Radiographic development of skeletal lesions in man many years after acquistion of radium burden.

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The present permissible occupational levels for the bone-seeking radionuclides are tied to that for 226Ra, which has served for several decades as the prime standard. To establish these permissible levels and that of 226Ra at certain points, observable effects have been related to carefully determined body content of the radionuclide under consideration. This has been done by many investigators with various species of experimental animals for many of the bone-seeking radionuclides, and a scale of relative radiotoxicities has been derived. The experimental approach is not possible in man. However, for the case of 226Ra effects in man we have attempted to derive as much information as possible from a rather large group of persons in midwestern United States who acquired a body burden of 226Ra approximately forty years ago. From these data we have related 226Ra body content to the incidence of skeletal and other rare tumors arising in the tissues lining the mastoids, paranasal sinuses, and oral cavity on the one hand, and to other radiographically observable destructive bone changes on the other. Clinical Material and Method of Study For the past twenty years a joint study of more than 400 persons bearing a detectable body burden of 226Ra has been under way at the Argonne National Laboratory and the Argonne Cancer Research Hospital. Most of these persons were radium dial painters in the Illinois River Valley region during 1920–1940; others received radium chloride intravenously or orally as a medicament between 1920 and 1933. Of the latter, members of a unique group of 41 patients were treated for mental illness in a state hospital in Illinois during 1931–1933 with a series of intravenous injections of radium chloride (1). Twenty-two of these mental patients have had skeletal radiographic studies along with determinations of radium burdens by gamma ray spectrometry, and 11 of these 22 have had these studies repeated almost every two years since the study began in 1951. In addition, 34 other patients who received radium as a medicament and 219 former radium dial painters have had partial or complete skeletal radiographic surveys and radium body determinations done on at least one occasion. The radiographic lesions appearing in these radium-bearing patients have been described by our group (2, 3) and others working in the field (4, 5). Such findings include coarsening of the trabecular pattern, localized areas of bone resorption, patchy sclerosis, small and large bone infarcts, aseptic necrosis, and pathological fractures of bone in addition to the aforementioned malignant tumors. A method for numerically scoring the radiographic lesions according to increasing severity was devised by our group, and with some modifications was adopted by the other radium study group at the Massachusetts Institute of Technology.