Occupational Hazards of the Radiologist, with Special Reference to Changes in the Blood

Abstract

THAT the practice of radiology entails certain hazards to health and life was forcibly impressed on its practitioners many years ago, but not until a large number of radiologists had suffered or died from radiodermatitis and cancer. Rolleston says that according to Ledoux-Labard there have been a hundred victims of cancer among radiologists. To this long roll of professional sacrifice is added from time to time the name of some pioneer who sustained his injuries in the early days, but was granted a postponement of the inevitable result. It was soon learned that this danger could be averted by the ordinary precautions which are now habitually employed. So effective are these methods in the prevention of skin lesions that the radiologist has apparently been lulled into a false sense of security from all harm. His serenity is not due to ignorance, but to an unwarranted optimism in the face of his abundant knowledge. He is fully aware that an intact skin may cover a multitude of internal changes wrought by irradiation. These changes are the expected result of radiotherapy; they are found at the necropsy table, are substantiated by experiments on animals, and are demonstrated conclusively by the microscope and the test tube. The literature on deep irradiation effects is overwhelming, both in magnitude and complexity, and the references here appended constitute but a small fraction of the total. Studies which are almost fascinating in interest have been made of irradiation effects on virtually every organ and tissue of the body, including the digestive tract, blood, bones, heart, lungs, liver, pancreas, eyes, brain, nerves, kidneys, spleen, gonads, and ductless glands. Findings have not always agreed, nor is this surprising in view of the different conditions under which the tests were made. Notwithstanding discrepancies and contradictions, it is impressive to note that alterations of some sort were found almost constantly, and that in many instances they were produced by moderate or even minute amounts of irradiation. Among generally accepted facts and theories the following are especially pertinent to the present theme, and will bear repetition, however familiar they may be: 1. Radium and the X-rays produce biologic effects which are essentially alike. 2. These effects vary according to the amount of irradiation, and range from stimulation to destruction (36, 44, 46, 64, 85, 87). Although supported by a great preponderance of evidence, the occurrence of stimulation has been denied by Pordes and others. Holzknecht insists that the X-ray is like curare, and that even in small amounts it is destructive, never stimulative. 3. Cells differ in sensitiveness to irradiation, and certain varieties are especially susceptible. Easy vulnerability of the sperm cells is well established. Lymphocytes, endothelium of blood and lymph vessels, immature cells, and cells in the process of mitosis are highly sensitive.