Australasian Physical & Engineering Sciences in Medicine Volume 28 Number 2, 2005

EDUCATIONAL NOTE

A standard approach to measurement uncertainties for

scientists and engineers in medicine*

K. Gregory1,2, G. Bibbo1,3 and J. E. Pattison1

1
School of Electrical and Information Engineering (Applied Physics), University of South Australia, Mawson
Lakes, Australia
2
Radiation Protection Division, Environment Protection Authority, Kent Town, Australia
3
Division of Medical Imaging, Women’s and Children’s Hospital, North Adelaide, Australia

Abstract
The critical nature of health care demands high performance levels from medical equipment. To ensure these
performance levels are maintained, medical physicists and biomedical engineers conduct a range of measurements on
equipment during acceptance testing and on-going quality assurance programs. Wherever there are measurements, there
are measurement uncertainties with potential conflicts between the measurements made by installers, owners and
occasionally regulators. Prior to 1993, various methods were used to calculate and report measurement uncertainties. In
1993, the International Organization for Standardization published the Guide to the Expression of Uncertainty in
Measurement (GUM). The document was jointly published with six international organizations principally involved in
measurements and standards. The GUM is regarded as an international benchmark on how measurement uncertainty
should be calculated and reported. Despite the critical nature of these measurements, there has not been widespread use
of the GUM by medical physicists and biomedical engineers. This may be due to the complexity of the GUM. Some
organisations have published guidance on the GUM tailored to specific measurement disciplines. This paper presents
the philosophy behind the GUM, and demonstrates, with a medical physics measurement example, how the GUM
recommends uncertainties be calculated and reported.

Key words uncertainty, error, accuracy, GUM,
measurement
Introduction
The performance tolerances of medical equipment are
generally more stringent than domestic and industrial
equipment due to the critical nature of health care. In the
case of medical X-ray units where patients are exposed to
ionising radiation, the performance levels may be set by
legal instruments, such as is done in South Australia1, or by
published recommendations2. Other medical equipment,
such as those relating to the administration of drugs
(eg balances and flow rate meters), and patient monitoring
*Presented in part at the 29th annual conference of the
Australasian Radiation Protection Society, Adelaide, SA,
Australia, 24-27 October 2004.
Corresponding author: Kent Gregory, Radiation Protection
Division - EPA, PO Box 721, Kent Town, SA 5071, Australia
Tel: 08 8130 0713, Fax: 08 8130 0777
Email: kent.gregory@state.sa.gov.au
Received: 14 February 2005; Accepted: 14 March 2005
Copyright © 2005 ACPSEM/EA
(eg thermometers and blood analysers), also need to
maintain high performance levels. There are examples in
the literature showing that the health care industry makes
widespread use of quality assurance (QA) programs3-5 to
monitor performance of equipment. These QA programs
usually include a variety of measurements that are
conducted at regular intervals. Performance measurements
may also be conducted on new equipment as part of
acceptance testing. As medical equipment is subject to so
many measurements, there is potential for conflicts to arise
between the various stakeholders, such as installers,
operators, purchasers, manufacturers and regulators. Any
measurements involved in such conflicts are likely to be
closely scrutinised, and the question of measurement
uncertainty may arise.
Prior to 1993, there was no international consensus on
how measurement uncertainties were to be calculated and
reported6. The variation in philosophies and calculation
methods caused three main problems, especially for
laboratories conducting comparisons with other laboratories
in different countries6. The first problem was that
laboratories had to give extensive explanations of the
measurement uncertainty calculation method they used
whenever results were reported, so that other laboratories
could make comparisons. The second problem was that it

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Australas. Phys. Eng. Sci. Med. Vol. 28, No 2, 2005
was common to keep random and systematic uncertainties
separated, both during calculations and in the final
reporting, even though they were both uncertainties. The
final problem was that some uncertainties were deliberately
overstated in the belief that this was acting conservatively.
Such practise has the capacity to increase type I and type II
errors7 in hypothesis testing (a type I error is when a good
result is erroneously rejected, while a type II error is when a
poor result is erroneously accepted). A desire to overcome
these three problems was the driver for what eventually
became the Guide to the Expression of Uncertainty in
Measurement6 (GUM).
In 1993, the GUM was jointly published by the
International Organization for Standardization and six
international organisationsa primarily concerned with
measurements and standards. The document is therefore
recognised by organisations internationally, including the
Australian National Measurement Institute (NMI). NMI
holds most of Australia’s First Level Standards, with the
exception of those relating to ionising radiation, which NMI
has delegated to the Australian Nuclear Science and
Technology Organisation and the Australian Radiation
Protection and Nuclear Safety Agency.
The GUM is underpinned with an extensive
mathematical basis and has the capacity to deal with most
measurement uncertainty problems. This generalist
approach comes at a cost; the GUM concepts and
methodologies are non-trivial, and may be difficult to
comprehend without continuous involvement in
measurement science at the highest levels (e.g. working at
institutions such as NMI). Some organisations8-10 have
published specific guidance on the GUM for various
measurement disciplines. Others11,12 have published
explanatory texts on the GUM in general. In particular, the
National Measurement Laboratory (part of NMI) has
published a document12 (the NMI Guide), which explains in
simple terms the philosophy, methods and reporting style of
the GUM for use in applied environments. The NMI Guide
also offers a number of pragmatic approaches that are in
keeping with the philosophy of the GUM, but substantially
reduce the complexity of the calculations.
The NMI Guide is still somewhat complex and requires
some introduction and further explanation before engineers
and scientists adopt the GUM more widely. Indeed, there
appears to be very little application of the GUM by
scientists and engineers in medicine within published
literature. These workers may be making use of simpler
methods13,14 for dealing with uncertainties that were
introduced to them during their undergraduate university
courses.
This paper presents a simplified theoretical
background, and uses a medical physics example to
illustrate how to apply the GUM to measurements made by
scientists and engineers in medicine.
a
International Bureau of Weights and Measures, International
Electrotechnical Commission, International Federation of
Clinical Chemistry, International Union of Pure and Applied
Chemistry, International Union of Pure and Applied Physics, and
the International Organization of Legal Metrology.
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Gregory et al • A standard approach to uncertainties
Theoretical background
Review of statistics
All measurements have an uncertainty. If a large
number of measurements are taken and each measurement
value is plotted against the number of times a measurement
value occurs (i.e. a histogram), the end product would be
the measurement’s uncertainty distribution. Uncertainty
distributions are typically scaled (standardised) so that the
area under a curve defining the histogram is equal to 1. This
is achieved by changing the x-axis to represent the
difference between each measurement value and the mean
value in terms of the number of standard deviations, and
changing the y-axis to represent probability density. Thus,
the probability of a measurement lying between two values
is equal to the area under the curve between these two
points. Most scientists and engineers will be familiar with
the Normal distribution, also known as the Gaussian
distribution and depicted in figure 1(a), which has a bell-
shaped curve. The Normal distribution is commonly
encountered in many types of measurements. The reason
why the Normal distribution is so common is explained by
the Central Limit Theorem. The ubiquitous nature of
Normal distributions is utilised by the GUM, and is
discussed later. Another uncertainty distribution is the
rectangular distribution as depicted in figure 1(b), which
applies to measurements that are rounded or truncated (such
as by a digital display). Occasionally, some measurements
are encountered that have uncertainty distributions that are
neither Normal nor rectangular, such as those depicted in
figures 1(c) and 1(d).
The aim of uncertainty analysis is to estimate the
uncertainty distribution for a final measurement result. The
final result’s uncertainty distribution is entirely dependent
on the uncertainty distributions of all factors that influence
Figure 1. Uncertainty distributions are like frequency histograms,
except they are standardised so that the area under an uncertainty
distribution curve is equal to 1. This is achieved by changing the
x-axis to represent the difference between measurement values
and the mean in terms of the number of standard deviations
(instead of measurement values), and changing the y-axis to
represent probability density (instead of frequency). Uncertainty
distributions can take any form, but the most common is the
Normal distribution (a). The rectangular distribution (b) is
associated with rounding or truncation of readings. Any
uncertainty distribution, including (c) and (d), may be assigned to
an uncertainty component.
Australas. Phys. Eng. Sci. Med. Vol. 28, No 2, 2005
the final result. This may include other measured quantities
(e.g. the measurement of mass and volume to determine
density), rounding of readings, or variations in atmospheric
or other conditions. Note that all factors that influence the
final result are collectively referred to as uncertainty
components (a term derived from the NMI Guide). Thus a
major task in uncertainty analysis is to characterise the
uncertainty distributions of the uncertainty components, so
that they can be combined.
In order to characterise an uncertainty distribution
exactly, the entire population of measurements would need
to be plotted as a histogram. As this is not possible for
infinite populations of measurements, a finite number of
measurements are sampled instead. From this sample,
inferences can be made about the infinite population. In the
case of the common Normal distribution of measurements,
the distribution of a finite sample of such measurements is
represented by a t-distribution (also called the Student’s
t-distribution). A t-distribution is virtually identical to a
Normal distribution when a sufficiently large number of
measurements are sampled (such as more than 20
measurements). However, if fewer measurements are
sampled, the shape of the t-distribution is flatter and
broader (see figure 2). This shape change reflects the fact
that with fewer measurements, less is known about the
infinite population. The shape of the t-distribution is
dependent on the degrees of freedom, ν. The value ν equals
the number of measurements sampled minus the number of
quantities calculated from the measurements. In most cases,
the measurements are used to calculate a mean, so ν will
equal one less than the number of measurements sampled.
For rectangular distributions, measurement sampling is
usually not required to ascertain the distribution shape.
Instead, its shape is obtained intuitively; the distribution is
flat with upper and lower bounds defined by, say, the
resolution of the instrument.
Figure 2. A comparison of the Normal distribution and t-
distributions with 1, 3 and 10 degrees of freedom. When the
degrees of freedom equals 20 or more, the t-distribution and the
Normal distribution may be considered equivalent for the
purposes of calculating uncertainties.
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Gregory et al • A standard approach to uncertainties
The uncertainty distribution of the final result is in
most cases, a known shape, due to the Central Limit
Theorem (CLT). The CLT states that when uncertainty
distributions are combined, the resulting distribution
approximates a Normal distribution. Knowing the shape of
the final result’s uncertainty distribution reduces the
amount of information needed regarding the distributions of
all the uncertainty components. In fact, only three quantities
for each uncertainty component are needed by the GUM to
estimate the uncertainty distribution of the final result.
The first quantity used to describe an uncertainty
distribution is the standard uncertainty, u (or estimated
standard deviation). This is a measure of the spread of the
distribution, with small u values indicative of repeatable
measurements (i.e. close agreement of successive
measurements). The second is the degrees of freedom, ν.
This quantity reflects the reliability of the value u. For
example, a value for u derived from many measurements
should have greater influence on the final result than
another u derived from a smaller number of measurements.
Thus, the higher the value of ν, the more reliable the value
of u. The third quantity is the sensitivity coefficient, c.
Values for c are used to take into account the relative
sensitivity of the final result to small changes in uncertainty
components. Thus if c = 1, an increase or decrease in the
value of an uncertainty component causes an equivalent
change in the final result. When c > 1 or c < 1, the
uncertainty component has, respectively, a greater and
lesser effect on the final result.
Background to the GUM and NMI Guide
The GUM and NMI Guide use methods and
terminology that may be unfamiliar to users of other
uncertainty analysis methodologies. For example, the term
measurand, which describes the quantity or parameter
subject to measurement, is used extensively in the GUM
and NMI Guide. While a detailed justification of why
certain procedures are used is documented in the GUM,
together with derivations of the equations, a brief
background is provided here, together with essential
terminology.
It is important to note that the GUM is not completely
regimented; there remain steps in the process requiring
professional judgment. As such, uncertainty analysis
remains an inexact science, since professional judgment is
subjective. This leads to uncertainty in the uncertainty
estimates. The NMI Guide plays on this fact, and proposes
a number of pragmatic approaches to the GUM process that
theoretically increase the uncertainty in the uncertainty
estimate. However, the NMI Guide argues that in practice
these increases are insignificant compared to the
uncertainty introduced through professional judgment.
There are four main steps in the GUM process, and
these are described in more detail below.
Step 1: Modelling the measurement
The first step in the process is to make what the GUM
refers to as a model of the measurement. This is a simple
task that involves writing an equation that relates the
Australas. Phys. Eng. Sci. Med. Vol. 28, No 2, 2005
(a)
(b)
Figure 3. (a) For a rectangular uncertainty distribution, the value
a is selected such that the range ±a includes the true value with
100% confidence; (b) For the Normal distribution, the value a is
selected such that the range ±a includes the true value with
approximately 95% probability. The estimated standard
uncertainty is half the value of a. If a very conservative value is
chosen (a′ ) such that the range ±a′ almost certainly includes the
true value (nearly 100%), half the value of a′ will be a poor
estimate of the standard uncertainty.
various uncertainty components to the final result (see
equation 9 in the example). Modelling the measurement
serves two purposes; it helps to identify uncertainty
components, and it assists in finding values of c for the
uncertainty components.
Step 2: Calculating values for u, ν and c
The GUM process involves characterising all
uncertainty components with these 3 descriptors; u, ν and c.
Values for the standard uncertainty u and the degrees of
freedom ν are calculated or assigned following what the
GUM refers to as either a Type A or Type B evaluation. It
may be helpful to think of Type A and Type B evaluations
as those uncertainties commonly described as ‘random’13,14
and ‘systematic’13,14 respectively (although this comparison
is not strictly true). In Type A evaluations, the value u is
equal to the estimated standard deviation of the population
of measurements, while ν is equal to its degrees of freedom.
Type B evaluations are performed when Type A
evaluations cannot be performed, such as when there is
only one value for an uncertainty component and additional
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Gregory et al • A standard approach to uncertainties
measurements cannot be obtained (e.g. a single value from
a table of reference data). With only a single value,
statistics cannot be used to calculate u and ν. Hence, u and
ν are derived using non-statistical approaches (i.e.
professional judgment), some of which have been
simplified by the NMI Guide. The first step in deriving u
and ν in a Type B evaluation is to assign an uncertainty
distribution representative of how the value of the
uncertainty component might vary if more values were
available. The GUM proposes that one of the four
distributions in figure 1 be assigned, with the triangular and
trapezoidal distributions assigned when there is insufficient
confidence to suggest the data do not follow a Normal
distribution, but sufficient information to suggest more
certainty than a rectangular distribution. The NMI Guide
suggests that uncertainty components, such as rounding or
truncation of readings, be assigned a rectangular
distribution, while almost all others may be assigned a
Normal distribution. The NMI Guide suggests that
triangular and trapezoidal distributions are rarely
encountered in the real world, and that more information
should be obtained before assigning such uncertainty
distributions to any measurement.
Having assigned an uncertainty distribution, the next
step is to estimate the range, ±a, (figure 3a and 3b) within
which the true value lies, and the likelihood that the true
value is within this range. If a rectangular distribution was
assigned, a value for a can be chosen such that the range ±a
represents exactly 100% of the uncertainty distribution. The
standard uncertainty can then be calculated;
a for a rectangular distribution (figure 3a) (1)
u=
3
If a Normal distribution was assigned, the NMI Guide
suggests choosing a value for a such that the range ±a
represents 95% of the measurements. The standard
uncertainty can then be calculated;
a for a Normal distribution (see figure 3b)
u= (2)
2
It is important not to deliberately increase a beyond
what is necessary, such as a′ in figure 3b. By deliberately
inflating the value a, the uncertainty calculated for the final
result may be unnecessarily large.
In order to assign values of ν, the NMI Guide argues that
the final result is not particularly sensitive to the ν values
chosen. If that is the case, then it is sufficient to categorise
each evaluation broadly as either poor, reasonable, good or
excellent (see table 1), and to assign the corresponding
value for ν. (Note that the third column in table 1, k, is
explained in Step 4.)
Values of the sensitivity coefficient c may be obtained
in one of three ways; (i) by making a small change in the
value of the uncertainty component in the model of the
measurement and calculating the consequent change in the
final result, (ii) experimentally changing the value of the
uncertainty component slightly and observing the
consequent change in the final result, or (iii) using calculus
Australas. Phys. Eng. Sci. Med. Vol. 28, No 2, 2005
Table 1. Relationship between measurement quality (as judged
through experience), degrees of freedom (ν) and coverage factor
(k) to generate a 95% confidence interval.
Measurement k for 95% confidence
ν
quality
Poor 2 4.30
Reasonable 8 2.31
Good 20
Excellent 1000
to differentiate the model of the measurement with respect
to the uncertainty component (this is a common uncertainty
analysis technique14). While it may not be possible to use
all three methods to calculate each value of c, at least one
method will be.
Step 3: Calculation of ucomb and νeff
Using the u, ν and c values, equations are then used to
calculate the combined standard uncertainty, ucomb and the
effective degrees of freedom of the final result, νeff.
Given two conditions specified below, the equation to
calculate ucomb is the square root of the sum of the squares
of the standard uncertainties, weighted with the respective
sensitivity coefficients. Thus for a final result with N
uncertainty components, the combined standard uncertainty
of the final result is given by:
∑
N
u comb = (c i u i ) 2
i =1
where ui is the ith standard uncertainty, and ci is the ith
sensitivity coefficient.
Equation (3) is valid if two conditions are met; (a),
each uncertainty component is not correlated with any other
uncertainty component, and (b), an approximately linear
relationship exists between each uncertainty component and
the final result for the range of values the uncertainty
components are likely to have. For most measurements, if
both the above conditions are not met, it is usually possible
to alter the way the measurement is made so that both
conditions are satisfied. If not, the mathematics becomes
more complex.
With regard to condition (a), the degree of correlation
is determined by calculating the correlation coefficient,
which can have any value from –1 (anti-correlated) to +1
(fully correlated). Values close to 0 are indicative of
uncorrelated uncertainty components. To account for
correlation, equation (3) becomes:
u 2 comb = ∑i =1 (ci ui ) + 2∑i =1 ∑ ci c j ui u j r (xi x j )
N 2 N −1 N
j =1+i
where r(xixj) is the correlation coefficient of the two
uncertainty components xi and xj.
In the special case where all uncertainty components
are fully correlated, i.e. r(xixj) =1, equation (4) reduces to;
N
u comb = ∑ (ci ui )
i =1
Gregory et al • A standard approach to uncertainties
Note that equation (5) is simply the linear sum of the
weighted standard uncertainties of the uncertainty
components. If any uncertainty components happen to be
correlated, it may be possible to alter the measurement
procedure to obtain uncorrelated uncertainty components,
interval and thus retain the simpler equation (3). However,
correlation may be a desirable effect, especially since anti-
correlated uncertainties can reduce the combined standard
2.09 uncertainty. The NMI Guide provides a pragmatic approach
1.96 to correlations to reduce the mathematical process.
With regard to condition (b), equations (3) and (4) are
the first terms in a Taylor series expansion, and are good
approximations if an approximately linear relationship
exists between the final result and each of the uncertainty
components. If this is not the case, the next term in the
Taylor series will need to be added to equations (3) and (4);
N N  1  ∂ 2 f  2 ∂f ∂ 3 f 
(6)
∑∑    + ui2u 2j
 2  ∂xi ∂x j  ∂xi ∂xi ∂x 2j 
i =1 j =1
 
where f is the model of the measurement with N
uncertainty components.
Non-linearity may occur when the value of the final
result is very small compared to the value of the uncertainty
components (such as calculating the area of a small
rectangle by measuring two sides using a ruler with a large
uncertainty), or the uncertainty components vary the final
result in a non-linear manner (such as an uncertainty
(3) component raised to a power in the model of the
measurement). The GUM provides more detail on non-
linearity.
As mentioned earlier, the CLT suggests that the final
result’s uncertainty distribution is a Normal distribution,
but this is only an approximation. However, with the
combined standard uncertainty, ucomb, and the effective
degrees of freedom, νeff, obtained from the Welch-
Satterthwaite formula6;
4
ucomb (7)
ν eff =
 ( c u ) 4

∑i=1  νi i 
N
 i 
the final result’s uncertainty distribution can be treated
mathematically like a t-distribution. In practice, νeff will
typically have a value greater than 20.
Step 4: State the final result
The final result’s uncertainty may be expressed simply
as ±ucomb, which represents a range of values within which
the true value is expected to lie with approximately 68%
(4)
probability (assuming νeff≥20). This is the traditional one
standard deviation or one sigma level. However, the GUM
reports the expanded uncertainty, U, calculated using
equation (8);
U = ucomb×k (8)
(5) where U is the expanded uncertainty, and k is the coverage
factor.
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Australas. Phys. Eng. Sci. Med. Vol. 28, No 2, 2005 Gregory et al • A standard approach to uncertainties

Table 2. An uncertainty analysis table. Each row represents a different uncertainty component, with values for
standard uncertainty (u), degrees of freedom (ν) and sensitivity factor (c).

Uncertainty components u ν c
Reading 0.0127 mGy 24 1.017 mGy/mGy
Rounding 0.000289 mGy 1000 1.017 mGy/mGy
Cal. Factor 0.025 units 20 1.953 mGy/unit
Temperature 0.50 K 20 0.00668 mGy/K
Pressure 50 Pa 20 -0.0000196 mGy/Pa
Position (vertical plane) 2 mm 20 0.00592 mGy/mm
Position (anode-cathode plane) 2 mm 20 0.00272 mGy/mm
Position (lateral plane) 2 mm 20 0 mGy/mm
The combined standard uncertainty
ucomb = 0.0523 mGy
and effective degrees of freedom:

Values for U can be calculated such that ±U has any
desired probability of containing the true value, including
the increasingly common12 95% probability. The value k is
selected from tabulated data6,12, given νeff and the desired
probability (known as confidence interval, CI). Some
typical values of k appear in table 1.
Both the final result and U need to be rounded such that
three objectives are met; namely U contains only significant
digits, the final result and U are rounded to the same least
significant digit, and the rounding process itself does not
introduce a significant uncertainty. Rounding is described
in more detail in the NMI Guide, but the basic steps appear
below.
1. Round the final result and U once only.
2. Round U to 1 significant digit if the first significant
digit is 5 or more, otherwise round to 2 significant
digits. (eg 0.0078 becomes 0.008, while 0.013 is
unchanged).
3. Round U upwards unless rounding down will only
change U by a few percent (eg 0.0078 becomes
0.008, while 0.0071 becomes 0.007)
4. Round the final result to match the significant digits
in U.
5. Round a 5 in the final result to the nearest even
number of the next significant digit (eg 10.65
becomes 10.6, while 10.75 becomes 10.8).
Summary of the GUM method
Step 3: Calculate the values of ucomb and νeff. For N
uncorrelated uncertainty components, the
values of ucomb and νeff are given by equations
(3) and (7), respectively.
Step 4: State the final result. The statement should
mention that the uncertainty was calculated in
accordance with the GUM, give the values of
U and k, indicate the CI used, and ensure the
final result and U are rounded appropriately.
Example
Consider the measurement of radiation dose from a
mammographic X-ray unit with exposure settings of 28
kVp, 20 mAs, with large focus selected, molybdenum
anode, 30 µm molybdenum filtration, at a position 40 mm
from the chest wall in the anode-cathode plane, 45 mm
above the imaging plate in the vertical plane, and centred
on the remaining axis (i.e. centred laterally with respect to
the patient).
All data for the example are summarised in table 2.
Step 1. Make a model of the measurement
Suppose that a calibrated, vented ionisation chamber is used
to measure the dose. The temperature and pressure of the
ambient atmosphere are also measured and used to
compensate the ionisation chamber. Given this information,
the measurement model is:

The GUM process is to;  temperature 

final result = reading × cal. factor ×  ×
Step 1: Make a model of the measurement. For  295.15  (9)
measurements with many uncertainty
 101325 
components, it may become difficult to manage  pressure 
the model. In such cases, it may be appropriate  
to separate the model into smaller parts, and
analyse these separately. where: final result is the dose to be determined, reading is
Step 2: Identify and characterise each uncertainty the value displayed by the electrometer, cal. factor is the
component. The NMI Guide suggests creating calibration factor for the ionisation chamber and
an uncertainty analysis table for recording the electrometer (a unitless value), temperature is the
results of this step, such as table 2. temperature inside the ionisation chamber at the time of

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Australas. Phys. Eng. Sci. Med. Vol. 28, No 2, 2005 Gregory et al • A standard approach to uncertainties

measurement (in K), pressure is the pressure inside the
ionisation chamber at the time of measurement (in Pa).
The final result is 1.97254 mGy, based on a reading of
1.940 mGy, a calibration factor of 1.01, pressure of 100 650
Pa, and temperature of 295.15 K.
Step 2. Identify and characterise each uncertainty
component
Four uncertainty components were identified when
modelling the measurement and appear in equation 9. Four
more uncertainty components have been identified;
rounding of the reading by the display, and variation of the
chamber’s position from the desired position in the three
spatial planes.
Calculation of c
For the purpose of demonstration, values of c have
been acquired using the three different methods for three
groups of uncertainty components.
(i) For the reading, the rounding of the displayed
reading, and the calibration factor, the differentiation
method is used. Differentiating the model with respect to
‘reading’:
∂ ( result )  temperatur e   101325 
c= = cal. factor ×  ×
∂ ( reading )  295.15   pressure 
c = 1.017 calculated using measured values for the
other uncertainty components.
For rounding, as the rounding of the reading is
essentially a change in the value of the reading, again,
c = 1.017.
For the calibration factor,
inverse square law is simple, modelling exposure variation
in the other planes is non-trivial, which makes these
uncertainty components well suited to an empirical
approach to evaluate c.
Vertically, a 10 mm position change altered the final
result by 0.0592 mGy.
Therefore c = 0.00592 mGy/mm.
In the anode-cathode plane, a 10mm position change
altered the final result by 0.0272 mGy.
Therefore c = 0.00272 mGy/mm.
Laterally, a 10 mm position change did not alter the
final result.
Therefore c = 0 mGy/mm.
Calculation of u and ν
Both the Type A and Type B evaluation methods will
be demonstrated in the evaluation of u and ν for each
uncertainty component.
(i) When the reading value was recorded, a further 24
individual readings were also taken to obtain information
about the distribution of these values. Thus, a Type A
evaluation can be used. The standard uncertainty of the
reading is equal to the estimated standard deviation of the
25 readings, i.e. 0.0127 mGy. The value ν in this case
 equals one less than the number of data used. Thus ν = 24.
(ii) The rounding of a displayed reading could be any
value in the range ±0.0005 mGy, as the reading is displayed
to 3 decimal places. Furthermore, there is equal probability
of the rounding being any value in this range, and zero
probability of the rounding being outside the range. This is
an example of a rectangular distribution. Thus from
equation 1;

∂(result)  temperature   101325  a 0.0005 = 0.000289 mGy

c= = reading ×  × u= =

∂(cal. factor)  295.15   pressure  3 3

c = 1.953 mGy/unit As the boundaries of the distribution are precisely

known, this evaluation would be judged as ‘excellent’ in
(ii) For the temperature and pressure, values for c are
accordance with table 1, thus ν = 1000.
derived by changing the value of these uncertainty
Assume the calibration factor was provided with
components by a small amount in the model equation (9),
only a limited explanation, such as “…the calibration
and observing the change in the final result.
factor = 1.01, with an uncertainty of 5%…”. To evaluate u
Increasing the temperature by 1 K to 296.15 K
increases the final result by 0.00668 mGy to 1.97922 mGy. and ν, a number of assumptions will need to be made. The
Thus first assumption is that the uncertainty distribution of the
calibration factor is a t-distribution. This is a reasonable
∆result 0.00668 assumption as it is consistent with the CLT. The next
c= = = 0.00668 mGy/K assumption is that it would be expected that coming from a
∆temperature 1
laboratory with traceable standards, the calibration was at
Similarly, increasing the pressure by 100 Pa to 100750 least ‘good’. This translates to ν=20 from table 1. Finally, a
Pa decreases the final result by 0.00196 mGy to 1.97058 decision needs to be made with regard to what confidence
mGy. Thus interval was used. If the stated uncertainty of 5% was
assumed to represent a 95%CI, then from equation 2;
∆result − 0.00196
c= = = −0.0000196 mGy/Pa
∆pressure 100 a 5%
u= = = 2.5% = 0.025 .
2 2
(iii) For positioning, values for c were obtained using
the empirical method. (iii) Atmospheric conditions were measured using a
Dose varies with position in the 3 spatial planes; portable temperature and pressure meter. The meter’s
vertically (inverse square law), the anode-cathode plane specifications stated that temperature measurements were
(‘heel’ effect) and laterally. Note that while modelling the accurate to ±1°C, and pressure measurements were accurate

137
Australas. Phys. Eng. Sci. Med. Vol. 28, No 2, 2005
to ±100 Pa. To gain a greater insight into the uncertainty of
temperature and pressure readings from the meter,
comparisons were made at ambient temperature and
pressure with a calibrated thermometer (±0.2°C, 95%CI)
and a calibrated barometer (±50 Pa, 95% CI). For all
measurements taken over a period of several weeks, the
difference between the portable meter and the calibrated
instruments was less than the stated ‘accuracy’. It is
therefore reasonable to assume that uncertainties of ±1°C
and ±100 Pa represent 95%CIs, and that the evaluation for
both is at least ‘good’. Hence, from equation 2, u for
temperature = 0.50 K, u for pressure = 50 Pa, and from
table 1, ν = 20 for temperature and pressure.
(iv) The uncertainty in placing the ionisation chamber
in the specified location of the three spatial planes was
assessed by repeatedly placing the chamber in position for
measurement and measuring its actual position with digital
vernier calipers. The measurement with calipers is not done
routinely; it is too time consuming. However, the data
regarding positioning uncertainty enabled values for u and
ν to be estimated for the three positioning uncertainty
components. It was estimated that for all three planes, the
ionisation chamber was within a = 4 mm of the correct
location 95% of the time, and the measurements followed a
Normal distribution. From equation 2, u = 2 mm. The
evaluation was regarded as good (ν = 20).
Step 3. Combine the uncertainties
This step is most simply performed using a spreadsheet
program. Using equations (3) and (7) gives, ucomb = 0.0523
mGy, and νeff = 26.
Step 4. State the final result.
Using tabulated data6,12, the appropriate coverage
factor, k, for the desired confidence interval can be found.
If a 95%CI is chosen, and given νeff = 26, then k = 2.056.
Hence U = 0.1074 mGy for a 95%CI. For Excel
spreadsheet users, U can be calculated using the formula
‘=TINV(0.05,ROUND(νeff,0))× ucomb’. Given the final
result of 1.97254 mGy, the final result and uncertainty need
to be rounded so they are harmonised. Firstly, round U in
accordance with the rounding method, yielding ±0.11.
Next, round the final result to the same decimal place,
yielding 1.97 mGy. The following statement can now be
made:
“Under the conditions prescribed for the measurement
the exposure was found to be 1.97 mGy. The uncertainty
was calculated in accordance with the ISO GUM, and was
found to have a 95% confidence interval of ±0.11 mGy and
26 degrees of freedom.”
The uncertainty analysis data for this example is shown
in table 2.
Discussion
A detailed description of the quantity to be measured is
an important step in reducing measurement uncertainty.
138
Gregory et al • A standard approach to uncertainties
The omission of any detail, such as whether or not the
X-ray unit should be warmed up prior to testing, can cause
different (yet valid) final results.
Note that for simplicity of the example, the final result
was based on the value of one individual reading, while a
further 24 readings were taken but only used to estimate the
standard deviation of the reading. However, it would be
more sensible to use the mean of the 25 individual readings
as the value of ‘reading’. If this were done, the standard
uncertainty of ‘reading’ would take the smaller value of the
experimental standard deviation of the mean (ESDM)6,11,12.
Since the ESDM equals the standard deviation of the
individual data divided by the square root of the number of
readings, the standard uncertainty of ‘reading’ would be
five times smaller.
Also note from the example that equation 3 was used,
despite one of the uncertainty components (vertical position
of the ionisation chamber) varying with the final result in
accordance with the inverse square law, not linearly as
required by equation 3. However, given the measurement
was conducted approximately 600mm from the anode, and
that the standard uncertainty was 2 mm, the variation of
vertical position and dose is approximately linear over this
range.
From the data in the uncertainty analysis table, table 2,
an extra column for the result c2u2 for each uncertainty
component can be generated. Uncertainty components with
larger values of c2u2 contribute the largest proportion to the
overall measurement uncertainty, and so effort may be
directed to improving these measurements. Conversely,
there is little to be gained by directing effort towards
improving the measurements of uncertainty components
with low values for c2u2.
It is only necessary to include uncertainty components
that are significant in the uncertainty analysis table. If it is
unknown as to whether or not an uncertainty component is
significant, it should be included.
Conclusions
Those who are familiar with other measurement
uncertainty methods, especially in the field of
radiotherapy15, may recognise elements of the GUM
process. The advantage of using the GUM process is
that it provides a uniform approach to the determination
and expression of uncertainty in measurement
internationally. This unified approach allows measurements
to be compared more easily than beforehand,
particularly if there is disagreement of two independently
measured results. The NMI Guide provides useful
background information on the GUM, as well as
pragmatic solutions for measurements in applied
environments, without deviating from the GUM
philosophy. While there will initially be some work in
applying the protocols to the measurements used to test
medical equipment, these can easily be programmed into
spreadsheets, after which further calculations are
straightforward.
Australas. Phys. Eng. Sci. Med. Vol. 28, No 2, 2005
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