Early X-ray workers: an effort to assess their numbers, risk, and most common (skin) affliction

OBJECTIVE: To assess quantitatively the number of early X-ray workers, their risk of becoming a radiation victim, and their most common radiation-induced (skin) disease. METHODS: Information on professional life and occupational disease was retrieved from the Ehrenbuch, a book of honour containing biographies of 404 radiation victims, as well as member and congress lists of the German and US radiological societies, obituaries, books, articles, and the Internet. RESULTS: The estimated numbers of X-ray users in a medical setting in the US increased from about 300 to 600 in 1900–1903, in Germany from about 700 to 1200 during 1905–1908. The risk for a beginning user eventually to die from radiation was 1–2 % in these years, but up to 10–25 % in 1896. Data on 198 victims of fatal radiation-induced skin disease were collected. The incidence of the various stages of skin afflictions with a fatal outcome was characterized by very wide distributions. CONCLUSIONS: After 1896, the radiation risk decreased very fast at first and more slowly thereafter to nearly zero in 1935. Many victims became quite old, partly because of the slower progress of tissue reactions at lower radiation doses, partly because of the success of often multiple surgical interventions. MAIN MESSAGES: US and German X-ray users amounted to several hundreds to thousand in 1900–1908. The risk eventually to die from radiation was about 1–2 % during 1900–1908. After 1896, this risk decreased from >10 % to nearly zero in 1935. The incidence of subsequent stages of skin harm varied strongly in time. X-ray victims could become quite old, dependent on radiation dose and surgery. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13244-015-0457-2) contains supplementary material, which is available to authorized users.