adefective or damaged holder shall not beused. If a holder is discovered upon TLDcollection with damage that could haveaffected its ability to protect the TLD card,it shall be reported in the remarks sectionof the NAVMED Form 6470/3, indicating whichTLD card number corresponds to the damagedholder, and the nature of the damage.

(6) Card Holder and Opener.(a) The card is notched in one

corner, and the back of the card holder ismolded so the notched card can be orientedone way only to sit flat and facilitate easyclosure of the holder. With properorientation of the card, the holder will snapshut easily. If the holder does not closeeasily, check for misorientation of the frontand back of the holder, or for some otherobstruction.

(b) To open the holder, place theopener in the slot at the top of the holdervia the back, with the thumb depressor of theopener oriented toward the bottom of theholder, and press the opener to open theholder. Do not torque the opener in the slotof the card holder. See Figure 2 for properopener orientation. Improper orientationwill make opening impossible.

(7) Wearing the DT-648. The holder withthe card enclosed should normally be worn onthe front of the trunk of the body.Attachment to the front of the body can beaccomplished by one of two methods (shown inFigure 3):

(a) The belt loops on the back of thecard holder can be used to place it on abelt; for neutron monitoring, this is theonly method authorized;

(b) An attachable strap can be usedto attach it to a pocket flap or lapel. Ineither of the two methods, the badge holdermust be positioned so the front of the holderis facing away from the body.

(8) Issuing TLDs(a) In general, LiF dosimeters are

issued for a period of 6 to 7 weeks (twiceper quarter). The first issue period of thecalendar year shall normally begin inJanuary. The Naval Dosimetry Center willforward a new batch of TLDs every 6 weeks.These TLDs shall be issued (a new issueperiod begun) as soon as practicable afterreceipt, but in no case later than the dateindicated on the shipping container. Do notmix TLD batches. All TLDs used during anissue period should be from the same batch.Inspect the TLDs upon receipt to ensure theserial numbers match those on the enclosedshipping list, and no damage has occurred intransit. Information required on thedosimetry reports shall be entered accordingto instructions on the reverse side of theforms or instructions in this manual,whichever is the more current. (Activitiesusing a BUMED approved computer program shallfollow the instructions provided in theprogram.) Special care must be taken toensure the names of the individuals receivingthe dosimeters are properly recorded, and thecorrect radiation type code and occupationalcode are assigned (see back of NAVMED Form6470/3) to ensure proper processing and doseassignment. The issue period for the DT 648LiF TLD shall be six to seven weeks (i.e.,twice per quarter), except as provided below:

(1) For personnel asigned tofleet ballistic missile submarines, the issueperiod shall be for the duration of a patrolcycle. For personnel assigned to fast attacksubmarines, LiF TLDs may be issued on a notto exceed calendar quarterly basis.

(2) Personnel in the dosimetryprogram have an ongoing need for monitoringand most are issued a LiF TLD for the entireissue period, to include absences from thecommand during the issue period (for example,leave). For personnel issued a TLD after thestart of the issue period, or who turn in aTLD before the end of the issue period (forexample, due to transfer or termination), theissue and collection dates should reflect theactual period of issue. For personnel who areissued a LiF TLD for a particular job of lessthan 6 weeks duration or started during theregular issue period, the issue period shouldbe for the duration of the time the TLD isactually issued to the individual for thejob. For example, if the individual isissued a TLD on the 11th of the month, and

Figure 3. DT-648 DT-648 TLD shown properusage at the waist and chest.

Figure 2. DT-648 Opener properly insertedinto the holder for opening.

6-5

the same TLD is collected from the individualon the 23rd of the same month, the issueperiod is from the 11th to the 23rd of themonth. A LiF TLD collected before the end ofthe issue period shall not be separated fromthe rest of the cards in issue; it should notbe sent under separate cover from the batchit was shipped in; it should be kept with therest of the batch until ready for submissionto the Naval Dosimetry Center. If anindividual is issued a TLD at some other timethan the start of the issue period and theindividual's jobs will involve exposure forthe rest of the period, then the issue periodshall be from the time of issue to the end ofthe period, including periods of leave.

(3) For personnel suspected ofhaving exceeded an exposure limit, their LiFTLD and two control TLDs from the same batchshall be submitted for evaluation as soon aspracticable. Submission of the TLDs shouldbe coordinated with the Naval DosimetryCenter to ensure receipt and promptprocessing.

(b) The issue period for postedenvironmental or area dosimeters, DT 648TLDs, shall be the same as that used forpersonnel.

(c) The issue period will be startedor stopped to allow an individual's radiationexposure record to be updated quarterly. Thedefinition of a calendar quarter is given inChapter 1 of this manual.

(d) If replacement dosimeters are notavailable at the end of the normal issueperiod, the issue period may be extendeduntil new dosimeters are available. However,if an extension of the normal 6 to 7 weekissue period is necessary, the NavalDosimetry Center shall be notified by messageto alert the Dosimetry Center to potentialshipping and/or TLD exchange problems. Areturn response will not be sent unlessrequested. LiF TLDs shall not be kept forgreater than 150 days without Naval DosimetryCenter approval.

(9) Collecting and Submitting TLDs forProcessing

(a) At the end of the issue period,all personnel and posted/area dosimeter TLDsshall be collected, the cards removed fromtheir holders and placed in the samenumerical order as they appear on the reportform, NAVMED Form 6470/3. (Activities usinga BUMED approved computer program need notplace the cards in any specific order if thisreport is submitted on magnetic media.) Thecards shall be submitted to the NavalDosimetry Center within five working daysafter collection unless otherwise approved byBUMED. All dosimeters from the same shipmentbatch shall be returned together.

(b) When removing the LiF TLD cardfrom its holder, observe any change inorientation from the designed orientation andif the TLD card has been rotated or put inupside down, note the change in orientationin the remarks section of the NAVMED Form6470/3. Damage to the TLD card, damage tothe holder that affects its ability toprotect the TLD card, or any unusualoccurrence associated with the TLD cardduring the issue period shall be recorded inthe Remarks section of the NAVMED Form

6470/3. Dirty cards shall be cleaned perparagraph 6-5(5)(a). (c) TLD cards shall be packed in theshipping container to maintain order. Cardsmay be secured in the shipping container byfilling voids with packing material. Do notwrap the cards or use adhesive tape or rubberbands that contact the cards.

(d) Forward an original dosimetryreport, NAVMED Form 6470/3 (see Appendix Afor sample) with each submission. Eachshipment shall be sent via traceable means,e.g., certified mail. Each shipment of TLDssent from the Dosimetry Center should containa printed list of card serial numbers in thatshipment; this list should be returned withthe shipment when sent to the DosimetryCenter for evaluation. If an entire shipmentis being returned to the Dosimetry Centerunused, the shipment shall be accompaniedwith a memorandum indicating the TLDs wereunused.

(e) If a DT-648 is used for researchor other purposes so it received a dosegreater than five rem, it shall be segregatedfrom the personnel monitoring TLDs and markedfor special processing. This precaution isto preclude high dosed TLDs being mistakenfor personnel monitoring dosimeters. Inaddition, if the dosimeters have been dosedin excess of 100 rads then that should beindicated. Processing DT-648 dosimetersdosed in excess of 500 rads requires specialadjustments to the processor to preventdamage and loss of glow curve information.

(10) Control LiF TLDs. The purpose ofsubmitting control dosimeters with eachsubmission group to be evaluated is todetermine the amount of radiation the TLDsreceive from background while they are intransit or being stored. As such, controlTLDs should be stored with the unused cardsin a background area, away from any existingman made radiation sources.

(a) Two control LiF TLD cards, whichmust be from the same batch as the issuedTLDs, shall be included and designated ascontrol cards in each submission forevaluation.

(b) Exposure from control TLDs issubtracted from the personnel/posteddosimeter exposure readings at the NavalDosimetry Center. The value of the controllisted on the exposure report form is rawexposure; the exposure listed forpersonnel/posted/area dosimeters is the netexposure of the card i.e., gross cardreadings minus the background exposure. (11) Storage of LiF TLDs

(a) When issued personneldosimeters are not being worn, they should bestored in a low background area, i.e., anarea where the dosimeters are not beingexposed to manmade radiation sources.Likewise, control and unissued LiF TLD cardsshall be stored in an area removed from man-made radiation sources. (b) Do not stockpile batches ofTLDs. Maintaining more than one set of TLDcards is not authorized. (12) Dosimetry Report Forms. The formused with the DT-648 dosimeter is theRadiation Exposure Report NAVMED Form 6470/3.The reverse side of the form has detailedinstructions on how to prepare the

6-6

report for submission. After the LiF cardsare evaluated, a report will be completed bythe Naval Dosimetry Center and returned tothe submitting activity. A copy of NAVMEDForm 6470/3 is contained in Appendix A.

(13) Changes to Program. Changes to thelocal dosimetry program shall be communicatedto the Naval Dosimetry Center by letter ormessage. Examples of the types of changesthat should be communicated are:

(a) Large changes in the number ofpersonnel monitored;

(b) Problems that affect yourprogram;

(c) Temporary or permanenttermination of the requirement for dosimetryservices;

(d) Address or UIC change.(14) Security and Identification

Stickers. These items are for optional usedetermined by the customer.

(a) After the TLD card is loaded intothe black holder, an optional gray stickerstating "USN Do Not Remove" may be placed inthe slot at the top of the badge holder toprevent tampering. The tape cannot beremoved without destroying the tape,indicative the holder may have been opened.The wearer shall be instructed not to attemptto open the holder, as the card holder may bedamaged or the card misoriented.

(b) The optional identificationsticker may be placed on the engraved sectionof the front of the black card holder. Theuse of different color stickers per issueperiod can assist in collection anddistribution of the dosimeters. Theidentification label must never be placeddirectly onto the LiF card. Adhesive residuewill alter the signal produced by the LiFchips when heated, producing an erroneousreading. In addition, do not write anyinformation, i.e., the wearer's name, on theLiF card.

(c) The silver mylar window on thebadge holder may become damaged or dislodgedon rare occasion. If so, round silver mylarwindow replacements are available from theNaval Dosimetry Center upon request. Thedamaged window cover should be completelyremoved before replacing it with a new one.If the round silver mylar replacement is notavailable at the time of need, the gray "USNDo Not Remove" sticker can be used in theinterim. Remove the damaged window and placea portion of the gray sticker on the insideof the badge holder with the adhesive facingout, covering the opening of the window.Damage to the window does not require asubsequent dose estimate to be performed.

(15) Suspension of Dosimetry Program.Commands may temporarily suspend personneldosimetry during upkeep or overhaul periodsas deemed operationally appropriate. If theNaval Dosimetry Center provides the dosimetrydevices, indicate the projected date ofprogram suspension to the Naval DosimetryCenter by letter. Reactivation of thepersonnel dosimetry program will requirewritten communication with the NavalDosimetry Center.

(16) Termination of Dosimetry Programs.To permanently terminate an existingpersonnel dosimetry program, submit a letterto the Naval Dosimetry Center stating thecommand name, UIC, and projected terminationdate. With the submission of the final issueof personnel dosimetry devices, include allunused/recovered TLDs, TLD holders, holderclips, and openers. Upon receipt of thefinal exposure information, forward aSituational Report of Occupational Exposure,NAVMED 6470/1, with remarks in block 17indicating the program has been discontinued.

(17) Decommissioned Vessels and Commands.Personnel radiation exposure recordsincluding annual and situational reports,exposure investigations, worksheets, charts,calibration results and statistical summarieswill be disseminated per SECNAVINST 5212.5series.

6-6. Environmental and Area Monitoring

(1) The DT-648 can be used as aphoton/beta monitor or a gamma/neutronmonitor.

(a) The DT-648 card placed in itsblack holder can be used as a photon/betaposted dosimeter. No special mounting orphantom is required; however, the deviceshall be oriented so the front of the cardholder faces the radiation source. The term"posted" is used with this type ofmonitoring.

(b) The DT-648 card placed in apolyethylene cylinder, which is essentiallythe same size and internal design as anAN/PDR-70, constitutes a gamma/neutron areamonitor to monitor gamma and neutronradiation. This area monitor, designated asthe BUMED Area Monitor (BAM) consists of thepolyethylene cylinder with a drawer thatholds two cards, totally encased in analuminum box for mounting and protection. Itmay be used in areas where the neutron energyspectrum is not known. The BAM is the onlydevice authorized for neutron areamonitoring. The area monitor should bemounted, either by bolting or gluing, so oneof the four larger surfaces faces the neutronsource, and the drawer is in the horizontalplane. The drawer is manually removed whenunlocked and two LiF TLD cards are insertedso the notched corners of the cards alignwith the positioning guide in the drawer. Aspecial drawer is needed for use with a DT-648 area monitor. When correctly inserted,one card will have the I.D. number side down,and the other the I.D. number side up withthe six digit serial number visible (seeFigure 4).

6-7

After positioning the cards, slowly slide thedrawer into the phantom, close and lock. Theserial numbers of the two cards must berecorded in columns 5 and 6 on the NAVMEDForm 6470/3, with one serial number enteredin column 5 and the other entered in column6. Order is unimportant. The term "areamonitor" is to be used only with thepolyethylene cylinder. Activities requiredto perform neutron area monitoring mayrequest the BAM from the Naval DosimetryCenter.

6-7. Extremity Monitoring

(1) A limited number of personnel,particularly those in nuclear medicine,radiation therapy and some industrialapplications, handle large quantities ofradioactive substances in the routineperformance of their job. To assureappropriate radiation protection practicesare followed and to evaluate exposure toextremities, the Naval Dosimetry Centerprovides and evaluates the EXT RAD-100 fingerring dosimeter (see Figure 5). Finger ringservice may be obtained upon request to theNaval Dosimetry Center, stating therequirement, number of personnel to bemonitored, location of the dosimeter on theindividual, radioactive materials beinghandled and other pertinent information. TheEXT RAD-100 is normally evaluated forexposure to photons only. Evaluation forbeta exposures may be performed upon request.Instructions for handling and use of the EXTRAD-100 are provided to the customer uponapproval of program implementation by theNaval Dosimetry Center.

6-8. Accident Dosimeter

(1) The DT-518/ PD accident dosimeter(Figures 6 and 7) is a passive dosimeterwhich may be mounted on bulkheads or onpersonnel badges.

Figure 4. BUMED Area Monitor(BAM) (top) with plastic drawershowing the placement of 2 DT-648 TLD cards (bottom)

Figure 5. EXTRAD-100 Finger ringthermoluminescent dosimeters at variousstages of assembly.

Figure 6. Illustration of the DT-518/ PDaccident dosimeter with retaining rings anddetector capsule.

Figure 7. Photograph of the DT-518/ PDaccident dosimeter. The scale shown isin inches.

6-8

The DT-518 contains sulfur pellets, an indiumfoil, and thermoluminescent powder. The twosulfur pellets and indium foil are used forneutron dose determination. Thethermoluminescent powder is used for gammadose determination. The sulfur pellets andindium foil are also contained in the endcapsof the DT-526/ PD.

In the event of a high dose (accident dose)the DT-518 accident dosimeter shall be sentto the Naval Dosimetry Center for readout.The technical manual for the DT-518 accidentdosimeter is NAVELEX 0967-LP-133-1010.

The DT-518 accident dosimeter measuresneutron exposures from 10 to 50,000 rad andgamma ray doses from 1 to 10,000 rad.

6-9. Battlefield Dosimeters

(1) The DT-60 Navy battlefield dosimeter(Figure 8) is a passive dosimeter that uses asilver phosphate glass that darkens withexposure to high-energy gamma and thermalneutron irradiation. The dosimeter is housedin a black plastic case that is sealed with arubber gasket.

The DT-60 is read in the CP-95/PD Reader.The CP-95/PD has an electronic computerindicator that runs on 110V, 60 Hz AC power.This reader is calibrated for gamma exposure.The CP-95 Reader has two scales that readoutin roentgen (R) (0-200 R, 0-600 R).

(2) The DT-236 Marine Corps battlefielddosimeter (Figure 9) is designed to measureshort duration, high intensity neutron andprompt gamma radiation. The dosimeter uses awide based silicon junction diode to measureneutron radiation and a silver activatedphosphate glass to measure gamma radiation.The elements are encased in a tamperresistant locket worn on the wrist.

The DT-236 is read with the AN/PDR-75 RADIACset. The reader is powered by a 24 Volt DCsource and uses a single digital readout todisplay the combined gamma and neutron doseranging from 0 to 1000 rad. The reader takesnon-destructive readings as often as desired.

The DT-236 can be used over a widetemperature range (-32o C to +52o C) andwithstands all military environmentalrequirements e.g. shock, vibration, nuclearhardness and decontamination.

Figure 8. DT-60 battlefield dosimeter.(Top: Opener, Left: Unopened, Right:Disassembled).

Figure 9. Marine Corps DT-236 battlefielddosimeter; (Top: On wristband, Bottom:Opened up).

7-1

Chapter 7STORAGE, HANDLING AND DISPOSAL

ArticleIntroduction ............................................... 7-1Surveys .................................................... 7-2Access Control of Areas .................................... 7-3Area Posting Requirements .................................. 7-4Labeling of Containers ..................................... 7-5Storage and Control of Radioactive Material ................ 7-6Transportation, Receipt, and Reporting of Lost Radioactive Material...................................... 7-7Waste Disposal ............................................. 7-8

7-1. Introduction

(1) The storage, handling, transportationand disposal of radioactive material will becontrolled so personnel will not be exposedto radiation unnecessarily and any exposuresreceived will be maintained as low asreasonably achievable.

(2) The Director, Naval NuclearPropulsion Program is responsible forprescribing and enforcing standards andrequirements for control of radiation andradioactivity associated with the NavalNuclear Propulsion Program (Executive Order12344 of 1 Feb 1982). The requirements ofthis Chapter do not apply to the NuclearPropulsion Program. Naval nuclear propulsionactivities shall follow the requirements ofthe applicable NAVSEA Radiological ControlsManual.

7-2. Surveys

(1) Activities shall perform appropriatesurveys to evaluate the extent of radiationlevels, concentrations or quantities ofradioactive material and the potentialradiological hazards present to ensurecompliance with the exposure limits inChapter 4.

(2) The activity shall ensure instrumentsand equipment used for quantitative radiationmeasurements, e.g., dose rate and effluentmonitoring instruments are calibratedperiodically for the radiation measured.

(3) The following survey records shall bemaintained indefinitely:

(a) Reports of surveys used toevaluate the release of radioactive materialto the environment.

(b) Surveys indicating significantcontaminating events, e.g., contamination ofan area so that:

(1) If an individual had beenpresent for 24 hours, the individual couldhave received an intake greater than 5 timesan ALI.

(2) It caused access to the areato be restricted for greater than 24 hours,other than to allow an isotope with a half-life of less than 24 hours to decay prior todecontamination.

(c) Surveys used to determineestimates of personnel exposure.

(d) Surveys used to demonstratecompliance with the dose limits for non-radiation workers.

(e) Surveys used to demonstratecompliance with the dose limits for minorsand declared pregnant women.

(f) Surveys used to demonstratecompliance with the dose limits forindividual members of the general public.

(4) Other survey records shall bemaintained for at least 3 years following thedate of the survey.

7-3. Access Control of Areas

(1) Unrestricted Area. Access to anunrestricted area shall not be limited orcontrolled by the activity.

(2) Radiation Area. Access to radiationareas shall be controlled to preventinadvertent entry by unauthorized personnel.

(3) High Radiation Area.(a) Personnel will not be allowed

access to high radiation areas unlessappropriate dosimetric devices are wornfollowing the criteria established in Chapter6.

(b) One or more of the followingaccess controls will be implemented. Thecontrols shall be implemented in a way thatdoes not prevent individuals from leaving ahigh radiation area.

(1) A control device that, uponentry into the area, causes the level ofradiation to be reduced below that level atwhich an individual might receive a deep doseequivalent of 100 mrem (1 mSv) in 1 hour at30 centimeters from the radiation source orfrom any surface from which the radiationpenetrates;

(2) A control device thatenergizes a signal so the individual enteringthe high radiation area and the supervisor ofthe activity are made aware of the entry; or

(3) Entryways that are locked,except during periods when access to theareas is required, with positive control overeach individual entry. Locked entryways mustnot prevent emergency exit.

(c) Control devices such asinterlocks and visual or audible alarms mustnever be bypassed.

(d) Control of entrance or access torooms or other areas in a hospital is notrequired solely because of the presence ofradiation sources or patients containingradioactive material, provided there arepersonnel in attendance who will take thenecessary precautions to prevent the exposureof individuals to radiation or radioactivematerial in excess of the limits establishedin Chapter 4 and to operate within the ALARAprovisions of the Radioactive Material Permitand the activity's radiation protectionprogram.

7-2

(4) Very High Radiation Areas. Adequatecontrols in addition to those for a highradiation area shall be implemented to ensurean individual is not able to gainunauthorized or inadvertent access to areasin which radiation levels could beencountered of 500 rads or more in 1 hour(8.33 rads per minute) at one meter from aradiation source or any surface through whichthe radiation penetrates.

(5) Contaminated Areas. Control measuressuch as monitoring, decontamination andisolation should be used to prevent spread ofcontamination to an uncontrolled area and toprotect personnel in the contaminated area.If protective clothing is required, provisionfor donning and removing the protectiveclothing and masks should be available at thepoint of entry and egress to the contaminatedareas.

(6) Reporting Requirements for Loss ofAccess, Damage due to Property or PersonnelInjury. An activity shall report to theChairman, Naval Radiation Safety Committee(OPNAV N-45) and Chief, BUMED (MED-21):

(a) Immediately by telephone or"IMMEDIATE" message but not later than 4hours after the discovery of an event thatrequires immediate protective actionsnecessary to avoid exposures to radiation orradioactive materials that could exceed thelimits in Chapter 4.

(b) Within 24 hours by telephone or"IMMEDIATE" message:

(1) Of a contaminating event thatrequires restricted access to the area byworkers or the public for more than 24 hoursby imposing additional radiological controlsor by prohibiting entry into the area.

(2) Of a contaminating event thatinvolves more than five times the ALI of thelowest inhalation class of an isotope.

(3) Of a contaminating event thathas access to the area restricted for areason other than to allow isotopes with ahalf-life of less than 24 hours to decayprior to decontamination.

(4) Of an event that requiresunplanned medical treatment at a medicalfacility of an individual with spreadableradioactive contamination on the individual'sclothing or body.

(5) Of a fire involving more thanfive times the ALI of the lowest inhalationclass of an isotope.

7-4. Area Posting Requirements

(1) Unrestricted Area. There are noposting requirements.

(2) Radiation Area. Radiation areasshould be posted conspicuously with signsbearing the standard radiation symbol and thewords "CAUTION RADIATION AREA." Additionalprecautions or information such as "NoLoitering," "No bunking," stay-time limits,or radiation levels may be added to thesigns.

(3) High Radiation Area. High radiationareas shall be posted conspicuously withsigns bearing the standard radiation symboland the words "CAUTION HIGH RADIATION AREA,""NO ENTRY BY UNAUTHORIZED PERSONNEL."Additional precautions, stay-time limits, orradiation levels may be included.

(4) Very High Radiation Area. Theentrance to a very high radiation area shallbe posted with a conspicuous sign or signsbearing the standard radiation symbol andwords "GRAVE DANGER, VERY HIGH RADIATIONAREA."

(5) Airborne Radioactivity Area.Airborne radioactivity areas shall be postedconspicuously with signs bearing the standardradiation symbol and the words "CAUTIONAIRBORNE RADIOACTIVITY AREA."

(6) Exceptions to the PostingRequirements

(a) Posting of caution signs in areasor rooms containing radioactive material isnot required if the radioactive material ispresent for periods of less than 8 hours, andis constantly attended during these periodsby an individual who takes the precautionsnecessary to prevent the exposure ofindividuals to radiation or radioactivematerials in excess of the limits establishedin Chapter 4.

(b) Rooms or other areas in hospitalsthat are occupied by patients are notrequired to be posted with caution signsprovided:

(1) The patient is being treatedwith sealed sources or has been treated withunsealed radioactive material in quantitiesless than 30 millicuries, or the measureddose rate at 1 meter from the patient is lessthan 5 mrem (0.05 mSv) per hour; and

(2) There are personnel inattendance who will take the necessaryprecautions to prevent the exposure ofindividuals to radiation or radioactivematerial in excess of the limits establishedin Chapter 4 and to operate within the ALARAprovisions of the activity's radiationprotection program.

(c) A room or area is not required tobe posted with a caution sign because of thepresence of a sealed source provided theradiation level at 30 centimeters from thesurface of the source container or housingdoes not exceed 5 mrem (0.05 mSv) per hour.

7-5. Labeling of Containers

(1) Each activity shall ensure eachcontainer of licensed material bears adurable, clearly visible label bearing theradiation symbol and the words "CAUTION,RADIOACTIVE MATERIAL." The label must alsoprovide sufficient information (such as theradionuclide(s) present, an estimate of theactivity, the date on which the activity wasestimated, radiation levels, and kinds ofmaterials) to permit individuals handling orusing the containers, or working in thevicinity of the containers, to takeprecautions to avoid or minimize exposures.

(2) Each activity shall, prior to removalor disposal of empty uncontaminatedcontainers to unrestricted areas, remove ordeface the radioactive material label orotherwise clearly indicate that the containerno longer contains radioactive materials.

(3) An activity is not required to labelcontainers:

(a) Holding radioactive material inquantities less than the quantities listed inAppendix C to Paragraphs 20.1001 through

7-3

20.2401 of Title 10, Part 20, Code of FederalRegulations; or,

(b) Holding radioactive material inconcentrations less than those specified inTable 3 of Appendix B of Paragraphs 20.1001through 20.2401 of Title 10, Part 20, Code ofFederal Regulations; or,

(c) Attended by an individual whotakes the precautions necessary to preventthe exposure of individuals in excess of thelimits listed in Chapter 4; or,

(d) In transport and packaged andlabeled per the Department of Transportation;or

(e) Used and accessible only byauthorized individuals.

7-6. Storage and Control of RadioactiveMaterials

(1) General. Activities shall preventthe unauthorized removal or access toradioactive materials that are stored incontrolled or unrestricted areas; and, shallcontrol and maintain constant surveillance ofradioactive material that is in a controlledor unrestricted area and that is not instorage.

(2) Nuclear Regulatory CommissionLicensed Radioactive Material. Specificregulations covering the possession and useof Nuclear Regulatory Commission (NRC)licensed radioactive materials are containedin the Code of Federal Regulations, Title 10.The Navy has been issued a specific licenseof broad scope by the NRC which authorizesthe Naval Radiation Safety Committee tocontrol the possession, use, storage, anddisposal of radioactive materials. TheCommittee will grant individual activities aNaval Radioactive Material Permit (NRMP) forthe use of NRC licensed, naturally occurring,and accelerator produced material in responseto an application made by OPNAVINST 6470.3.Advice and assistance is available from theappropriate technical support center aslisted in OPNAVINST 6470.3.

(3) Transfer and Accountability.Radioactive material controlled by an NRMPmay be transferred only to persons currentlyholding a state license or registration, NRClicense or NRMP to possess the specific typeand quantity of material.

7-7. Transportation, Receipt, and Reportingof Lost Radioactive Material

(1) Transportation. Transportation ofradioactive materials should be by applicableportions of the following regulations ordocuments:

(a) Title 49 CFR Parts 171-179Department of Transportation regulations forshipment by rail or highway.

(b) Title 14 CFR Part 103 FederalAviation Agency regulations for shipment byair.

(c) Title 26 CFR Part 146-U.S. CoastGuard regulations for shipment by water.

(d) Title 39 CFR Part 15-U.S. PostalRegulation for shipment by mail.

(e) NAVSUP PUB 505 Packaging andHandling of Dangerous Materials forTransportation by Military Aircraft.

(2) Procedures for Receiving and OpeningPackages

(a) Each activity who expects toreceive a package containing quantities ofradioactive material in excess of a Type Aquantity, as defined in Paragraph 71.4 andAppendix A to Part 71 of Title 10 Code ofFederal Regulations shall make arrangementsto receive:

(1) The package when the carrieroffers it for delivery; or

(2) Notification of the arrival ofthe package at the carrier's terminal and totake possession of the package expeditiously.

(b) Each activity shall monitor theexternal surfaces of a package known tocontain radioactive material for radioactivecontamination and radiation levels if thepackage:

(1) Is labeled as containingradioactive material; or

(2) Has evidence of potentialcontamination, such as packages that arecrushed, wet, or damaged.

(c) Each activity shall perform themonitoring required by paragraph (b) of thissection as soon as practicable after receiptof the package, but not later than 3 hoursafter the package is received at theactivity's facility if it is received duringthe activity's normal working hours, or notlater than 3 hours from the beginning of thenext working day if it is received afternormal working hours.

(d) The activity shall immediatelynotify the final delivery carrier, Chairman,Naval Radiation Safety Committee (OPNAV N45)and Chief, BUMED (MED-21) by telephone ormessage when:

(1) Removable radioactive surfacecontamination exceeds the limits of Paragraph71.87 of Title 10, Code of FederalRegulations; or

(2) External radiation levelsexceed the limits of Paragraph 71.47 of Title10, Code of Federal Regulations.

(e) Each activity shall establish,maintain, and retain written procedures forsafely opening packages in which radioactivematerial is received and ensure dueconsideration is given to specialinstructions for the type of package beingopened.

(3) Loss or Theft of Radioactive Material(a) Each activity shall report by

telephone or "IMMEDIATE" message to theChairman, Naval Radiation Safety Committee(OPNAV N-45) and Chief, BUMED (MED-21),immediately after its occurrence becomesknown, any lost, stolen, or missingradioactive material in an aggregate quantityequal to or greater than 1,000 times thequantity specified in Appendix C toParagraphs 20.1001 through 20.2401 of Title10 Part 20 of the Code of Federal Regulationsunder such circumstances it appears to theactivity an exposure could result to personsin unrestricted areas. A written reportshall follow within 30 days.

(b) Each activity shall report within30 days after the occurrence of any lost,stolen, or missing radioactive materialbecomes known to the activity in a quantityequal to or greater than 10 times thequantity specified in Appendix C to

7-4

Paragraphs 20.1001 to 20.2401 of Title 10Part 20 of the Code of Federal Regulations.

(c) The written report shall containthe following information:

(1) A description of the licensedmaterial involved, including kind, quantity,and chemical and physical form; and,

(2) A description of thecircumstances under which the loss or theftoccurred; and,

(3) A statement of disposition, orprobable disposition, of the radioactivematerial involved; and,

(4) Exposures of individuals toradiation, circumstances under which theexposures occurred, and the possible totaleffective dose equivalent to persons inunrestricted areas; and,

(5) Actions that have been takento recover the material; and,

(6) Procedures or measures thathave been, or will be, adopted to ensureagainst a recurrence of the loss or theft ofradioactive material.

(4) Management of Irradiated orContaminated Personnel Informationconcerning management of irradiated orcontaminated personnel including personneldecontamination procedures may be obtainedfrom BUMEDINST 6470.10 series or theappropriate NAVSEA Manual or from theTechnical Support Centers listed in OPNAVINST6470.3.

7-8. Waste Disposal

(1) Improper disposal of radioactivewaste presents potential hazards to thepublic. Regulations issued by the NuclearRegulatory Commission contain certainrequirements which must be met by personsdisposing of radioactive material which hasreached the end of its useful life. TheNaval Radiation Safety Committee hasestablished a centrally managed low levelradioactive waste (LLRW) disposal programthat uses an interservice support agreementwith the Department of the Army forconsolidation, compaction and burial of LLRW.Navy and Marine Corps activities shall usethis program for radioactive waste disposalunless an alternate method is authorized bytheir Naval Radioactive Materials Permit(NRMP) or by the Chairman, Naval RadiationSafety Committee (OPNAV N-45).

(a) Procedures. Commands shalldispose of radioactive material per Title 10Code of Federal Regulations and their NRMP.

(1) Activities shall dispose ofradioactive material by:

(a)Transfer to a NuclearRegulatory Commission authorized recipient;

(b) Decay in storage; or(c) Release in effluents

within the limits of Paragraph 20.1301 ofTitle 10 Part 20, Code of FederalRegulations. (2) Materials which cannot be disposed ofby the above methods shall be disposed of byusing the LLRW disposal program. Thetechnical support center conducting thisprogram is NAVSEA Detachment, RadiologicalAffairs Support Office (NAVSEADET RASO),Yorktown, VA. Radiation safety officersshall contact RASO directly for procedures

and instructions. Do not ship radioactivematerials for disposal without RASOauthorization.

(3) Navy and Marine Corps personnel areprohibited from accepting radioactivematerial from civilians, civilianinstitutions or other Government agencies forthe purpose of waste disposal.

(b) Records. Commands shall maintainrecords of disposal of radioactive materialper Title 10 Code of Federal Regulations, thecommand's NRMP or NAVSEA Instructions asappropriate.

A-1

APPENDIX A

SAMPLE FORMS

NAVMED 6470/10 Record of Occupational Exposure to A-3 Ionizing Radiation

NAVMED 6470/11 Record of Occupational Exposure A-5to Ionizing Radiation From Internally Deposited Radionuclides

NAVMED 6470/1 Annual/Situational Report of Exposure A-7to Ionizing Radiation

STANDARD FORM 88 Report of Medical Examination A-9

STANDARD FORM 93 Report of Medical History A-11

NAVMED 6470/3 Radiation Exposure Report A-13

A-2

RECORD OF OCCUPATIONAL EXPOSURE TO IONIZING RADIATION

1. NAME (Last, First, Middle Initial) 2. SOC. SEC. NUMBER 3. RANK/RATE/GRADE 4. DATE OF BIRTH

INDIVIDUAL’S PERIOD OF EXPOSURE DOSE EQUIVALENT THIS PERIOD(rem)

ACCUM-ULATEDDOSE(rem)

INITIALS

Activity5

OccCode6

From

(YYYYMMMDD)7

To

(YYYYMMMDD)8

ShallowDose

Equiv.9

DeepDose

Equiv.Photon

10

DeepDose

Equiv.Neutron

11

CommittedEffective

DoseEquiv.

12

TotalEffective

DoseEquiv.

13

LifetimeTotal

EffectiveDoseEquiv.

14

PersonMakingEntry15

16. REMARKS (Continue on additional sheet(s) if necessary)

TO BE RETAINED PERMANENTLY IN INDIVIDUAL’S HEALTH RECORD NAVMED FORM 6470/10 (4/1999)

A-3

INSTRUCTIONS FOR PREPARATION OF NAVMED FORM 6470/10ITEM1. Enter the last name, first name and middle initial. Separate each component of the name with a space. If the full name

exceeds 40 spaces, truncate after the 40th space. 2. Enter Social Security Number, e.g., 000-00-0000. If the individual does not have a social security number, i.e., a foreign

national, enter a pseudo SSN as: 800 for the first 3 digits, the year, month, and day of birth. (i.e., 800-YY-MMDD) 3. Enter, in not more than 10 spaces, the rank/rate/grade the individual possesses when initiating this form. This item need not be

updated until a new NAVMED FORM 6470/10 is initiated. Use standard military/civil service abbreviations, e.g., CAPT, COL, MAJ, HMCS, MM2, SSGT, LCPL, GS9, WG5, etc. Abbreviate civilian titles as necessary, e.g., Radiological Physicist to Rad Phys; Electrical Welder to Elec Wldr, etc.

4. Enter date of birth by 4 digit year, month, and day using no spaces and all capitals, e.g., 1975APR13. 5. Enter the name of the activity or unit. The activity’s / unit’s abbreviated name or ship hull number(s) may be used. The activity

should represent either the activity or unit where the individual is permanently assigned or, if TAD, where the exposure occurred. 6. Occupation Codes:

10 Nuc. Propl. (Rad. Worker) 20 Weapons (Rad. Worker) 30 Medical (Diagnostics) 40 Gamma Radiographer 11 Nuc. Propl. (Non-Rad.) 21 Weapons (Non-Rad.) 31 Dental 41 X-ray Radiography and 12 Nuc. Propl. (Visitor) 22 Weapons (Visitor) 32 Medical (Nuc. Med.) Accel. Radiography <10 MeV 33 Medical (Therapy) 42 Accel. Radiography => 10 MeV 50 Research 43 RADIAC Calibration 51 Research (Isotopes) 90 Other 44 General Industrial

7. Enter the 4 digit year, month, and day the exposure period began using no spaces and all capitals, e.g., 1999JAN04. 8. Enter the 4 digit year, month, and day the exposure period ended, e.g., 1999FEB15. Note: For items 9 – 14, enter radiation doses received in rem to three decimal places, i.e., 03.450. Enter doses evaluated as zero as 00.000.Do not use ‘X’s’or the term minimal. If not monitored, leave blank. Do not enter 00.000 for radiation types not specifically monitored. 9. Enter shallow dose equivalent, which is the external exposure to the skin at a tissue depth of 0.007 centimeters or 7

milligrams per centimeters squared. If shallow dose equivalent was not monitored, leave blank. 10. Enter deep dose equivalent photon, which is external exposure from photon radiations (x and gamma rays) to the whole body at a

tissue depth of 1 centimeter or 1000 milligrams per centimeter squared. 11. Enter deep dose equivalent neutron, which is external exposure from neutron radiation to the whole body at a tissue depth of 1

centimeter or 1000 milligrams per centimeter squared. 12. Enter the committed effective dose equivalent, which is exposure from internally deposited radionuclide(s). 13. Enter the total effective dose equivalent, which is the sum of the deep dose equivalents for external exposure (items 10 & 11) and the

committed effective dose equivalent for internal exposure (item 12). The total effective dose equivalent does not include the shallow dose equivalent for external exposure (item 9). 14. Enter the lifetime total effective dose equivalent, which is the summation of the individual’s total effective dose equivalents. That

is, add item 13 to the previous item 14. If item 14 is being updated from a DD 1141, then item 13 is added to the previous item 14 (Total Lifetime Exposure).

15. Initials of person making line entry. The associated name and title of each individual initialing item 15 will be recorded in the

remarks section (item 16), e.g., JD - John Daniels, HMC, USN, RB - Robert Bums, 1LT, USA. 16. Enter other pertinent information, e.g., estimated exposure, skin contamination, the name and title of individual(s) initialing item 15,

annotation(s) to correct administrative errors on the NAVMED FORM 6470/10, etc.Note: This record is required for all individuals who have been or are being monitored for exposure to ionizing radiation. It shall be filed inthe individual’s health record, where it shall be retained permanently.

A-4

RECORD OF OCCUPATIONAL EXPOSURE TO IONIZING RADIATION FROMINTERNALLY DEPOSITED RADIONUCLIDES

1. NAME (Last, First, Middle Initial) 2. SOC. SEC. NUMBER 3. RANK/RATE/GRADE 4. DATE OF BIRTH

Individual’sActivity

5

Date

(YYYYMMMDD)6

Time

7

AnatomicalLocation or

SampleMonitored

8

Detector’sMDA

(nCi)9

Radio-Nuclide

10

AmountDetected(nCi)11

CommittedEffective

DoseEquivalent

(rem)12

InitialsOf

PersonMakingEntry13

16. REMARKS (Continue on additional sheet(s) if necessary)

TO BE RETAINED PERMANENTLY IN INDIVIDUAL’S HEALTH RECORD NAVMED FORM 6470/11 (4/1999)

A-5

INSTRUCTIONS FOR PREPARATION OF NAVMED FORM 6470/11ITEM

1. Enter the last name, first name and middle initial. If the full name exceeds 40 spaces, truncate after the 40th space. 2. Enter Social Security Number, e.g., 000-00-0000. If the individual does not have a social security number, i.e.,

a foreign national, enter a pseudo SSN as: 800 for the first 3 digits, the year, month, and day of birth. (i.e., 800-YY-MMDD)

3. Enter, in not more than 10 spaces, the rank/rate/grade the individual possesses when initiating this form. This

item need not be updated until a new NAVMED FORM 6470/11 is initiated. Use standard military / civil serviceabbreviations, e.g., CAPT, HMCS, MM2, SSGT, LCPL, GS9, WG5, etc. Abbreviate civilian titles as necessary,e.g., Radiological Physicist to Rad Phys; Electrical Welder to Elec WIdr, etc.

4. Enter date of birth by 4 digit year, month, and day using no spaces and all capitals, e.g., 1975APR13. 5. Enter the name of the activity or unit. The activity’s / unit’s abbreviated name or ship hull number(s) may be

used. The activity should represent either the activity or unit where the individual is permanently assigned or, if TAD, where the exposure occurred.

6. Enter the 4 digit year, month, and day of monitoring using no spaces and all capitals, e.g., 1999JAN04. 7. When required, enter the military time of day when monitoring was performed, e.g., 1410. 8. Enter the anatomical location or type of sample monitored, e.g., chest, thyroid, abdomen, feces, urine. 9. Enter the minimum detectable activity (MDA) of the counting system at the 95% or higher confidence level

in nanocuries (nCi). 10. Enter the radionuclide monitored for or detected, e.g., Co-60, I-131. If more than one radionuclide is

monitored for or detected, list the radionuclides on successive lines. Items 5-9 do not need to be repeated when reporting multiple radionuclides.

11. Enter the amount of activity detected in nanocuries (nCi). If the resultant activity is less than MDA, enter < MDA. 12. Enter the committed effective dose equivalent in rem, which is occupational exposure from internally deposited

radionuclide(s). The committed effective dose equivalent will be calculated by a BUMED approved facility (seeNAVMED P-5055).

13. Initials of person making line entry. The associated name and title of each individual initialing item 13 will be

recorded in the remarks section (item 14), e.g., JD - John Daniels, HMC, USN.

14. Enter any remarks or explanatory comments, e.g., abnormal radionuclides detected, method of calculation, etc.

EXPOSURE TO IONIZING RADIATION __ANNUAL __REPORT OF PERSONNEL EXPOSURE TO IONINZING RADIATION (REPORT SYMBOL MED 6470-1) _ _SITUATIONAL __REPORT OF PERSONNEL EXCEEDING RADIATION EXPOSURE LIMITS (REPORT SYMBOL MED 6470-2)1. ACTIVITY SUBMITTING REPORT (Name and Address) 2. UIC 3. CALENDAR YEAR REPORTED 4. DATE PREPARED

MEMBER’S INFORMATION PERIOD OFEXPOSURE

DOSE EQUIVALENT THIS PERIOD(rem)

ACCUMULATED(rem)

Name (Last, First, Middle Initial)5

SocialSecurityNumber

6

DateOf

Birth

YYYYMMMDD7

OccCode8

From

YYYYMMMDD9

To

YYYYMMMDD10

ShallowDose

Equiv.11

DeepDose

Equiv.Photon

12

DeepDose

Equiv.Neutron

13

CommittedEffective

DoseEquiv.

14

TotalEffective

DoseEquiv.

15

LifetimeTotal Effective

DoseEquiv.

16

17. REMARKS (Continue on additional sheet(s) if necessary)

18. Signature (Individual Preparing Report) 19. APPROVED (Radiation Health Officer, Medical Officer, or Approving Authority)

TITLE: NAVMED FORM 6470/1 (4/1999) Page _____ of ______

A-7

INSTRUCTIONS FOR PREPARATION OF NAVMED 6470/1Personnel Exposure to Ionizing Radiation (Report symbol MED) 6470- 1)

Personnel Exceeding Radiation Exposure Limits (Report Symbol MED 6470-2)

1. Generala. This dual purpose form may be used for either report but the reports must not be combined on the same form.

b. These reports are required on all personnel in the Naval Establishment who have been or are being monitored for exposure to IonizingRadiation. It shall be the responsibility of each activity of the Naval Establishment having personnel monitored to submit these reports(both paper copy and diskette) to the Naval Dosimetry Center per the following time periods. Retain a copy for yourrecords.

1. NAVMED 6470/1 - Report of Personnel Exposure to Ionizing Radiation shall be submitted annually to the Naval Dosimetry Center, prior to 1 April or within 30 days of receipt of final annual exposure information (whichever is later) and shall include all personnel on board 31 December who were monitored for such exposure at any time during the calendar year at the reporting activity.

2. NAVMED 6470/1 - Report of Personnel Exposure to Ionizing Radiation must also be prepared and submitted as a situational reportif an individual so monitored was transferred, or terminated employment during the calendar year. This report shall be submitted to the NavalDosimetry Center within 30 days of receipt of final exposure information for such transfer or termination. Data shall be obtained from theindividual’s Record of Occupational Exposure to Ionizing Radiation.

3. NAVMED 6470/2 - Report of Personnel Exceeding Radiation Exposure Limits is required on all personnel in the NavalEstablishment who have exceeded radiation exposure limits. It shall be the responsibility of the activity at which the limits were exceeded tosubmit this report to BUMED, Undersea Medicine and Radiation Health Division. A copy of the report shall be attached to each individual’sNAVMED FORM 6470/10 for permanent retention. If personnel have received a dose of more then 3 rem in any one calendar quarter, thereport shall be forwarded within 30 days from the determination of such exposure. If personnel have received a dose of more than 5 rem in asingle incident, a report shall be forwarded within 24 hours from the determination of such exposure. If any individual has received a dose ofmore than 25 rem in a single incident, Chief, Bureau of Medicine and Surgery, shall be notified immediately by immediate message ortelephone.

2. Specific Coding Instructions (see NAVMED P-5055, Chapter 5, for additional information) a. Check the appropriate boxes to indicate which report is being submitted and if the report being submitted is an annual or situationalreport.

b. Item.1. Enter name and address of reporting activity.2. Enter UIC.3. Enter calendar year reported.4. Enter date reported.5. Enter name as currently carried on rolls - last name, first name, and middle initial as appropriate. If this combination exceeds

40 spaces, truncate name at 40 characters.6. Enter individual’s social security account number. Enter social security number, e.g., 000-00-0000. If the individual does

not have a social security number, i.e., a foreign national, enter a pseudo SSN as: 800 for the first 3 digits, the year, month, and day of birth. (i.e., 800-YY-MMDD)

7. Enter individual’s year and month of birth.8. Enter occupation code in which the majority of exposure occurred (see NAVMED P-5055, chapter 5, for occupation codes)9. Enter 4 digit year, month and day monitoring period was considered to have started using no spaces, i.e., 19991027.10. Enter 4 digit year, month and day monitoring period was considered to have ended using no spaces, i.e., 19991226.

Note: For items 11 – 16, enter radiation doses received in rem to three decimal places, i.e., 03.450. Enter doses evaluated as zero as 00.000.Do not use ‘X’s’or the term minimal. If not monitored, leave blank. Do not enter 00.000 for radiation types not specifically monitored.

11. Enter shallow dose equivalent.12. Enter deep dose equivalent photon.13. Enter deep dose equivalent neutron dose.14. Enter the committed effective dose equivalent.15. Enter total effective dose equivalent accumulated for this period; sum of items 12, 13, and 14.16. Enter the accumulated total lifetime dose equivalent.17, 18, 19 are self-explanatory.

Reporting Procedures are explained in detail in Chapter 5 of NAVMED P-5055, Radiation Health Protection Manual.

STANDARD FORM 93 REV. OCTOBER 1974 PRESCRIBED BY GSA/ICMR APPROVEDFIRMR (41 CFR) 201-45.505 OFFICE OF MANAGEMENT AND BUDGET No. 29-R0191

REPORT OF MEDICAL HISTORY(THIS INFORMATION IS FOR OFFICIAL AND MEDICALLY - CONFIDENTIAL USE ONLY AND WILL NOT BE RELEASED TO UNAUTHORIZED PERSONS)

1. LAST NAME-FIRST NAME-MIDDLE NAME 2. SOCIAL SECURITY OR IDENTIFICATION NO.

3. HOME ADDRESS (Number, street or RFD, city or town, State and Zip Code) 4. POSITION (title, grade, component)

5. PURPOSE OF EXAMINATION 6. DATE OF EXAMINATION 7. EXAMINING FACILITY OR EXAMINER, AND ADDRESS Ionizing Radiation Work ( ) 8. STATEMENT OF EXAMINEE’S PRESENT HEALTH AND MEDICATIONS CURRENTLY USED (Follow by description of past history, if complaint exists)

9. HAVE YOU EVER (Please check each item) 10. DO YOU (Please check each item)

YES NO (Check each item) YES NO (Check each item)

Lived with anyone who had tuberculosis Wear glasses or contact lenses

Coughed up blood Have vision in both eyes Bled excessively after injury or tooth extraction Wear a hearing aid

Attempted suicide Stutter or stammer habitually Been a sleepwalker Wear a brace or back support 11. HAVE YOU EVER HAD OR HAVE YOU NOW (Please check at left of each)

DON’T DON’T DON’T YES NO KNOW (Check each item) YES NO KNOW (Check each item) YES NO KNOW (Check each item)

Scarlet fever, erysipelas Cramps in your legs “Trick” or locked knee

Rheumatic fever Frequent indigestion Foot trouble

Swollen or painful joints Stomach, liver or intestinal trouble Neuritis

Frequent or severe headache Gall bladder trouble or gallstones Paralysis (including infantile)

Dizziness or fainting spells Jaundice or hepatitis Epilepsy or fits

Eye trouble Adverse reaction to serum, Car, train, sea or air sickness drug, or medicine Ear, nose or throat trouble Broken bones Frequent trouble sleeping

Hearing loss Tumor, growth, cyst, cancer Depression or excessive worry Chronic or frequent colds Rupture/hernia Loss of memory or amnesia Severe tooth or gum trouble Piles or rectal disease Nervous trouble of any sort

Sinusitis Frequent or painful urination Periods of unconsciousness

Hay Fever Bed wetting since age 12 Occupational or accidental exposure to ionizing radiation above

Head Injury Kidney Stone or blood in urine Table III limits Cancer or precancerous

Skin diseases Sugar or albumin in urine lesions

Thyroid trouble VD--Syphilis, gonorrhea, etc. Anemia

Tuberculosis Recent gain or loss of weight Work involving the handling of unsealed radium sources Asthma Arthritis, Rheumatism, or Bursitis or other unsealed sources Shortness of breath Bone, joint or other deformity

Pain of pressure in chest Lameness Chronic cough Loss of finger or toes Palpitation or pounding heart Painful or “trick” shoulder or elbow 12. FEMALES ONLY: HAVE YOU EVER

Heart trouble Recurrent back pain Been treated for a female disorder

High or low blood pressure Radiation therapy Had a change in menstrual pattern

Radiopharmaceuticals received for therapeutic or experimental purposes 13. WHAT IS YOUR USUAL OCCUPATION? 14. ARE YOU (Check one) Right handed Left handed 93-103

YES NO CHECK EACH ITEM YES OR NO. EVERY ITEM CHECKED YES MUST BE FULLY EXPLAINED IN BLANK SPACE ON RIGHT

15. Have you been refused employment or been unable to hold a job or stay in school because of: A: Sensitivity to chemicals, dust, sun- light, etc. B. Inability to perform certain motions.

C. Inability to assume certain positions. D. Other medical reasons (If yes, give reasons.) 16. Have you ever been treated for a mental condition? (If yes, specify when, where, and give details.)

17. Have you ever been denied life insur- ance? (If yes, state reason and give details.)

18. Have you had, or have you been advised to have, any operations? (if yes, describe and give age at which occurred.)

19. Have you ever been a patient in any type of hospital? (If yes, specify when, where why, and name of doctor and complete address of the hospital.) 20. Have you ever had any illness or injury other than those already noted? (if yes, specify when, where, and give details.) 21. Have you consulted or been treated by clinics, physicians, healers, or other practitioners within the past 5 years for other than minor illnesses? (if yes, give complete address of doctor, hospital, clinic, and details.)

22. Have you ever been rejected for military service because of physical, mental, or other reasons? (If yes, give date and reason for rejection.) 23. Have you ever been discharged from military service because of physical, mental, or other reasons? (if yes, give date, reason, and type of discharge: whether honorable, other than honorable, for unfitness or unsuitability.)

24. Have you ever received, is there pending, or have you applied for pension or compensation for existing disability? (If yes specify what kind, granted by whom, and what amount, when, why.)

I certify that I have reviewed the foregoing information supplied by me and that it is true and complete to the best of my knowledge.I authorize any of the doctors, hospitals, or clinics mentioned above to furnish the Government a complete transcript of my medical record for purposesof processing my application for this employment

TYPED OR PRINTED NAME OR EXAMINEE SIGNATURE

NOTE: HAND TO THE DOCTOR OR NURSE, OR IF MAILED MARK ENVELOPE “TO BE OPENED BY MEDICAL OFFICER ONLY.”25. Physician’s summary and elaboration of all pertinent data (Physician's shall comment on all positive answers in items 9 through 24. Physician maydevelop by interview any additional medical history he deems important, and record any significant findings here.)

TYPED OR PRINTED NAME OF PHYSICIAN OR DATE SIGNATURE NUMBER OFEXAMINER ATTACHED SHEETS

REVERSE OF STANDARD FORM 93 *U.S. Government Printing Office: 1989- 241- 175/80263

Instructions1. See reverse side before completing this form2. Submit Original of this form with each submission of TLD to Naval Dosimetry Center,

RADIATION EXPOSURE REPORT NEHC Detachment, Bethesda, MD 20889-5614.1. ACTIVITY SUBMITTING REPORT (Name, Address, and Telephone Number) 2. UIC 3. DATE SUBMITTED

MEMBER’S INFORMATION EXPOSURE PERIOD INFORMATION DOSE EVALUATION4.

Name (Last, First, Middle Initial)

5.

Soc.Sec.

Number

6.

TLD Number

7.

Issued Collected

YYYY MMM DD YYYY MMM DD

8.

RadType

9.

OccCode

10.

ShallowDose

Equiv.

11.DeepDose

Equiv.Photon

12.DeepDose

Equiv.Neutron

13.Total

EffectiveDose

Equiv.

14.

Extremity

15. REMARKS

16. SUBMITTED BY 17. DATE RECEIVED 18. DATE RELEASED 19. APPROVED BY PAGE OF

NAVMED FORM 6470/3 (4/1999)

A-13

INSTRUCTIONS FOR PREPARATION OF NAVMED 6470/3

The following instructions are applicable to the numbered items on the other side of this form. TLD cards submittedfor evaluation shall be listed in the following order: CONTROL TLD Cards first, followed by all TLD Cards issued topersonnel, then by POSTED TLD Cards, then by BUMED AREA MONITOR (BAM) TLD Cards, and finally all UNUSED TLDCards.The TLD cards do not have to be submitted to the NAVDOSCEN in the same order as they are listed on the NAVMED6470/3 if this report is submitted on magnetic media (e.g., generated by SAMS, ARCMIS, and RER computer programs.).

ITEM1. List complete name, mailing address, and telephone number of submitting activity.2. List five digit Unit Identification Code (UIC).3. Record date on which the report is submitted.4. The following entries are required in block (4): “CONTROL” for control TLD cards; last name, first name and middle

initial for TLD cards issued to personnel; “POSTED” for posted TLD cards; “BAM-followed by serial number ofBUMED area monitor, e.g. BAM-500,” for BUMED area monitor TLD cards (Do not list the physical location of the areamonitors.); and ‘UNUSED’ for any TLD cards not used.

5. List social security number (SSN) for all personnel to whom TLD cards were issued. If the individual does not have asocial security number, i.e., a foreign national, enter a pseudo SSN as: 800 for the first 3 digits, the year, month, and dayof birth. (i.e., 800-YY-MMDD) Leave blank for CONTROL, POSTED, and UNUSED TLD cards. List the serialnumber of the first TLD card placed in the BUMED area monitor.

6. List the serial number of the TLD card issued. List the serial number of the second TLD card placed in the BUMED areamonitor.

7. List dates of issue and collection for each dosimeter in the following format YYYYMMDD.8. Use one of the following numeric codes to indicate the type of radiation exposure to be evaluated for each dosimeter:

1. Deep Photon2. Deep Neutron3. Deep Photon. Deep Neutron4. Shallow Photon and/or Beta5. Shallow Photon and/or Beta; Deep Photon6. Shallow Photon and/or Beta; Deep Photon; and Deep Neutron7. Extremity High Energy Photon (>70 keV)8. Extremity Low Energy Photon (<= 70 keV)9. Extremity Beta

9. Use one of the following numerical codes to indicate the occupation (occ) code of the person issued the TLD card or forTLD cards not issued to personnel:

00 Control 31 Dental01 Posted 32 Medical (Nuclear Medicine.)02 Area Monitor 33 Medical (Therapy)03 Unused 40 Gamma Radiographer10 Nuclear Propulsion (Radiation Worker) 41X-ray Radiography and Accelerator11 Nuclear Propulsion (Non Radiation Worker) Radiography < 10 MeV12 Nuclear Propulsion (Visitor) 42 Accelerator Radiograph => 10 MeV20 Weapons (Radiation Worker) 43 RADIAC Calibration21 Weapons (Non Radiation Worker) 44 General Industrial22 Weapons (Visitor) 50 Research30 Medical (Diagnostics) 51 Research (Isotopes)

90 Other

10. Through 14. Leave Blank.15. Use as appropriate by submitting activity.16. Printed name and title, and signature, of person submitting report.17. through 19. Leave Blank.

Copies of this form and other associated radiation dosimetry materials are available on request from the Naval Dosimetry Center.Phone numbers: DSN 295-0142/ 0403/ 6164, Commercial (301) 295-0142/ 0403/ 6164.

B-1

APPENDIX B

ANNUAL LIMIT ON INTAKE

The annual limit on intake (ALI) and derived air concentrations(DAC) of some common isotopes as listed in Appendix B, Title 10Part 20 are provided below.

ALI (microcuries) DACIsotope Ingestion Inhalation uCi/ml

Americium-241 0.8 0.006 3 x 10-12

Carbon-14 2,000 2,000 1 x 10-6

Cesium-137 100 200 6 x 10-8

Chromium-51 40,000 20,000 8 x 10-6

Cobalt-60 200 30 1 x 10-8

Iodine-123 3,000 6,000 3 x 10-6

Iodine-125 40 60 3 x 10-8

Iodine-131 30 50 2 x 10-8

Iridium-192 900 200 9 x 10-8

Phosphorus-32 600 900 4 x 10-7

Plutonium-239 0.8 0.006 3 x 10-12

Radium-226 2 0.6 3 x 10-10

Strontium-90 30 4 2 x 10-9

Technetium-99m 80,000 200,000 6 x 10-5

Thallium-201 20,000 20,000 9 x 10-6

Thorium-232 0.7 0.001 5 x 10-13

Tritium (H-3) 80,000 80,000 2 x 10-5

* ALI and DAC values listed assume the most conservativeclass. If the chemical form is known, a more appropriate classmay be used.