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Computational Phantoms of the ICRP Reference Male and Reference
Female
Maria Zankla*, Janine Beckera, Helmut Schlattla, Nina Petoussi-Henssa, Keith F.
Eckermanb, Wesley E. Bolchc, Christoph Hoeschena
aHelmholtz Zentrum München – German Research Center for Environmental Health**,
Institute of Radiation Protection, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany.
bOak Ridge National Laboratory, Life Science Division, 1060 Commerce Park, Oak
Ridge, TN 37831-6480, USA.
cUniversity of Florida, Departments of Nuclear and Radiological Engineering and
Biomedical Engineering, Gainesville, FL 32611-8300, USA.
Abstract. Computational models of the human body – together with radiation transport codes – have been used
for the evaluation of organ dose conversion coefficients in occupational, medical and environmental radiation
protection. During the last two decades, it has become common practice to use voxel models that are derived
mostly from (whole body) medical image data of real persons instead of the older mathematical MIRD-type body
models. It was shown that the schematic organ shapes of the MIRD-type phantoms presented an over-
simplification, having an influence on the resulting dose coefficients, which may deviate systematically from those
calculated for voxel models. In its recent recommendations, the ICRP adopted a couple of voxel phantoms for
future calculations of organ dose coefficients. The phantoms are based on medical image data of real persons and
are consistent with the information given in ICRP Publication 89 on the reference anatomical and physiological
parameters for both male and female subjects. The reference voxel models were constructed by modifying the
voxel models "Golem" and "Laura" developed in our working group of two individuals whose body height and
weight resembled the reference data. The organ masses of both models were adjusted to the ICRP data on the
Reference Male and Reference Female, without spoiling their realistic anatomy. This paper describes the methods
used for this process and the characteristics of the resulting voxel models. Furthermore, to illustrate the uses of
these phantoms, conversion coefficients for some external exposures are also presented.
KEYWORDS: Computational models; voxel phantoms; ICRP Reference Male and Reference
Female; organ doses; conversion coefficients.
1. Introduction
Computational phantoms of the human body – together with radiation transport codes – have been used
for the evaluation of organ dose conversion coefficients in occupational, medical and environmental
radiation protection. During the last two decades, voxel models were introduced that are derived mostly
from (whole body) medical image data of real persons instead of the older mathematical MIRD-type
body models. Among other laboratories, the Helmholtz Zentrum München – German Research Center
for Environmental Health (i.e., the former GSF – National Research Center for Environment and
Health) has developed 12 voxel phantoms of individuals of different stature and ages: 2 pediatric ones, 4
male and 6 female adult models [1-4].
It was shown that the schematic organ shapes of the MIRD-type phantoms presented an over-
simplification, having an influence on the resulting dose coefficients, which – in some cases – deviate
systematically from those calculated for voxel models [2, 5]. As a consequence of these findings, the
International Commission on Radiological Protection (ICRP) decided to use voxel phantoms – being the
current state of the art – for the update of organ dose conversion coefficients, following the current
ICRP Recommendations [6]. To this end, the ICRP decided for the first time to officially adopt specific
phantoms for their calculations. These phantoms should possibly accommodate all organs and tissues
* Presenting author, E-mail: zankl@helmholtz-muenchen.de
** Formerly: GSF – National Research Center for Environment and Health
1
that have been identified as relevant source organs [7, 8] or which are known to be radiation sensitive
and therefore either contribute to the quantity effective dose or are protected by separate dose limits [6,
9]. The dose conversion coefficients recommended by the ICRP are for whole populations or parts
thereof, e.g. the working population, patients in medical radiation applications, or the public. Therefore,
the voxel models to be adopted by ICRP should not have pronounced individual characteristics but they
should as far as possible be representative of the adult Reference Male and Reference Female [10] with
respect to their external dimensions and their organ masses. At our working group, phantoms have been
developed upon request by the ICRP that largely conform to this demand [11, 12].
2. Method to construct reference computational phantoms
2.1 Selection of primary image data
The voxel phantoms representing the ICRP adult Reference Male and Reference Female were
constructed on the basis of individual voxel phantoms segmented from whole body computed
tomographic (CT) data of real patients. The principal selection criterion was that these persons should
already closely resemble the external characteristics of the Reference Male and Reference Female, i.e.,
a body height of 176 cm and 163 cm, respectively, and a whole body mass of 73 kg and 60 kg,
respectively [10]. This ensured that only moderate changes had to be made to the external shape of
these phantoms, and thus the risk for distorting the anatomical realism could be minimised. The male
phantom selected for this purpose was Golem [13] with a height of 176 cm and a weight of 69 kg.
Among the previously segmented female phantoms [3] none was sufficiently close to this
specification; therefore, the voxel model Laura (167 cm, 59 kg) was segmented for this specific
purpose [4].
The Golem data set was stemming from a whole-body CT examination of a single average-sized 38-
year old male patient and consisted of 220 slices of 256 x 256 pixels. The original voxel size was 8
mm in height with an in-plane resolution of 2.08 mm, resulting in a voxel volume of 34.6 mm3. 122
individual objects were segmented (67 of these being bones or bone groups), including many – but not
all – of the organs and tissues later identified in the ICRP characterization of the reference anatomical
data [10]. The primary data of Laura were derived from a high resolution whole-body CT scan of a 43-
year old patient of 167 cm height and a weight of 59 kg. The data set consisted of 174 slices of 5 mm
width (head and trunk) and 43 slices of 2 cm width (legs), each with 256 x 256 pixels. The 2-cm slice
images were re-sampled to result also in slices of 5 mm width. The resulting data set consisted of 346
slices; the voxel size was then 5 mm height with an in-plane resolution of 1.875 mm; this corresponds
to a voxel volume of 17.6 mm3. 88 organs and tissues were segmented for Laura, where 19 of them
were bone regions.
2.2 Adjustment to the ICRP reference values of anatomical data
The following steps were then followed: (1) adjustment of the body height and the skeleton mass of
the segmented model to the reference data by voxel scaling, (2) adjustment of the single organ masses
to the reference values by adding or subtracting a respective number of organ voxels, and (3)
adjustment of the whole body mass to the reference values by adding or subtracting a respective
number of adipose tissue voxels.
2.2.1 Adjustment of the skeleton
First, using the reference mass data for the skeletal constituents (mineral bone, cartilage, red bone
marrow, yellow bone marrow, and "miscellaneous") [10] and the density data for these tissues [14],
the skeleton volume aimed at was evaluated. From this value together with the number of voxels
making up the segmented skeleton of the phantom, the volume of a single voxel was evaluated. The
ratio of the reference body height to that of the individual voxel phantom was used as scaling factor
for the voxel height; then the quotient between volume and height of a voxel was calculated, and then
the in-plane resolution was evaluated as square root of this quotient. The decision to modify the
skeleton only by scaling was made since we believe that the skeleton can be considered as the "frame"
2
that more or less defines the body shape of a person, and that thus the distortion of anatomical
relations would be minimal.
It was, however, not possible for both models to accommodate the entire brain mass within the skull.
Therefore, it was necessary to increase the volume of the skull. Golem had a noticeably narrow head,
and other organs in the head were also small compared to the reference values. Therefore, we decided
to increase the voxel size of all the voxels of the entire head, and then re-sample this volume with the
smaller voxel size of the rest of the body. This means that the reference phantom has a greater number
of head voxels than Golem had. For the female reference phantom, only the skull was increased: The
interior surface voxels of the skull were replaced by brain, and an additional layer of skull voxels was
then added at the exterior surface. In order not to lose a layer of the surrounding tissues, this had to be
preceded by an outward movement of the surrounding muscle, adipose tissue and skin voxels.
Furthermore, an outward movement of the female phantom’s ribs (as occurring also during breathing)
was necessary as well to accommodate the liver. This was also done while the thickness of tissues
covering the ribs – muscle, adipose tissue and skin – was preserved again.
Apart from these unavoidable modifications of the skeleton shape, the volume of the skeleton was
adjusted to the reference value by voxel scaling. Since Golem’s body height corresponds to the
reference value, the original voxel height was kept unmodified. Laura was taller than the ICRP adult
Reference Female, so the voxel height for the female reference voxel model was reduced from 5.0 to
4.84 mm. After the mentioned moderate changes to the skulls of both phantoms, the numbers of
segmented skeleton voxels (including the segmented cartilage) were 211427 and 378204 for the male
and female reference voxel phantom, respectively.
Table 1 shows the skeleton volumes of the ICRP adult Reference Male and Reference Female as
derived from the reference mass data from ICRP Publication 89 and mass density data of ICRU Report
46 [10, 14]. Voxel volumes of 36.54 and 15.25 mm3 for the male and female reference voxel phantoms
were evaluated from these values and the segmented skeleton voxel numbers, by dividing the volume
values aimed at by the respective numbers of skeleton voxels for both phantoms. The voxel height
being fixed already, this resulted in voxel in-plane resolutions of 2.137 mm for the male and 1.775 mm
for the female phantom, respectively.
Table 1: Reference mass values [10], mass density values [14] and volumes derived for various
constituents of the skeleton of the adult ICRP reference individuals.
Mass (g) Volume (cm3)
male female
Mass density
(g cm-3) male female
Mineral bone 5500 4000 1.92 2864.6 2083.3
Cortical bone 4400 3200 2291.7 1666.7
Trabecular bone 1100 800 572.9 416.7
Cartilage 1100 900 1.10 1000.0 818.2
Red bone marrow 1170 900 1.03 1135.9 873.8
Yellow bone marrow 2480 1800 0.98 2530.6 1836.7
Miscellaneous 200 160 1.03 194.2 155.3
Total 10450 7760 1.35 7725.3 5767.4
2.2.2 Adjustment of individual organs
Since all voxels of a single phantom have the same size, this voxel volume together with the number
of segmented voxels for each organ and tissue resulted in a value of the volume of each organ and
tissue of the scaled phantom. Multiplying these volumes with the appropriate tissue density gives the
respective organ or tissue mass. In a first approach, four different types of “soft tissue” were
considered. For these, the elemental compositions of organs with similar composition were averaged,
and the densities for these tissues were averaged as well. The elemental composition and the density of
“Soft tissue 1” was averaged from those of brain, heart, and kidneys; those of “Soft tissue 2” from
3
eyes, liver, and pancreas; those of “Soft tissue 3” from stomach, intestine, ovaries, spleen, testes,
thyroid, and urinary bladder; and those of “Soft tissue 4” from adrenals, gall bladder, oesophagus,
pituitary gland, prostate, thymus, tonsils, trachea, ureters, and uterus. This procedure resulted in
densities of 1.05 g cm-3 for Soft tissues 1 and 2, 1.04 g cm-3 for Soft tissue 3, and 1.03 g cm-3 for Soft
tissue 4 [11]. At a later stage, it was decided to use specific elemental compositions for most soft-
tissue organs; but for the densities, the averaged values that were derived for soft tissues 1 through 4
were not modified any more.
The second main step of adjusting the phantoms was then to adjust the individual organ and tissue
masses to the reference values by adding or subtracting a respective number of voxels. This was done
by the software tool "VolumeChange" that was designed specifically for this purpose [15]. It uses the
programming language IDL ("Interactive Data Language") and represents each organ by its surface
voxels. The volumes are then modified by shifting surface voxels – inward for decreasing, outward for
increasing the respective volume. The individual organs were adjusted to the respective reference
values one by one, beginning with those that were larger than reference size in order to make room for
those that had to be enlarged. Some fine structures could not be adjusted exactly to the reference
values, due to limitations of voxel resolution and visibility. For most organs, however, a close
approximation of the reference values could be achieved. The only limitation then was due to the fact
that each organ has to consist of an integer number of voxels. That means that the resulting volumes
may deviate from the value aimed at by at most half a voxel volume, i.e. approximately 18.3 mm3 for
the phantom of the Reference Male and 7.6 mm3 for that of the Reference Female.
At this stage, further anatomical details were segmented in the reference computational phantoms,
going back to the original CT images from which Golem and Laura had been segmented. Some effort
was made to identify a larger amount of blood vessels, which was especially demanding for the male
phantom, due to the relatively large slice thickness, which resulted in a decreased detectability of fine
structures. Furthermore, lymphatic nodes were incorporated into the phantoms. Since these objects
could not be identified on the medical images, they were drawn manually, at locations specified in
anatomical textbooks [16-19]. Only a part of the lymphatic tissue reference mass was thus introduced;
the distribution throughout the body and higher concentration at the specified locations was however
correctly mirrored, such as in the groin, the axillae, etc. and to a certain extent also in the hollows of
the knees and the crooks of the arms.
2.2.3 Adjustment of the whole body mass
When the individual organs had been adjusted to their reference mass values and additional structures
had been incorporated, the internal anatomy was fixed. The final step was then to adjust the whole
body masses to 73 and 60 kg for the male and female reference voxel models, respectively. In both
cases, the whole body masses were lower than the value aimed for, so the body had to be "wrapped"
with additional layers of adipose tissue. Towards the end of this procedure, small iterations had to be
made since each modification of the number of adipose tissue voxels resulted also in small changes to
the skin mass, because the number of body surface voxels was modified. Finally, the whole body
masses were adjusted to the reference values within 0.01 g.
3. Description of the computational phantoms of the ICRP adult Reference Male and Reference
Female
To clearly distinguish the ‘reference’ voxel models from the models from which they originate, new
names were given to them: for the male phantom, the name chosen initially by the developers was
“Rex” (Reference adult male voxel model; Rex is also the Latin word for "king,"), and to the female
phantom, the corresponding female name – “Regina” (Latin for "queen") – was given [11, 12]. The
ICRP did not adopt these names, and chose “ICRP Adult Male” (ICRP-AM) and “ICRP Adult
Female” (ICRP-AF) instead.
4
3.1 General features of the reference computational phantoms
The main characteristics of both reference adult voxel phantoms are summarized in Table 2, and
graphical representations are shown in Figure 1 (ICRP-AM) and Figure 2 (ICRP-AF).
Table 2: Main characteristics of the adult Reference Male and Reference Female computational
phantoms
Property ICRP-AM ICRP-AF
Height (cm) 176 163
Weight (kg) 73.0 60.0
Number of (non-zero) voxels (millions) 1.95 3.89
Slice thickness (voxel height, mm) 8.0 4.84
Voxel in-plane resolution (mm) 2.13714 1.775
Voxel volume (mm3) 36.54 15.25
Number of columns 254 299
Number of rows 127 137
Number of slices 220 346
Figure 1: Frontal view of the ICRP-AM, the
voxel phantom representing the ICRP adult
Reference Male
Figure 2: Frontal view of the ICRP-AF, the
voxel phantom representing the ICRP adult
Reference Female
3.2 Special features of the skeleton
The skeleton is a highly complex structure of the body, composed of cortical bone, trabecular bone,
red and yellow bone marrow, cartilage and endosteum (“bone surfaces”). The internal dimensions of
most of these tissues are smaller than the resolution of a normal CT scan and, thus, these volumes
cannot be segmented in the voxel models. Therefore, the skeletal dosimetry has to be based on the use
of fluence-to-dose response functions that are multiplied with the particle fluence inside specific bone
regions to give the dose quantities of interest to the target tissues.
Nevertheless, an attempt was made to represent the gross spatial distribution of the source and target
volumes in the voxel models as realistically as possible at the given voxel resolution [12]. Therefore,
the skeleton was divided into those nineteen bones and bone groups for which individual data on red
5
bone marrow content and marrow cellularity are given in ICRP Publication 70 [20]. These individual
bones were sub-segmented into an outer shell of cortical bone and the enclosed spongious part of the
bone. The long bones contain a medullary cavity as third component; this is again enclosed by cortical
bone. This sub-division resulted in 44 different identification numbers in the skeleton: two – cortical
bone and spongiosa – for each of the nineteen bones mentioned above, and a medullary cavity for each
of the six long bones (upper and lower half of humeri, lower arm bones, upper and lower half of
femora, and lower leg bones). Furthermore, that amount of cartilage that could be identified on the CT
images and could, thus, be segmented directly, was attributed to four body parts – head, trunk, arms
and legs. Hence, the skeleton covers a total of 48 individual identification numbers.
The total volume of each bone results directly from the segmented number of voxels and the voxel
volume. The cortical shell around the spongiosa was chosen to be one voxel layer; the cortical bone at
the long bones’ shafts is thicker, and its thickness was adjusted such that the total cortical bone volume
is in agreement with the reference value. For each of the nineteen bones, the spongiosa is composed of
various proportions of trabecular bone, red bone marrow and yellow bone marrow. Furthermore, the
additional volumes of “miscellaneous” [10] and the not directly segmented cartilage had to be
accommodated in the skeleton; for practicability, these were merged within the spongiosa volume of
all skeletal sites. In ICRP Publications 70 [20] and 89 [10], reference data are given for the total
masses of red and yellow bone marrow, the percentage distribution of the red bone marrow among
individual bones, and the bone marrow cellularity in individual bones, based on earlier data by Cristy
[21]. Further data on the bone marrow distribution are not available. The volume of red bone marrow
in each of the nineteen bone groups can be calculated from the reference values of the total amount of
red bone marrow and its percentage distribution. The bone marrow cellularity in an individual bone
gives the proportion of the entire marrow in this bone that is still haematopoietic active; that means the
red bone marrow fraction. From this value, the total bone marrow volume in that bone can be
calculated for all those bones with a cellularity that is non-zero. This permits then the evaluation of the
volume of yellow (i.e., inactive) marrow. Accordingly, each of the nineteen bones or bone groups has
its own unique bone-specific spongiosa composition.
3.3 Limitations
During the process of adjustment to the reference values, some problems were encountered: as already
mentioned above, the original intention to modify the skeleton exclusively by scaling could not be
followed since in both cases it was not possible to accommodate the required brain mass inside the
segmented skull. Therefore, the skulls of both phantoms had to be increased a bit, and for the female
reference phantom, also the ribs had to be moved slightly outwards – as during breathing – to create
enough space for the liver.
Since the patients were in supine position during acquisition of the medical image data, the forces of
gravity were acting differently from the situation in a standing person. Hence, the abdominal organs
are shifted slightly towards the thoracic region, and hence the lungs are compressed. After consultation
with the ICRP, the lung masses were adjusted to the reference values by increasing the density
compared to the ICRU density value for a fully inflated lung.
Further limitations of the resulting reference voxel models are due to the fact that the dimensions of
some tissues are much smaller than the resolution of the available image data and could therefore (1)
not be identified on the images (e.g., medium and small blood vessels, fine bronchial structures, and
lymphatic tissue), (2) not be explicitly defined (e.g., the marrow cavities and the endosteum layer
lining these cavities, the dimensions of which are only tens of micrometres), or (3) not be represented
in their true size (like the mucous membranes of the extrathoracic airways).
Since (a) not all small tissues could be exactly adjusted to their reference values, (b) the reference
values of ICRP Publication 89 [10] are rounded values, and (c) the adipose tissue was used to exactly
adjust the whole body masses to the reference values, the resulting adipose tissue masses are 10% and
5% higher for the male and female phantom, respectively, than the corresponding reference values.
6
4. Selected dosimetric results
The ICRP will use the computational phantoms representing the adult Reference Male and Reference
Female, ICRP-AM and ICRP-AF, for a variety of dose calculations for external and internal
exposures. Various workers will contribute to these results. In the following, a few selected
preliminary results from our working group are presented for external photon exposures [11]. The
exposure conditions are the following idealised geometries: broad parallel beams of mono-energetic
photons that impinge on the phantoms from the front (AP), the back (PA), the left (LLAT) and the
right (RLAT) side, a photon beam rotating around the phantoms’ length axes (ROT), as well as a fully
isotropic photon irradiation (ISO). Conversion coefficeints of equivalent dose pera ir kerma free-in-air
for the liver and the stomach are presented in Figure 3 and Figure 4, respectively. Conversion
coefficients of the effective dose according to the recently revised definition are presented in Figure 5.
Figure 3: Liver equivalent dose per air kerma free-in-air conversion coefficients for various
geometries of monoenergetic photons and the reference computational models with four soft tissues,
Rex (left) and Regina (right). The data are from the work of Schlattl et al. [11].
Liver - Rex
0
0.2
0.4
0.6
0.8
1
1.2
1.4
0.01 0.1 1 10
Photon energy (MeV)
Liver equi valent dose / ai r kerma (Sv/Gy
)
AP Re x
PA Rex
LLAT Rex
RLAT Rex
ROT Rex
ISO Rex
Liver - Regina
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
0.01 0.1 1 10
Photon energy (MeV)
Liver equi valent dose / ai r kerma (Sv/Gy
)
AP Re gina
PA Regina
LLAT Regina
RLAT Regina
ROT Regina
ISO Regina
Figure 4: Stomach equivalent dose per air kerma free-in-air conversion coefficients for various
geometries of monoenergetic photons and the reference computational models with four soft tissues,
Rex (left) and Regina (right). The data are from the work of Schlattl et al. [11].
Stomach - Rex
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
0.01 0.1 1 10
Photon energy (MeV)
Stomach equi valent dose / ai r kerm
a
(Sv/Gy)
AP Re x
PA Rex
LLAT Rex
RLAT Rex
ROT Rex
ISO Rex
Stomach - Regina
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
0.01 0.1 1 10
Photon energy (MeV)
Stomach equivalent dose / ai r kerm
a
(Sv/Gy)
AP Regina
PA Regina
LLAT Regina
RLAT Regina
ROT Regina
ISO Reg ina
7
Figure 5: Effective dose per air kerma free-in-air conversion coefficients for various geometries of
monoenergetic photons and the reference computational models with four soft tissues, Rex and
Regina. The data are from the work of Schlattl et al. [11].
Effective dose
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
0.01 0.1 1 10
Photon energy (MeV)
Effecti ve dose / air kerma (Sv/Gy)
AP
PA
LLAT
RLAT
ROT
ISO
5. Conclusions
While in the past mathematical phantoms of the human body with simplified shapes of the body and
the internal organs were used for all types of organ dose calculations, a variety of voxel models
became available in recent years that are based on medical image data of real persons. It was shown by
a series of studies performed by different research groups that the voxel models do not only have the
advantage of a much more realistic anatomy – which is quite obvious – but that this difference has also
a clear impact on the calculated organ doses. These findings have persuaded the ICRP to employ this
new type of computational body models for the next update of dose coefficients for external and
internal exposures to ionising radiation that is planned following the new ICRP Recommendations.
The models "ICRP-AM" and "ICRP-AF" described in this work present the effort undertaken at our
working group upon request by ICRP's DOCAL Task Group to construct voxel models representing
the adult Reference Male and Reference Female.
The reference voxel phantoms presented in this work are the official computational models
representing the ICRP Reference Male and Reference Female. The ICRP will publish recommended
values for dose coefficients for both internal and external exposures using the ICRP-AM and ICRP-AF
phantoms.
Acknowledgements
The authors wish to express their gratitude to Dr. D. Gosch and Prof. K. Friedrich, Centre for
Radiology, University of Leipzig, Germany, and to Dr. D. Hebbinghaus and Prof. B. Kimmig, Clinic
for Radiation Therapy, University of Kiel, Germany, for providing the computed tomographic data.
The development of the reference voxel phantoms was financially supported by the German Federal
Ministry for the Environment, Nature Conservation and Nuclear Safety under contract StSch 4256.
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9
