This study is aimed to investigate the effects of ionising radiation (IR) on micronuclei (MN) formation and chromosome aberrations (CAs) in Chinese radiation workers. The study was conducted using peripheral blood lymphocytes from 1392 radiation workers from Public Hospitals of the city of Tangshan (the exposed group), and 143 healthy individuals as the control group. Fluorescence in situ hybridisation (FISH) was used to detect the unstable and stable nuclear CAs on metaphase. The MN assay was performed using the cytochalasin B method for cytokinesis-block. The MN and CA frequencies were significantly higher in the exposed group than in healthy controls (both p < 0.001). Examination of the incidence rates of MN and CA showed an increasing trend among workers in some occupations compared with the others (all p < 0.05). There were also significant differences in MN and CA rates among workers with different exposure times (all p < 0.05). Stable CA rates demonstrated an increased trend among workers with different exposure times (all p < 0.05), while no significance of unstable CA rates was found among workers with different exposure times (all p < 0.05). Importantly, the frequencies of CA and MN increased among different cumulative radiation dose groups (all p < 0.05). Correlation analysis showed that the frequencies of MN and CA were positively associated with the cumulative radiation dose. Long-term exposure to IR may have harmful effects on the health of radiation workers. The data obtained here show an increased risk of genetic instability that correlated with occupation, exposure time and equivalent dose among Chinese radiation workers.