Ionizing radiation is of huge benefit to society; however, the risks of radiation overexposure in occupational settings or due to accidents or other incidents are of growing concern, not least due to the potential implications for exposed individuals in terms of acute high dose (e.g. ARS) and/or longer term low dose health effects such as cancer or genetic effects. This manuscript considers the state of the art for biological and ‘fortuitous’ physical retrospective dose estimation either in blood or in materials being carried by suspected exposed individuals, respectively, in support of routine and emergency radiation incident response, and the potential future progress in this fascinating and active field. In recent years, international experts in this field have engaged in active collaboration and networking on support of these goals, and continued efforts in this area will ensure the global community remains ready to respond to radiation accidents and incidents. In addition, over and above improved dose and exposure characterization in the field of radiation emergency medicine, scientific developments in biological markers may contribute to potential contributions to individualized or stratified risk estimation in molecular epidemiology to assess long term, low dose radiation risk; in personalized medical dosimetry for better justification and optimization for use of radiation in such settings, and even perhaps for potential future situations involving radiation exposure, for example protection of individuals traveling to space.