Shoe-fitting fluoroscope

A shoe fluoroscope displayed at the US National Museum of Health and Medicine. This machine was manufactured by Adrian Shoe Fitter, Inc. circa 1938 and used in a Washington, D.C., shoe store

Shoe-fitting fluoroscopes, also sold under the names X-ray Shoe Fitter, Pedoscope and Foot-o-scope, were X-ray fluoroscope machines installed in shoe stores from the 1920s until about the 1970s in the United States, Canada, United Kingdom, Germany and Switzerland.[1] In the UK, they were known as Pedoscopes, after the company based in St. Albans that manufactured them.[2] At the beginning of the 1930s, Bally was the first company to import pedoscopes into Switzerland from the UK. In the second half of the 20th century, growing awareness of radiation hazards and increasingly stringent regulations forced their gradual phasing out.

A shoe-fitting fluoroscope was a metal construction covered in finished wood, approximately 4 feet (1.2 m) high in the shape of short column, with a ledge with an opening where the child (or the adult customer) would then place his or her feet in the opening provided and while remaining in a standing position, look through a viewing porthole at the top of the fluoroscope down at the x-ray view of the feet and shoes. Two other viewing portholes on either side enabled the parent and a sales assistant to observe the child's toes being wiggled to show how much room for the toes there was inside the shoe. The bones of the feet were clearly visible, as was the outline of the shoe, including the stitching around the edges.

The gimmick changed from decade to decade to suit the market at the time, but the most famous sales pitches were that the fluoroscope allowed salesmen to better fit shoes and that it made it more fun for kids to go to the shoe store. During the Great Depression, a popular sales pitch was that the fluoroscope allowed the best possible fit, which made for longer-lasting shoes and implied that customers would not have to buy as many pairs for themselves or for their children. In reality, the shoe-fitting fluoroscope was nothing more than a way to attract potential customers because the fit also depends on the flesh size, which was difficult to make out in the fluoroscope.

Invention

There are multiple claims for the invention of the shoe-fitting fluoroscope. The most likely is Dr. Jacob Lowe who demonstrated a modified medical device at shoe retailer conventions in 1920 in Boston and in 1921 in Milwaukee. Dr. Lowe filed a US patent application in 1919, granted in 1927, and assigned it to the Adrian Company of Milwaukee for $15,000. Syl Adrian claims his brother, Matthew Adrian, invented and built the first machine in Milwaukee; his name is featured in a 1922 ad for an X-ray shoe fitter. Then there is Clarence Karrer, the son of an X-ray equipment distributor claims to have built the first unit in 1924 in Milwaukee, but had his idea stolen and patented by one of his father's employees. In the meantime, the British company Pedoscope filed a British patent application in 1924, granted in 1926, and claimed to have been building these machines since 1920.[3]

The X-ray Shoe Fitter Corporation of Milwaukee and Pedoscope Company became the largest manufacturers of shoe-fitting fluoroscopes in the world.

Health concerns

An Adrian Fluoroscope at the Dufferin County Museum, Ontario, Canada (2012). This device required lengthy decommissioning work before it could be safely put on public display

The risk of radiation burns to extremities were known since Wilhelm Röntgen's 1895 experiment, but this was a short-term effect with early warning from erythema. The long-term risks from chronic exposure to radiation began to emerge with Hermann Joseph Muller's 1927 paper showing genetic effects,[4] and the incidence of bone cancer in radium dial painters of the same time period. However, there was not enough data to quantify the level of risk until atomic bomb survivors began to experience the long-term effects of radiation in the late 1940s. The first scientific evaluations of these machines in 1948 immediately sparked concern for radiation protection and electrical safety reasons, and found them ineffective at shoe fitting.[5]

Large variations in dose were possible depending on the machine design, displacement of the shielding materials, and the time and frequency of use. Radiation surveys showed that American machines delivered an average of 13 roentgen (r) (roughly 0.13 sievert (Sv) of equivalent dose in modern units) to the customer's feet during a typical 20 second viewing, with one capable of delivering 116 r (~1 Sv) in 20 seconds.[5] British Pedoscopes were about ten times less powerful.[6] A customer might try several shoes in a day, or return several times in a year, and radiation dose effects may be cumulative.[6] A dose of 300 r can cause growth disturbance in a child,[5] and 600 r can cause erythema in an adult. Hands and feet are relatively resistant to other forms of radiation damage, such as carcinogenesis.

Although most of the dose was directed at the feet, a substantial amount would scatter or leak in all directions. Shielding materials were sometimes displaced to improve image quality, to make the machine lighter, or out of carelessness, and this aggravated the leakage. The resulting whole-body dose may have been hazardous to the salesmen, who were chronically exposed, and to children, who are about twice as radiosensitive as adults.[7] Monitoring of American salespersons found dose rates at pelvis height of up to 95 mr/week, with an average of 7.1 mr/week (up to ~50 mSv/a, avg ~3.7 mSv/an effective dose).[5] A 2007 paper suggested that even higher doses of 0.5 Sv/a were plausible.[8] The most widely accepted model of radiation-induced cancer posits that the incidence of cancers due to ionizing radiation increases linearly with effective (i.e., whole-body) dose at a rate of 5.5% per Sv.[9]

Years or decades may elapse between radiation exposure and a related occurrence of cancer, and no follow-up studies of customers can be performed for lack of records. A 1950 medical article on the machines pointed out though: "Present evidence indicates that at least some radiation injuries are statistical processes that do not have a threshold. If this evidence is valid, there is no exposure which is absolutely safe and which produces no effect."[5] Three shoe salespersons have been identified with rare conditions that might be associated with their chronic occupational exposure: a severe radiation burn requiring amputation in 1950,[10] a case of dermatitis with ulceration in 1957,[11] and a case of basal-cell carcinoma of the sole in 2004.[8]

Regulation

There were no applicable regulations when the shoe-fitting fluoroscopes were first invented. An estimated 10,000 machines were sold in the US, 3,000 in the UK, 1,500 in Switzerland, and 1,000 in Canada before authorities began discouraging their use.[8] As understanding grew of the long-term health effects of radiation, a variety of bodies began speaking out and regulating the machines.

1931 ACXRP recommends limiting dose to 0.1 r per day (~0.5 r/week) in all applications.[12]
1934 IXRPC recommends limiting dose to 0.2 r per day (~1 r/week) in all applications.[13]
1946 ASA recommends limiting foot dose to 2 r per 5 second exposure.[3]
Children to be limited to 12 exposures per year.[3]
1948 Warnings specific to the shoe-fitting fluoroscope start appearing in US journals.[14]
1949 Tripartite Conference on Radiation Protection recommends lowering the dose limits:[15]
0.3 rep/week (~0.3 r/week) for whole body bone marrow
1.5 rep/week (~1.5 r/week) for the hands
1950 Warnings start appearing in UK journals.[6]
ICRP adopts the Tripartite recommendations, with some lack of clarity about units.[16]
1953 A definitive recommendation against use on children was published in the journal Pediatrics[8]
US Food and Drug Administration bans the machines.[17]
1954 NCRP recommends reducing dose limits by a factor of 10 for children, and other changes:[18]
15.6 mSv/a (~0.03 r/week) for whole body bone marrow
78 mSv/a (~0.15 r/week) for the hands
1956 UK Ministry of Health considers regulating the machines.[6]
1957 Pennsylvania is first US state to ban use of these machines.[3]
ICRP recommends limiting occupational whole body dose to 50 mSv/a (~0.1 r/week)
1958 The UK Government required all machines be fitted with a warning sign advising customers of possible health risks, and that they should not use a machine more than 12 times a year.[19]
1958 NCRP recommends limiting public whole body dose to 5 mSv/a (~0.01 r/week)[20]
1959 Switzerland prohibits the machines on June 4.
1960 160 devices still in use in the Canton of Zürich.[21]
1970s By 1970, 33 US states have banned the machine.[8]
Late 1970s: Last recorded sighting of a shoe-fitting fluoroscope in service in Boston.[10]
1990 ICRP recommends reducing limits on exposure and other changes:[22]
occupational foot dose to 500 mSv/a (~1 r/week)
occupational whole body dose to 20 mSv/a (~0.04 r/week)
public whole body dose to 1 mSv/a (~0.002 r/week)

References

  1. ↑ Shoe-Fitting Fluoroscope (ca. 1930-1940) Oak Ridge Associated Universities.
  2. ↑ Pedoscope X-ray apparatus, St Albans, England 1930-1955
  3. 1 2 3 4 Frame, Paul. "Shoe-Fitting Fluoroscope". Health Physics Historical Instrument Collection. Oak Ridge Associated Universities. Retrieved 14 November 2012.
  4. ↑ Muller, Hermann Joseph (22 July 1927). "Artificial Mutation of the Gene" (PDF). Science. LXVI (1699): 84–87. Bibcode:1927Sci....66...84M. doi:10.1126/science.66.1699.84. PMID 17802387. Retrieved 13 November 2012.
  5. 1 2 3 4 5 Lewis, Leon; Paul E. Caplan (January 1950). "The Shoe-Fitting Fluoroscope as a Radiation Hazard" (PDF). California Medicine. 72 (1): 26–30. PMC 1520288Freely accessible. PMID 15408494. Retrieved 14 November 2012.
  6. 1 2 3 4 Dyson, E. D. (4 August 1956). "Shoe Fitting X-Ray Fluoroscopes: Radiation Measurements and Hazards" (PDF). British Medical Journal. 2 (4987): 269–272. doi:10.1136/bmj.2.4987.269. PMC 2034993Freely accessible. PMID 13342467. Retrieved 13 November 2012.
  7. ↑ Little JB (2000). "Chapter 14: Ionizing Radiation". In Kufe DW, Pollock RE, Weichselbaum RR, Bast RC Jr, Gansler TS, Holland JF, Frei E III. Cancer medicine (6th ed.). Hamilton, Ont: B.C. Decker. ISBN 1-55009-113-1.
  8. 1 2 3 4 5 Smullen, Michael J.; David E. Bertler (2007). "Basal Cell Carcinoma of the Sole: Possible Association with the Shoe-Fitting Fluoroscope" (PDF). Wisconsin Medical Journal. 106 (5): 275–278. PMID 17874675. Retrieved 13 November 2012.
  9. ↑ "The 2007 Recommendations of the International Commission on Radiological Protection". Annals of the ICRP. ICRP publication 103. 37 (2-4). 2007. ISBN 978-0-7020-3048-2. Retrieved 17 May 2012.
  10. 1 2 Lapp, David R. (1 January 2004). "The X-ray Shoe Fitter — An Early Application of Roentgen's 'New Kind of Ray'" (PDF). The Physics Teacher. 42 (6): 354. Bibcode:2004PhTea..42..354L. doi:10.1119/1.1790343. Archived from the original (PDF) on March 26, 2010. Retrieved 13 November 2012.
  11. ↑ Kopp, H. (7 December 1957). "Radiation Damage Caused by Shoe-Fitting Fluoroscope" (PDF). British Medical Journal. 2 (5057): 1344–1345. doi:10.1136/bmj.2.5057.1344. PMC 1963031Freely accessible. PMID 13479715. Retrieved 14 November 2012.
  12. ↑ Meinhold, C. B. (April 1996). "One Hundred Years of X Rays and Radioactivity -- Radiation Protection: Then and Now" (PDF). International Congress. Vienna, Austria: International Radiation Protection Association. Retrieved 14 May 2012.
  13. ↑ Clarke, R. H.; Valentin, J. (2009). "The History of ICRP and the Evolution of its Policies" (PDF). Annals of the ICRP. 39 (1): 75–110. doi:10.1016/j.icrp.2009.07.009.
  14. ↑ Fredrick, W. G.; Smith, R. G. (1948). "Health Problems of X-Ray Shoe Fitting". American Industrial Hygiene Association Quarterly. 9 (4): 89–93. doi:10.1080/00968204809344081.
  15. ↑ Lauriston S. Taylor, ed. (September 1949). "Appendix 16". The Tripartite Conferences on Radiation Protection. US Department of Energy. Retrieved 14 November 2012.
  16. ↑ Recommendations of the International Commission on Radiological Protection and of the International Commission on Radiological Units (PDF). National Bureau of Standards Handbook. 47. US Department of Commerce. 1950. Retrieved 14 November 2012.
  17. ↑ Nedd, C. A. II (1992). "When the Solution is the Problem: A Brief History of the Shoe Fluoroscope" (PDF). American Journal of Roentgenology. 158 (6): 1270. doi:10.2214/ajr.158.6.1590121. Retrieved 13 November 2012.
  18. ↑ Permissible Doses from External Sources of Radiation (PDF). National Bureau of Standards Handbook. 59. US Department of Commerce. 24 September 1954. p. 56. Retrieved 14 November 2012.
  19. ↑ Charlton, Amy. "If the shoe fits…". Science Museum, London. Retrieved 1 August 2014.
  20. ↑ Inkret, W. C.; Meinhold, C. B.; Taschner, J. C. (1995). "A Brief History of Radiation Protection Standards" (PDF). Los Alamos Science. 23: 116–123. Retrieved 12 November 2012.
  21. ↑ Dommann, Monika (2003). Durchsicht, Einsicht, Vorsicht, Eine Geschichte der Röntgenstrahlen 1896 bis 1963. Zürich: Chronos Verlag. ISBN 3-0340-0587-3.
  22. ↑ "1990 Recommendations of the International Commission on Radiological Protection". Annals of the ICRP. ICRP publication 60. 21 (1-3). 1991. ISBN 978-0-08-041144-6. Retrieved 17 May 2012.
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