mechanisms of tissue accumulation and washout of thesecompounds are not yet fully understood, evidence is emergingthat their interaction with subcellular organdíes and complexmacromolecules might provide a new basis for advancingknowledge in important aspects of tumor biology that bearsome relevance to the therapy of cancer patients.

ACKNOWLEDGMENTThe author is indebted to Dr. David Piwnica-Worms (The

Mallinckrodt Institute of Radiology, Washington University, St.Louis, MO) for stimulating discussion and offering constructivecriticism of this article.

REFERENCES1. Piwnica-Worms D, Kronauge JF. Holman BL, Davison A, Jones AG. Comparative

myocardial uptake characteristics of hexakis (alkylisonitrile) technetium(I) complexes:effect of lipophilicity. Invest Radial 1989:24:25-29.

2. Rossetti C. Vanoli G. Paganelli G. et al. Human biodistribution, dosimetry and clinicaluse of technctium(I!l)-99m-Q12. J NucíMed 1994:35:1571-1580.

3. Biniakiewicz DS. Washbum LC. McGoron AJ. Gereon MC. Synthesis and biodistri-bulion of new Te Q-series complexes with ester functionality [Abstract]. J NucíMed 1995;36(suppl.):17P.

4. Crankshaw CL. Marmion M, Burleigh BD. Deutsch E, Piwnica-Worms D. Nonreducible mixed ligand Tc(lll) cations (Q complexes) are recognized as transport substratesby the human multidrug resistance (MDR) P-glycoprotein [Abstract]. J NucíMed

l995;36(suppl.):l30P.5. Wackers FJT. The maze of myocardial perfusion imaging protocols in 1994. J Nucí

Cardio! 1994:1:180-188.6. Sharma V, Herman LW. Barbaries E. Rao W, Kronauge JF, Piwnica-Worms D.

Synthesis and initial characterization of novel aryl-isonitrile yi*mTccomplexes targeted

to the multidrug resistance (MDR) P-glycoprotein [Abstract]. J NucíMed 1995:36(suppl.):27P-28P.

7. Mansi L. Rambaldi PF, La Provitera A, Di Gregorio F, Procaccini E. Tc-99mTetrofosmin uptake in breast tumore [Abstract]. J NucíMed 1995;36(suppl.):83P.

8. li.illmivi JR, Bannerman J, Boxen I, et al. Accumulation of Tc-99m tetrofosmin inbreast tumour cells in vitro: role of multidrug-resistance P-glycoprotein [Abstract]. JNucíMed 1995;36(suppl.):202P.

9. Kronaugc JF, ChiùML, Cone JS, et al. Comparison of neutral and cationic myocardialperfusion agents: characteristics of accumulation in cultured cells. NucíMed Biol1992:19:141-148.

10. Pasqualini R, Duatti A. Bcllande E, et al. Bis(dithiocarbamato) nitrido technetium-99mradiopharmaceuticals: a class of neutral myocardial imaging agents. J NucíMed1994:35:334-341.

11. Piwnica-Worms D, Kronauge JF. Delmon L. Holman BL, Marsh JD, Jones AG. Effectof metabolic inhibition on technetium-99m-MIBI kinetics in cultured chick myocardialcells. J NucíMed 1990:31:464-472.

12. Carvalho PA, Chiù ML. Kronauge JF. et al. Subcellular distribution and analysis oftechnetium-99m-MIBI in isolated perfused rat hearts. J NucíMed 1992:33:1516-1521.

13. Piwnica-Worms D, Kronauge JF, Chiù ML. Uptake and retention of hexakis (2-

methoxyisobutyl isonitrile) technetium(I) in cultured chick myocardial cells. Mitochondria!and plasma membrane potential dependence. Circulation 1990:82:1826-1838.

14. ChernotYDM. Strichartz GR. Piwnica-Worms D. Membrane potential determination in

large unilamellar vesicles with haxakis(2-methoxyisobutyl-isonitrile)technetium(I).Biochim Biophys Acta 1993;1147:262-266.

15. Delmon-Moingeon LI, Piwnica-Worms D. Van den Abbeele AD, Holman BL, Davison A,Jones AG. Uptake of the cation hexakis(2-methoxyisobutylisonitrile)-technetium-99m byhuman carcinoma cell lines in vitro. Cancer Res 1990:50:2198-2202.

16. Chiù ML, Kronauge JF, Piwnica-Worms D. Effect of mitochondrial and plasmamembrane potentials on accumulation of hexakis (2-methoxyisobutylisonitrile) tech-netium(I) in cultured mouse fibroblasts. J NucíMed 1990:31:1646-1653.

17. Piwnica-Worms D, Kronauge JF, Chiù ML. Enhancement by tetraphenylborate oftechnctium-99m-M!BI uptake kinetics and accumulation in cultured chick myocardialcells. J NucíMed I991;32:I992-I999.

18. Piwnica-Worms D, Chiù ML, Kronauge JF. Divergent kinetics of 2UITI and WmTc-

sestamibi in cultured chick ventricular myocytes during ATP depletion. Circulation1992:85:1531-1541.

19. Piwnica-Worms D, Kronauge JF, LeFurgey A, et al. Mitochondrial localization andcharacterization of wTc-Sestamibi in heart cells by electron probe x-ray microanalysisand **Tc NMR spectroscopy. Magn Res Imag 1994:12:641-652.

20. Cesani F, Emst R, Walser E, Villanueva-Meyer J. Technetium-99m sestamibi imagingof a pancreatic VIPoma and parathyroid adenoma in a patient with multiple type Iendocrine neoplasia. Clin NucíMed 1994:19:532-534.

21. Al-Sebaie S, Rush C. Liver métastasesdetected by WmTc sestamibi during routine

cardiac imaging. Clin NucíMed 1995:20:84-85.22. Abdel-Dayem HM. Scott AM. Macapinlac HA, El-Gazzar AH. Larson SM. Role of

thallium-201-chloride and """"Tc-sestamibi in tumor imaging. In: Freeman LM, ed.

Nuclear Medicine Annual 1994. New York: Raven Press: 1994:181-234.23. Moscow JA, Cowan KH. Multidrug resistance. J Nati Cancer fnst 1988:80:14-20.

24. Goldstein LJ, Galski H, Fojo A, et al. Expression of a multidrug resistance gene inhuman cancers. J Nail Cancer Insl 1989:81:116-124.

25. Deuchars KL, Ling V. P-Glycoprotein and multidrug resistance in cancer chemotherapy. Semin Oncol 1989:16:156-165.

26. Ford JM, Hait WN. Pharmacology of drugs that alter multidrug resistance in cancer.Pharmacol Rev 1990:42:155-199.

27. Piwnica-Worms D, Chiù ML, Budding M, Kronauge JF, Kramer RA, Croop JM.Functional imaging of multidrug-resistant P-glycoprotein with an organotechnetiumcomplex. Cancer Res 1993:53:977-984.

28. Rogan AM, Hamilton TC, Young RC. Klecker RW. Ozols RF. Reversal of adriamycinresistance by verapamil in human ovarian cancer. Science 1984:224:994-996.

29. Ozols RF, Cunnian RE, Klecker RW, et al. Verapamil and adriamycin in the treatmentof drug-resistant ovarian cancer patients. J Clin Oncol 1987:5:641-647.

30. Miller TP, Grogan TM, Dalton WS. et al. P-Glycoprotein expression in malignantlymphoma and reversal of clinical drug resistance with chemotherapy plus high-doseverapamil. J Clin Oncol 199l;9:17-24.

31. Sonneveld P, Durian BG, Lokhorst HM. Marie J-P, et al. Modulation of multidrug-resistant multiple myeloma by cyclosporin. Lancet 1992:340:255-259.

32. Moretti JL, Caglar M. Duran-Cordobcs M, Morere J-F. Can nuclear medicine predictresponse to chemotherapy? Ear J NucíMed 1995:22:97-100.

33. Moretti JL, Caglar M, Boaziz C, Caillat-Vigneron N, Morere J-F. Sequential functionalimaging with technetium-99m-hexakis-2-methoxyisobutylisonitrile and indium-lll-

octreotide: can we predict the response to chemotherapy in small cell lung cancer? EurJNucI Med 1995:22:177-180.

34. Dimitrakopoulou-Strauss A, Strauss LG, Goldschmidt H, et al. Evaluation of tumourmetabolism and multidrug resistance in patients with treated malignant lymphomas.Eur J NucíMed 1995:22:434-442.

35. Ciarmicllo A. Del Vecchio S. Potena Ml. et al. Technetium-99m-sestamibi efflux andP-glycoprotein expression in human breast carcinoma [Abstract], J NucíMed 1995;36(suppl.):129P.

MIRDOSE: Personal Computer Software forInternal Dose Assessment in Nuclear MedicineMichael G. StabinOak Ridge institute for Science and Education, Oak Ridge, Tennessee

Key Words: internaldosimetry; computersJ NucíMed 1996; 37:538-646

Ihe calculation of internal dose estimates is performed bysumming the radiation absorbed in various target tissues from a

Fteceived Jul. 28, 1995; revision accepted Jul. 29, 1995.For correspondence or reprints contact: Michael G. Stabin, Radiation Internal Dose

Information Center, Oak Ridge Institute for Science and Education, P.O. Box 117, OakRidge, TN 37831.

number of source organs in the body that contain significantquantities of radioactive material. In nuclear medicine, the mostcommonly used method for the calculation of internal doseestimates is that developed by the Medical Internal RadiationDose (MIRD) committee, as described in various documents,but most recently summarized in the MIRD Primer (/). In thisarticle, the expression given for the absorbed dose is:

Dk = iî2: Eq. l

538 THKJOURNALOFNUCLEARMEDICINE•Vol. 37 •No. 3 •March 1996

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where Dk is the mean absorbed dose to region k (Gy); A0 is theadministered activity (Bq); TJ is the residence time in sourceregion j (s); A¡is the mean energy emitted per nuclear decay foremission type i (Gy-kg/Bq-s); </>¡(rk<—rj) is the fraction of

energy emitted in source region j which is absorbed in targetregion k; and mk is the mass of target region k (kg).

The residence time for a source region is the ratio of thecumulated activity (the total number of disintegrations) to theinitial activity in the region. The units are time; typicalcumulated activity units are Bq-s, and units for the initialactivity are typically Bq.

One may also see the ratio of the absorbed fraction 4>(rk«—r¡)over the mass mk given as the specific absorbed fraction <ï>(rk<—Tj). The quantity E A¡4>¡(rk<—rj)/mk is often referred to as theS-value (for region j irradiating region k).

A number of the parameters in this expression are rathertedious to look up and evaluate on a routine basis, and thus lendthemselves well to treatment with computer programs. Thesummations also involve repetitive tasks that are best done bycomputer, leaving the analyst free to devote energy to morecreative tasks. Therefore, the MIRDOSE computer softwarewas developed several years ago (2) and has been continuallysupported and updated since then.

Although the software was originally described in the proceedings of a Midyear Meeting of the Health Physics Society(2), and has been distributed around the world with somelimited documentation, the software has never been fullydescribed in the open literature. Such a description serves twopurposes: (a) it provides the current technical basis for thesoftware and (b) it permits the citation of the software in anopen literature reference for users who wish to use it to performdose assessment in publications or other documents.

In addition, this article outlines some of the importantdifferences between versions 2 and 3 of the program to helpusers understand variations in program output between the twoversions and any effect this might have on their work.

STRUCTURE OF THE PROGRAM

OverviewThe main function of the program is to provide estimates of

the radiation dose per unit administered activity from user-entered source organ residence times for a given radionuclideand one or more phantoms. The program uses libraries ofradionuclide decay data and specific absorbed fractions todevelop S-values for the source organs chosen by the user andthe target organs desired. The estimates of radiation dose perunit administered activity are given in SI and traditional units,with the two organs contributing the first and second highestpercentages of the total dose; all source organ contributions tototal dose may be viewed if desired. All model input andassumptions are given with the program output. The programwill also provide tables of S-values for all source and targetorgans for a given phantom or phantoms if desired, in lieu ofradiation dose estimates.

Program Data LibrariesThe two major dataseis needed to use Equation 1, given a set

of source organ residence times, are the radionuclide decay dataand the specific absorbed fractions for the various phantoms ofinterest. In version 2 of the program, 59 radionuclides wereavailable (Table 1). Decay data were taken from severalsources; the main source was a preliminary version of the datawhich was eventually published as the MIRD: RadionuclideData and Decay Schemes (3). Some other data, however, weretaken from a document by David Kocher (4) and ICRP

Publication 38 (5). These data were entered manually andproofread, and some selection was made of the number ofimportant emissions. In version 3, all of the radionuclides in theMIRD: Radionuclide Data and Decay Schemes (3), except forthose including alpha or spontaneous fission decays, wereelectronically transferred into the program data files (Table 2).Generally, the authors of this publication omitted transitionsthat did not contribute more than 0.1% to the total energy pertransition in that category of emission (3 ).

Two major classes of emissions were considered in version 2:photons ("penetrating" emissions) and electrons and betaparticles ("nonpenetrating" emissions). In addition, a third

class of emission was derived, which usually constituted aminor contribution to overall dose; this category included anyx- or gamma-rays with energy below 10 keV. These photonswere treated as "nonpenetrating" emissions in that they were

generally absorbed where they were emitted; they were given adifferent classification so that they would not be treated aselectrons in the electron dose models for bone and marrow(described below). In version 3, this classification scheme wascontinued with the modification that beta particles were distinguished from monoenergetic electrons for use in the calculationof dose to small spheres, as required by the model used tocalculate dose to small, unit density spheres (see SpecialModels And Features, below). The inclusion of alpha emitterswas intentionally avoided, as alpha emitters have not been usedmuch in nuclear medicine and because their introduction causedan increase in program complexity. The use of some alphaemitters in antibody therapy has prompted consideration ofinclusion of this feature in future versions.

In both versions 2 and 3, the pediatrie phantom series ofCristy and Eckerman (6) was used for the photon-specificabsorbed fraction libraries, giving the user the ability tocalculate dose estimates for adults (70 kg), 15-yr-olds (57 kg),10-yr-olds (32 kg), 5-yr-olds (19 kg), 1-yr-olds (9.2 kg) and

newborns (3.4 kg).The model for the 15-yr-old has been used often as an adult

female reference model. These phantoms were designed to takeinto account the size, shape and position of the various organsat the different ages based on available literature. The masses ofthese phantoms and of the organ regions in each phantom areshown in Table 3. The bone marrow in the models changesconsiderably with age. In the newborn, the active marrow isdistributed throughout the entire length of the long bones, aswell as in the other bones of the skeleton. With age, the longbones contain less and less active marrow and more and moreinactive, or yellow, marrow. Thus, it is questionable whetherthe model for the 15-yr-old should be used for the adult female.In reviewing these data, however, it was felt that the individualvariation in marrow location and mass in adult women was asgreat, or greater, than the difference between the 15-yr-old andthe adult phantoms, and that the approximation was reasonable.Thus, it was used in this fashion for a number of years.

In version 3, the pregnant female phantom series of Stabin etal. (7) was added to the software. These phantoms weredesigned to represent the adult female at different stages ofpregnancy. In addition, this series included a specific model forthe adult female different from the 15-yr-old Cristy/Eckermanphantom. The organ masses are based on those suggested inICRP Publication 23 (8) for the adult female. The specificabsorbed fractions for the 15-yr-old were modified in the caseof organ self-irradiation to account for these mass differences,while specific absorbed fractions for organ cross-irradiationwere left unchanged. The bone and marrow model for the15-yr-old was also used to represent the adult female. The

MIRDOSE: PERSONALCOMPUTERSOFTWARE•Stabin 539

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TABLE 1Radionuclides Available in MIRDOSE 2

TABLE 2Radionuclides Available in MIRDOSE 3

SH ^K ^Co ""Y 127Xe192lr11Q43K 66Ga 97Ru 129|195Au13N

45Ca 67Ga ""Tc 130I195Hg14f»SI/™-- 6800 111ln 131I 195TT1D*.

U wl Uà IM Iil15O^Fe 72Ga 113mln 133Xe197Hg18pS2mMn 73Se '23"Te 129CS198AU^Na

52Mn 75Se 123I 137Cs«"TI24Na57Co 81mKr 124I 157Dy203Hgp58^-»-. M1Rh 125j 169YH^^Pb3Sg

59pe 82Rb 126|178yymasses

of the adult female and the pregnant femalephantomsareshown in Table4.Specific

absorbed fractions for electrons and betaparticles(plusand minus) are estimated based on the rules laid outinMIRD

Pamphlet No. 11 (9) for "nonpenetrating"emissionsand

the masses of the target regions in the variousphantoms(Tables3 and 4). Basically, the absorbed fraction is set to1.0when

the source and target are the same and to 0.0 whentheyaredifferent, with a few exceptions. Those exceptionsinclude:1

. When the source organ is the contents of a holloworganandthe target is organwall.2.

When the source or the target organ is the totalbody.3.When the source organ is in the bone or marrow andthetarget

organ is one in which crossfire can occur inthisregion.The

equations for the first two exceptions are given inMIRDPamphletNo. 11 (9). For bone and marrow, versions 2 and3are

completely different. In version 2, the model for boneandmarrowin ICRP Publication 30(10) was adopted, as it wasfeltthat

this was the model that would be widely used bymanysegmentsof the radiation protection community. With experi

ence with this model and examination of itsassumptions,however,it became apparent that it was considerably conser

vative and that the more accurate model developedbyEckerman( / / ) would be much more useful in nuclear medi

cine. A description of the new bone and marrow model isgiveninthe article by Eckerman and Stabin (72), but abriefdescription

and summary of some of the pertinent results willbepresented(see section on Special Models andFeatures).Calculational

FrameworkInversion 2, only one phantom could be chosen at a time.Inversion

3, all six phantoms in the pediatrie phantom series orallfourphantoms in the pregnant female phantom series usedwitha

given choice of radionuclide and set of residence times. Foragivenphantom, after the program receives all needed input,itproceeds

to estimate the S-values it needs to calculate all ofthedoseestimates needed, as in Equation 1.Starting

with the first source organ, S-values arecalculatedforeach target organ, considering each emission in thedecayscheme

separately. In version 2, the user was asked tospecifythetarget organs to be studied; in version 3 theprogramautomatically

calculates dose to all 26 available target organs.Iftheemission is a "nonpenetrating" emission, its energyisabsorbed

locally as described in the rules for these emissionsinMIRDPamphlet 11 (seeabove).After

all radionuclide emissions are considered, thetotalS-valuefor a source/target organ combination is stored intheS-valuematrix in the proper position, and the next targetorganis

considered. Then, the next source organ is considered untilalltheneeded S-values are calculated.3H

67Cu ^Nb 131Cs195Au7Be62Zn 9SmNb 132Cs195mAu11CœZn "Mo 134Cs198Au14Q697n ^"Tc 134mCs199Aui3fg69mZn 95Tc 137Cs195Hg140^Ga 95mTc 128Ba195mHg15O67Ga 97mTc 131mBa197Hg19Q68Ga 99yc 133Ba197mHgiBp72Ga ""Tc 135mBa203Hg19Ne^Ge 97Ru 137mBa206Hg22Na72As 103Ru 134La2<XTI24Na73As 103mRh 140La""TI28Mg74As 103Pd 134Ce202TI28AI72Se 109Pd 139Ce206TI30p^^A ^^mAfl 1^1 Oß2OÖT132p

73mop ^^®CH ^^Pm^^Tl33p

75ge 109|n 147pm 201pb

35o 77mc* 11 11 145c*2O3nu.S 'mSe In Sm Pbsept 75Br 111mln 153Sm204mpb37Ar

76Br 113mln 154Eu212Pb40K

80Br 114m|n 157^204B¡42\s

80mo_ llSmt- 159n\/206o:IV ! M in L/y t¡t43K82Br 113cn165DVr\ DI oíiLjy45Ca"Kr 117mSn165Er47Ca79Kr 118Sb167mEr49Ca81Kr 118mSb171Er^Sc81mKr 123Te167Tm47Sc83mKr 123mTe17(Tm49ScKKr 122I171Tm«V85mKr 123I169Yb""Cr77Rb 124I177Ta51Cr79Rb 125,178T351Mn

81Rb 126I179Ta52Mn^Rb 129I182Ta52mMn82mRb 130,17?WMMn

MRb 131I178W^FeMRb 132I181W55c«86QK 132mi188>Ai\i hi ; , W

59Fe 82Sr 133I186Re^Co^Sr 122Xe188Re^Co^Sr 123Xe190mOs57Co^Sr 127Xe191Os5ÖQQ87mg_ 129m\/g 191mQc^Co

89Sr 131mXe190lr57Nj90Sr 133Xe190m1,r63|^j

87y 133mXe190m2|r57Cu

^Y 128Cs 191mlr62Q.J90y 129Cs192lr64Cu952,. 130Cg195mptAfter

calculation of the S-values, the program checks toseeifthe S-values for total body as a source need to be correctedtobeS-values for the "remainder of the body," i.e., the totalbodyminus

any source organs. This option is invoked if"totalbody"is chosen as a source along with any other organs.If"total

body" is the only source chosen, or if it is not chosenatall,

this option is notused.Inversion 3, the name of the source organ on the inputscreenchanges

from "total body" to "remainder of the body" ifanyother

source organs are chosen to attempt to alert the userthattheresidence time for the "remainder of the body" isexpectedforthis entry. In version 2, "remainder of the body" isshownwhen

the residence time is requested. The S-values fortotalbodyas a source are corrected according to thefollowingformula

(J3):

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TABLE 3Masses of Source Regions in the Cristy and Eckerman Phantom Series

Mass (g) of organ in eachphantomOrganAdrenalsBrainBreasts

(includingskin)Breasts(excludingskin)Gallbladder

contentsGallbladderwallGl

tractLL1contentsLLIwallSI

contents andwallstomachcontentsstomachwallULJcontentsUL.I

wallHeartcontentsHeartwallKidneysLiverLungsOvariesPancreasRemaining

tissueSkeletonActive

marrowCorticalboneTrabecular

boneSkinSpleenTestesThymusThyroidUrinary

bladdercontentsUrinarybladderwallUterusWhole

bodyNewborn*3.4kg5.833520.2050.1072.120.4086.987.9852.910.66.4111.210.536.525.422.912150.60.3282.8023604701401189.110.84311.31.2912.42.883.8536001yr9.8kg3.528841.100.7324.810.91018.320.613836.221.828.727.872.750.662.92921430.71410.3640015029920027125.51.2122.91.7832.97.701.4597205yr19kg5.2712602.171.5119.73.7336.641.427575.149.157.955.213492.81165842901.7323.61330032087521953848.31.6329.63.4564.714.52.701980010yr32kg7.2213603.652.6038.57.2861.770.046513385.197.593.42191511738874533.1330.023100610158039688877.41.8931.47.9310323.24.163320015yrr55-58

kg10.5141040736149.09.27109127838195118176168347241248140065110.564.94000010503220806215012315.528.412.416035.979.056800Adultmale70kg16.3142040335155.710.51431671100260158232220454316299191010008.7194.351800112040001000301018339.120.920.721147.679.073700'Phantom

and total phantom weight.

fAlso used as adult female phantom.(\1

^^*VrriRB/

.,

.ft-

* r\llrk *~~ IWI I,programremovedcf*rt*f*r\

r\would

end withaninversion 3 asthemnt

tVif»m f\r ci»nH tJierror

status.Thisusermay viewthef*m

tf\ o /"i t c L* ili*» filimitation

wasresultsontheif

1 ' 1 t i •(' IIC*> 111

where S(rk <—RB) is the S-value for remainder of the bodyirradiating target region rk; S(rk <—TB) is the S-value for thetotal body irradiating target region rk; S(rk <—rh) is the S-value

for source region h irradiating target region rk; mTB is the massof the total body; mRB is the mass of the remainder of the body,i.e., the total body minus all other source organs used in thisproblem; and mh is the mass of source region h.

After all corrected S-values are available, the program simplyloops over all of the source organs for each target organ,calculating the individual contributions to dose and the totaldose. Each contribution to an organ's total dose is saved in a

matrix so that the individual contributors may be identified in asubsequent search routine. After printing a header in which theprogram version is displayed, along with a notation of the user's

chosen radionuclide, program output label and the date, theprogram proceeds one target organ at a time and prints ordisplays the results for each target organ as it is calculated.

In version 2, the only output option was to print to thecomputer's LPT1: printer port; if no printer was available, the

version 3, the results are automatically shown on the screen,with options available to send the results to a file or the defaultprinter.

With any program output in either version 2 or 3, all of theorgan residence times are listed below the program output, aswell as the assumptions used in either the Dynamic BladderModel or ICRP 30 GI Tract Model (see section Special Modelsand Features), if used. The user also has the option, in eitherversion, to look at all source organ contributions to a targetorgan's total dose; if this option is chosen, this output will be

included on any program output. In version 3, the user also hasthe option of looking next at dose estimates for other phantomswhich were initially chosen for study. If this output is to be sentto a file or printer, its output will follow that for the previousphantom; all of the above information about residence timesand model assumptions will be printed again with the output.

Production of S-Value TablesIf, instead of dose estimates, the user simply wants to produce

a complete table of S-values for the radionuclide and phan-

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TABLE 4Masses of Source Regions in the Pregnant Female Phantom Series

Mass (g) of organ in eachphantomOrganAdrenalsBrainBreasts

(excludingskin)GallbladdercontentsGallbladder

wallLLIcontentsLLIwallSmall

intestinecontentsSmallintestinewallStomach

contentsStomachwallULIcontentsULI

wallHeartcontentsHeartwallKidneysLiverLungsOvariesPancreasRemaining

tissue*SkeletonActive

marrowCorticalboneTrabecular

boneSkinSpleenThymusThyroidUrinary

bladdercontentsUrinarybladderwallUterine

wallFetusPlacentaWhole

bodyWholebody(maternaltissues)Adult

female(nonpregnant)1412003605081351603756002301402102004102402751400651118540000130030007501790150201716035.980——5800056800Three-monthpregnantfemale1412003605081351603756002301402102004102402751400651118539300130030007501790150201712836.9374458—5800056400Six-monthpregnantfemale1412003605081351603756002301402102004102402751400651118541700130030007501790150201710734.583416403106150057500Nine-monthpregnantfemale1412003605081351603756002301402102004102402751400651118539500130030007501790150201742.323.9109529604666370056600

•Remainingtissue is defined as the part of the phantom remaining when all defined organs have been removed. This region of the phantom has been used

in the radiation transport code to model muscle for dosimetrie purposes. The appropriate mass of muscle to use in such calculations in the adult female,however, is 15,500 g. The entries for this region have been rounded to two significant figures.

tom(s) chosen, that may be done by selecting this pathway. It ishelpful to have all of the S-values printed on one or two pages,with columns of values for each source organ. With 24-27source organs available, this results in the need for printing12-14 columns per page.

Printing these results is problematic because many differentprinters are available. For this reason, version 2 was distributedwith copies of the source code so that modifications could bemade by the user to allow the S-value table to be printed incompressed print on any individual printer. In version 3, theS-values were simply printed in fewer columns, therefore usingmore pages and the standard printer handling routines wereconsidered adequate. For this reason, the source code was notdistributed with version 3 and is not available. Output ofS-values to a file is also permitted so that the user may adapt thesource output to any format using available editors.

Special Models and FeaturesPlot Program. Version 2 was released with a program that

performed simple least-squares fitting of data to functions

involving one, two or three exponential terms. The purpose ofthis routine was to permit the user to calculate residence times,given a set of bioretention data. The program asked the user toenter activity for times at which measurements were taken andthe corresponding values of measured activity. The programthen fit the data to the desired number of exponential terms,using standard least squares methodology (14). The programreturned the values of a and b for the following equation:

A(t) = a,e"blt + a2e"b2tEq. 3

where A(t) is the activity at time t; a¡is the amount of activityassociated with component i; and b¡is the rate coefficient forclearance of component i, (hr~'). b¡= 0.693/T¡,where T¡is the

half-time for clearance of component i (hr).If this expression is integrated to infinity, the residence time

may be quickly estimated as:

a, a2Eq. 4

542 THEJOURNALOFNUCLEARMEDICINE•Vol. 37 •No. 3 •March 1996

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TABLE 5Residence Times (HR) in the Gastrointestinal Tract

at Various Ages

Gl tractsegmentStomachSmallintestineUpper

largeintestineLower

largeintestinePhantomNewborn0.50.581.93.51-yr-old0.50.782.544.685-yr-old1.03.110.218.81

0-yr-old1.04.013.024.015-yr-old1.04.013.024.0Adult"1.04.013.024.0

These values used for the adult and pregnant female cases.

where T is the residence time (hr).This expression assumes that the rate coefficient as defined

above represents the sum of biological and physical elimination(the effective removal coefficient).

ICRP 30 Gastrointestinal Tract ModelIn ICRP Publication 30 (10), a model for material transport

through the gastrointestinal (GI) tract was proposed. In thismodel, material was assumed to enter the stomach and pass tothe small intestine (SI), upper large intestine (ULI), lower largeintestine (LLI) and be excreted in the feces at standard rates.Absorption from the SI into the blood was also allowed by themodel. This model was implemented in both versions 2 and 3 tobe used in cases in which activity in the GI tract was assumedto follow these kinetics.

In addition, activity was permitted to also enter the SI andpass through the rest of the system at the standard rates, torepresent cases in which activity entered the GI tract from theliver. The GI transit times were based on measurements inadults and were thought to be too long to represent children. Nopublished values of GI transit rates for children of different agescould be located. Discussions with various pediatricians, however, permitted estimation of total GI transit times in children ofdifferent ages. These total GI transit times were then scaled foreach of the segments of the GI tract below the stomach inproportion to the values used for adults. The GI transit timesused for the different ages are shown in Table 5.

Dynamic Bladder ModelA mathematical model which predicted the total number of

disintegrations occurring in the urinary bladder, assuming inputinto the bladder based on a sum of exponential terms and aregular voiding pattern, was given by Cloutier et al. (75). Thismodel was implemented in both versions of the software. Theuser was asked for the number of components to the inputfunction (number of exponential terms) and for the fraction ofinjected activity and the biological half-time for clearance foreach of the terms. The program then calculated the residencetime in the bladder according to the formula given in this model.

Region-Specific Bone and Marrow Model

In version 3, the new bone and marrow model of Eckerman(11) for electron dose to bone surfaces and marrow fromsources in the trabecular or cortical bone was implemented.This replaced the model in version 2, which was based on themodel given in ICRP Publication 30 (10). Photon dose in bothversions was based on the photon-specific absorbed fractions ofCristy and Eckerman for children and adults (6). The modelused in version 3 was a significant departure from that used in

version 2 both in terms of the numerical values estimated andcapability.

The ICRP 30 model for electron dosimetry of bone andmarrow was based somewhat on the work of Spiers et al. (16),but was generally very conservative and had little dependenceon energy. Basically, a conservatively high value for thefraction of electron energy emitted in a source absorbed in atarget was chosen to represent all energies. In the Eckermanmodel (//), the absorbed fractions were estimated at variousenergies. Then, the electron and/or beta spectrum for a radio-nuclide was folded over the absorbed fraction spectrum toproduce dose conversion factors. In addition, the absorbedfraction spectrum was defined for several different bone groupsin the body, permitting study of the absorbed dose to bonesurfaces or marrow in different regions of the skeleton.

Knowledge of the fraction of marrow existing in differentbones then permitted the expression of an absorbed dosedistribution in histogram format. Therefore, in version 3 thisnew model was implemented and users were permitted use ofthe most recent photon- and electron-absorbed fractions. Userswere also given the ability to look at marrow dose distributionsand dose-volume histograms. An example of the output fromthe program showing this information is given in Figure 1. Theresidence times used to generate these results are those shownin Table 9.

Absorbed Dose to Small, Unit Density SpheresCalculation of the absorbed dose to small, unit density

spheres is often of interest, e.g., in the dose calculation to atumor or to a small organ. Absorbed fractions for photons,given the assumption that the activity is distributed uniformlythroughout the sphere, have been available for a number ofyears (17,18). Absorbed fractions for electrons and beta particles were recently published for a number of sphere sizes andemission energies (19). These dataseis were combined inversion 3 to permit the user to calculate S-values for anyradionuclide in the program very easily (Fig. 2). An example ofthe output of this module is shown in Table 6.

RESULTS AND DISCUSSIONTables 7-9 show a comparison of results generated by

versions 2 and 3 for the reference adult phantom (70 kg), givena set of entered residence times. In Table 7, values for 14C-

glucose are shown. Carbon-14 is a pure beta emitter, and themodel shown for '4C-labeled glucose uses only four organs: the

brain, liver, urinary bladder contents and remainder of the body.The results between the two versions are virtually identical,

with the exception of the dose to the bone marrow and bonesurfaces. This is not due to the change in the bone and marrowmodel, but in the way that the dose from the remainder of thebody to these organs is estimated.

In version 2, uniform activity in the remainder of the bodywas assumed to be uniform in marrow and bone and theabsorbed fractions for electrons irradiating marrow and bonesurfaces were applied to estimate S-values. In version 3, it wasassumed that all organs should receive the same dose fromactivity uniform in the remainder of the body. This was themethod employed in MIRD Pamphlet No. ¡I, and is a morereasonable approach.

Table 8 shows a comparison of results from the two codes for"""Tc-labeled MIBI (methoxyisobutyl isonitrile). The results

are quite similar for all organs in this case.Table 9 shows a comparison of results for a monoclonal

antibody labeled with 131I, which has some uptake in the red

marrow and the bone. In this table, the differences between the

MIRDOSE: PERSONALCOMPUTERSOFTWARE•Stabin 543

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2.111-01_1.

751-011.

Ill-01l».Tjt-oa

.__4.

171-02j0

00«+00sc

sr;--

1——CVfPSOSMSLJUJAMALRBPV™iLU

LU U,K

- Skull,Craniunsr

. skull,raclaiCV

•Clavicle»SP

-ScapulaeSU

- Spine.UpperSU

. Spin«,MiddleSL

- Spin«,LoverAM

. Arma,MiddleAL

. Ama.LowerPV

-felviaLD

. Leg«.Upp*rLL

. L*gs. Lower

FIGURE 1. Sample of marrow dose report available in MIRDOSE versions3.0 and 3.1. This plot shows marrow dose to different regions of the skeleton.On the computer screen, the histogram regions are shaded in different colorsand on the printed output they are shown in different shades of grey (on ablack and white printer) or color (on a color printer). For purposes ofreproduction here, they are left unshaded.

uptake in the bone and marrow dose are clearly seen. All of thereasons for these differences will not be immediately clear fromthis example. The reader is directed to the paper by Eckermanand Stabin (12) for a more complete explanation of the newbone model and its differences from previous models.

Some minor differences may be noted for many other organsbetween the two codes. This may be attributed to a difference in

DOB*Voluow HlffCograI. Diff«r»nci«l

DOMvoluiM Histogram*II Int*gr«l

100.00« 100.00« 100.00«91.60«

RGURE 2. (A) Sample of the differential marrow dose volume histogramreport available in MIRDOSE versions 3.0 and 3.1. This figure shows thefractions of marrow receiving absorbed doses between the values on theabscissa, based on the data in Figure 1 and assumed fractions of marrow inthe different regions of the skeleton. On the computer screen, the histogramregions are shaded in different colors, and on the printed output, they areshown in different shades of grey (on a black and white printer) or color (ona color printer). (B) Sample of the integral marrow dose volume histogramreport available in MIRDOSE version 3.0 and 3.1. This figure shows thefractions of marrow receiving absorbed doses greater than or equal to thevalues on the abscissa, based on the data in Figure 1 and assumed fractionsof marrow in the different regions of the skeleton. On the computer screen,the histogram regions are shaded in different colors and on the printedoutput they are shown in different shades of grey (on a black and whiteprinter) or color (on a color printer).

the marrow mass between the two codes. MIRDOSE 2 uses amarrow mass of 1500 g, one which has been widely used andquoted.

MIRDOSE 3 uses a marrow mass of 1120 g, which wasactually the original mass of active marrow suggested in ICRPPublication 23 (8), whereas the value of 1500 g is the mass ofmarrow which contains some red marrow (but which actuallyalso contains some yellow marrow). When this slight massdifference is introduced into the calculation for the remainder ofthe body S-value correction (Equation 2), the S-values for theremainder of the body to the different organs of the bodybecome slightly higher, and thus the doses are increasedslightly.

Effective Dose Equivalent and Effective DoseIn version 3, the quantities effective dose equivalent (70) and

effective dose (20) were also calculated and added to the list ofdose estimates given by the program. In theory, these quantitiespermit the representation of a nonuniform internal dose as asingle value, which is the dose equivalent to that which thewhole body could uniformly receive that would result in thesame overall risk as the actual nonuniform dose distributionreceived. This may permit comparison of the radiation risk ofdifferent diagnostic agents (e.g., a 99mTc-labeled heart agentcompared to 201T1) using a single number, or comparison of

nuclear medicine and x-ray procedures, etc.The two quantities—effective dose equivalent and effective

dose—are identical in concept. They are different in name, in

the numerical values of the organ risk weighting factorsassigned (Table 10) and slightly different in the scheme used toestimate dose to remainder organs. Both values are given inversion 3 for comparison and selection as the user chooses.

These quantities were originally designed for use in radiationprotection programs (70), but their use has been suggested fornuclear medicine (21-23) by the ICRP (who designed it) and

TABLE 6S-Values for Self-Irradiation: Small Unit Density Spheres,

lodine-131

Self-dose S-value

Sphere mass (g) (mGy/MBq-s) (rad/jitCi-hr)

0.010.100.501.002.004.006.008.0010.0020.0040.0060.0080.00100.00300.00400.00500.00600.001000.002000.003000.004000.005000.006000.002.34E+00*2.70E-01'5.70E-02-2.95E-021.50E-027.64E-035.16E-033.89E-033.13E-031.58E-038.10E-045.55E-044.26E-043.45E-041.21E-049.23E-057.49E-056.30E-053.90E-052.05E-051.41E-051.09E-058.89E-067.55E-063.11E+01*3.60E+00*7.59E-01*3.93E-012.00E-011.02E-016.87E-025.18E-024.17E-022.11E-021.08E-027.39E-035.68E-034.59E-031.61E-031.23E-039.97E-048.39E-045.20E-042.73E-041.88E-041.45E-041.18E-041.01E-04

'Electron/beta only.

544 THE JOURNALOFNUCLEARMEDICINE•Vol. 37 •No. 3 •March 1996

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TABLE 7Comparison of MIRDOSE Versions 2 and 3 Results: Pure Beta

Emitter in Four Organs: Carbon-14-Labeled Glucose

TABLE 8Comparison of MIRDOSE Versions 2 and 3 Results: Photon and

Electron Emitter in Several Organs: Technetium-99m-MIBI*

Estimated radiation dose(mGy/MBq)

Target organ MIRDOSE 2 MIRDOSE 3

AdrenalsBrainBreastsGallbladder

wallLLIwallSmallintestineStomachULI

wallHeartwallKidneysLiverLungsMuscleOvariesPancreasRed

marrowBonesurfacesSkinSpleenTestesThymusThyroidUrinary

bladderwallUterusTotal

bodyEffectivedoseequivalentResidence

timesBrainLiverUrinary

bladdercontentsRemainder

ofthebody2.47E-023.17E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-024.91

E-022.47E-022.47E-022.47E-022.47E-023.24E-022.21

E-022.47E-022.47E-022.47E-022.47E-022.47E-025.45E-022.47E-022.55E-022.93E-02*1.58E+OOhr3.29E+00

hr6.25E-01hr6.08E+01

hr2.47E-023.17E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-024.91

E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-022.47E-025.46E-022.47E-022.55E-022.84E-02

"Effective dose equivalent not available in version 2, but calculated based

on the estimated organ doses.

others. There is some controversy about the use of thesequantities at the time of this writing (24,25), but the quantitiesare calculated in MIRDOSE 3 and offered to the user, in casethey are of interest.

CONCLUSIONThe MIRDOSE computer software greatly facilitates the

calculation of internal radiation dose estimates by the MIRDtechnique. The user need only calculate organ residence times,enter them into the program and radiation dose estimates for allorgans are estimated, including the effective dose equivalentand effective dose (in version 3). The program makes use ofstandard and most up-to-date models used in internal dosimetry.This results in standardization of dose estimates calculated froma given set of residence times, and should greatly enhance theability of users, manufacturers, regulators and others to interpretradiation dose estimates.

Finally, it should be made clear that this program is in no wayassociated with the MIRD Committee of the Society of NuclearMedicine. The name of the program implies only that it uses theMIRD technique. The MIRD Committee wishes it to be knownthat it does not endorse the MIRDOSE program, its input data,methods or results.

Estimated radiationdose(mGy/MBq)Target

organAdrenalsBrainBreastsGallbladder

wallLLIwallSmallintestineStomachULI

wallHeartwallKidneysLiverLungsMuscleOvariesPancreasRed

marrowBonesurfacesSkinSpleenTestesThymusThyroidUrinary

bladderwallUterusTotal

bodyEffectivedose equivalentMIRDOSE

26.26E-031.83E-031.85E-032.96E-024.19E-017.11E-021.28E-021.70E-014.96E-032.31

E-028.21E-032.75E-038.82E-036.25E-028.78E-031.25E-021.30E-023.40E-038.63E-037.91E-032.46E-032.22E-035.37E-023.39E-021.08E-026.31E-02TMIRDOSE

36.25E-031.83E-031.85E-032.96E-024.20E-017.09E-021.28E-021.70E-014.95E-032.31

E-028.19E-032.75E-038.81E-036.24E-028.77E-031.24E-021.31

E-023.39E-038.62E-037.90E-032.46E-032.22E-035.37E-023.39E-021.07E-026.31

E-02Residence

timesGallbladder

contentsLowerlargeintestinecontentsSmall

intestinecontentsUpper

largeintestinecontentsHeart

wallKidneysLJverLungsSpleenUrinary

bladdercontentsRemainder

ofthebody7.35E-02

hr8.86E+00

hr1.48E+00

hr4.80E+00

hr5.30E-02

hr2.90E-01hr1.86E-01hr4.90E-02hr2.40E-02hr7.80E-01hr3.86E+00

hr'Methoxyisobutyl

isonitrile.

Effective dose equivalent not available in version2,onthe estimated organ doses.but

calculated based

ACKNOWLEDGMENTSThis work was performed for the U.S. Department of Energy

under contract DE-AC05-76OR00033 and for the U.S. Foodand Drug Administration under Interagency Agreement No.FDA 224-75-3016, DOE 40-286-71. This article has beenauthored by a contractor of the U.S. Government under contractDE-AC05-76OR00033. Accordingly, the U.S. Government retains a nonexclusive, royalty-free license to publish or reproduce the published form of the contribution, or allow others todo so, for U.S. Government purposes.

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TABLE 9Comparison of MIRDOSE Versions 2 and 3 Results: Photon and

Electron Emitter in Several Organs, Including the Red Marrow andBone: lodine-131-Labeled Monoclonal Antibody

TABLE 10Comparison of Organ Risk Weighting Factors for Effective Dose

Equivalent and Effective Dose

Estimatedradiationdose(mGy/MBq)

Targetorgan MIRDOSE2 MIRDOSE3

AdrenalsBrainBreastsGallbladder

wallLLIwallSmallintestineStomachULI

wallHeartwallKidneys

LiverLungs

MuscleOvariesPancreasRed

marrowBonesurfacesSkinSpleen

TestesThymus

ThyroidUrinarybladderwallUterusTotal

bodyEffectivedose equivalent4.16E-029.25E-038.77E-032.78E-021.62E-022.05E-021.95E-021.98E-021.38E-021.57E+00

4.68E-021.29E-02

1.38E-021.69E-023.15E-021.92E-012.65E-019.40E-035.87E-02

9.63E-031.02E-02

9.58E-031.34E-011.83E-022.51E-02

1.49E-01*4.19E-029.47E-039.16E-032.83E-021.67E-022.10E-022.00E-022.02E-021.43E-021.56E+00

4.68E-021.32E-02

1.42E-021.74E-023.19E-021.07E-019.93E-029.72E-035.88E-02

1.01E-021.07E-02

9.95E-031.34E-011.88E-022.51

E-021.34E-01

Residencetimes

KidneysLiverRed marrowCortical boneTrabecularboneSpleenUrinarybladder

contentsRemainderof the

body

3.71E+OOhr4.17E-01 hr1.50E+OOhr5.00E-01 hr5.00E-01 hr4.17E-02 hr4.00E-01 hr

2.60E+00 hr

"Effectivedose equivalentnot availablein version2, but calculatedbased

on the estimatedorgan doses.

REFERENCES1. Loevinger R. Budinger T, Watson E. MIRD primer for absorbed dose calculations.

New York: Society of Nuclear Medicine; 1988.2. Watson E, Stabin M. Basic alternative software package for internal radiation dose

calculations. In: Kathren RL. Higby DP, McKinney MA, eds. Computer applicationsin health physics. Proceedings of the 17th Midyear Topical Symposium of the HealthPhysics Society. Richland. WA; 1984.

3. Weber D, Eckerman KF, Dillman LT. Ryman J. MIRD: radionuclide data and decayschemes. New York. Society of Nuclear Medicine; 1989.

4. Kocher D. Radioactive Decay Data Tables, Oak Ridge National Laboratories, OakRidge, Tennessee. 1981. DOE/TIC-11026.

5. ICRP Publication 38. Radionuclide transformations—energy and intensity of emis

sions. Oxford. Pergamon Press; 1983.6. Cristy M, Eckerman K. Specific absorbed fractions of energy at various ages from

internal photons sources. ORNL/TM-K3KI VÕ-V7.Oak Ridge, TN: Oak Ridge National

Laboratory; 1987.

OrganGonadsRed

marrowColonLungsStomachBladderBreastsLiverEsophagusThyroidSkinBone

surfacesRemainderEffective

doseequivalent (ICRP30)0.250.12—0.12——0.15——0.03—0.030.30*Effective

dose(ICRP60)0.200.120.120.120.120.050.050.050.050.050.010.010.05T

"The weighting factor for the remainder in the effective dose equivalent is

to be divided equally among the five highest organs not explicitly mentionedin this list which receive the highest absorbed doses.

^e weighting factor for the remainder in the effective dose is to bedivided equally among ten organs not explicitly mentioned in this list butwhich were assigned by the ICRP (adrenals, brain, ULI, small intestine,kidneys, muscle, pancreas, spleen, thymus and uterus).

7. Stabin M, Watson E, Cristy M, et al. Mathematical models of the adult female atvarious stages of pregnancy. ORNL Repon ORNL/TM-129Ü7.Oak Ridge, TN: OakRidge National Laboratory; 1995: in press.

8. International Commission on Radiological Protection. Report of the Task Croup onReference Man. ICRP Publication 23. New York: Pergamon Press; 1975.

9. Snyder W, Ford M, Warner G. Watson S. "S," absorbed dose per unit cumulated

activity for selected radionuclides and organs, MIRD Pamphlet No. 11. New York:Society of Nuclear Medicine; 1975.

10. International Commission on Radiological Protection. Limits for intakes of radionuclides by workers. ICRP Publication 30. New York: Pergamon Press: 1979.

11. Eckerman KF. Aspects of dosimetry of radionuclides within the skeleton withparticular emphasis on the active marrow. In: Fourth International Radiopharmaceu-lical Dosimelry Symposium: Schlafke-Stelson AT and Watson EE. eds. CONF-851113.Oak Ridge, TN: Oak Ridge Associated Universities; 1986:514-534.

12. Eckerman K, Stabin M. Dose conversion factors for marrow and bone by skeletalregions (Abstract). J NucíMed 1995;36:1994;35:112P.

13. Cloutier R, Watson E, Rohrer R. Smith E. Calculating the radiation dose to an organ.J NucíMed 1973:14:53-55.

14. Draper N, Smith H. Applied regression analysis. New York: John Wiley & Sons;1966:7-13.

15. Cloutier R, Smith S. Watson E, Snyder W, Warner G. Dose to the fetus fromradionuclides in the bladder. Health Phys 1973:25:147-161.

16. Spiers FW. Beta dosimetry in trabecular bone. In: Mays CW. ed. Deìavetleffects ofbone-seeking radionuclides Salt Lake City, UT: University of Utah Press; 1969:95-108.

17. Brownell G, Ellen W. Reddy R. MIRD pamphlet no. 3—absorbed fractions for photon

dosimetry. J NucíMed I968;27(suppl):37.18. Elicit W, Humes R. MIRD pamphlet no. 8—absorbed fractions for small volumes

containing photon-emitting radioactivity. J NucíMed 1972:13(suppl):30.

19. Siegel JA, Stabin MG. Absorbed fractions for electrons and beta panicles in smallspheres [Abstract]. J NucíMed 1988;29:803.

20. International Commission on Radiological Protection. 1990 recommendations of theInternational Commission on Radiological Protection. ICRP Publication 60. NewYork: Pergamon Press; 1991.

21. International Commission on Radiological Protection. Protection of the patient innuclear medicine. ICRP Publication 52. New York: Pergamon Press; 1987.

22. International Commission on Radiological Protection. Radiation dose to patients fromradiopharmaceuticals. ICRP Publication 53. New York: Pergamon Press; 1988.

23. United Nations Scientific Committee on the Effects of Atomic Radiation. Sources andeffects of ionizing radiation, UNSCEAR 1993 Report to the General Assembly. NewYork: United Nations; 1993.

24. Poston J. Application of the effective dose equivalent to nuclear medicine patients. JNucíMed 1993:34:714-716.

25. Stabin M, Stubbs J. Watson E. Recent controversy in radiation dosimetry. Eur J NucíMed 1993:20:371-372.

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1996;37:538-546.J Nucl Med.   Michael G. Stabin  MedicineMIRDOSE: Personal Computer Software for Internal Dose Assessment in Nuclear

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