Objective: As gonad shielding is currently under debate, this study evaluates the practice, from its introduction in about 1905 until today. Methods: The literature was searched for developments in shielding and insights into the effects of ionising radiation on gonads. Based on own pre-1927 dose reconstructions, reported doses after 1927, a 2015-report from the European Union and recent own measurements, the effects of technological evolution and optimisation on radiation dose and hereditary risk were assessed. Results: In the 1900s, gonad shielding was first applied to prevent male sterility, but was discontinued when instrumental developments led to reduced radiation doses. In the 1950s, concerns about hereditary risks intensified and gonad shielding was recommended again, becoming routine worldwide. Imaging-chain improvements over time were considerable: in 2018, the absorbed dose was 0.5% of its 1905 value for the testes and 2% for the ovaries, our optimised effective dose a factor five lower than the value corresponding to the current EU diagnostic reference level, and the reduction in detriment-adjusted risk by shielding less than 1 × 10 −6 for women and 5 × 10 −6 for men. Conclusions: Assessment of pelvic doses revealed a large reduction in radiation risks facilitated by technological developments. Optimisation likewise contributed, but unfortunately, its potential was never adequately exploited. Today, using a modern and optimised X-ray system, gonad shielding can be safely discontinued for women. For men, there might be a marginal benefit, but potential negative side-effects may well dominate. Discontinuation of gonad shielding seems therefore justifiable.

Objectives To derive conversions of antiquated exposure data into modern equivalents and to apply these in the assessment of the skin dose of pelvic radiographs since 1896. Methods The literature 1896–2018 was searched for implicit and explicit dose information. The early implicit dose data contained now obsolete descriptions of radiation quality and quantity for long since disappeared X-ray systems of limited efficiency. Converting the old information into modern specifications was achieved using contemporary data and computer simulations. Final dose calculations were done with modern software. Explicit radiation doses of later date reported in old quantities and units were adapted according to current recommendations. Results For the period before 1927 conversion algorithms for spark gap data and penetrometer hardnesses to high voltage could be derived. Electrical and X-ray efficiencies of several old röntgen systems were determined. Together they allowed reconstruction of 53 doses. After 1927 doses were generally explicitly specified; 114 were retrieved. Although an enormous spread was observed, the average skin dose was reduced by a factor of about 400. Conclusions Antiquated exposure data were successfully used for dose reconstruction. Extreme dose variability was a constant. Efforts to cut down doses were effective as skin doses went down from sub-erythema values to about one milligray. Electronic supplementary material The online version of this article (10.1186/s13244-019-0710-1) contains supplementary material, which is available to authorized users.

ObjectivesTo commemorate victims of electrical accidents that occurred in the first decades of radiology and relate these accidents to the evolution of the X-ray apparatus.MethodsDigitised newspapers, scientific journals, books and reports of legal procedures were searched for electrical accidents involving X-ray systems. Information on the historical systems was retrieved from the scientific literature and brochures from manufacturers.ResultsWe found 51 fatal and 62 non-fatal but serious electrical accidents. Most of them occurred between 1920 and 1940 and involved transformers that provided output currents well above the threshold for the induction of ventricular fibrillation. The accidents led to recommendations and regulations to improve safety for operators and patients, and spurred manufacturers to technical developments that culminated in fully electrically shockproof systems by 1935.ConclusionsAlthough largely forgotten, the development of the shockproof X-ray systems we take for granted today lasted about 4 decades and was associated with considerable human suffering. The complete solution of the problem is a success story of engineering realised by contributions from all parties involved.Main messages• The development of electrically shockproof X-ray systems took about 4 decades (1895–1935).• Between 1896 and 1920 electrical shocks from X-ray systems were common, but their consequences limited.• After 1920, transformers killed by delivering currents above the ventricular fibrillation threshold.• Inductors, static generators and high-frequency coils were generally low-current systems and safe.• We found 51 fatal and 62 serious non-fatal electrical accidents, most occurring from 1920 to 1940.Electronic supplementary materialThe online version of this article (doi:10.1007/s13244-013-0238-8) contains supplementary material, which is available to authorised users.

ObjectiveTo assess quantitatively the number of early X-ray workers, their risk of becoming a radiation victim, and their most common radiation-induced (skin) disease.MethodsInformation 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.ResultsThe 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.ConclusionsAfter 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 messagesUS 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 materialThe online version of this article (doi:10.1007/s13244-015-0457-2) contains supplementary material, which is available to authorized users.

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