Chest X-Ray Health Surveillance - PowerPoint Presentation

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Chest X-Ray Health Surveillancefor Employees Exposed to Respirable Crystalline Silica

Prepared byIndustrial Diagnostics Company LtdNovember 2019

In 2016 the HSE outlined their approach to the control of exposure to RCS at work

Estimated 800 people die each year - lung cancer caused by exposure to silica dust. 12,200 deaths per year - other workplace respiratory disease.World wide global estimate was 28,000 deaths per year

Bernardino Ramazzini (1713)

..maladies that attack stone cutter, quarrymen and other such workers…often breath in rough, sharp, jagged splinters…hence they are usually troubled with cough..asthmatic infections and become consumptive…when the bodies of such workers were

dissected they were found to be stuffed

with small stones

400

years later the HSE issued guidance on health surveillance for employees exposed to RCSIncluded the requirement for CXR to look for the small stones first identified in 1713

First CXR program in 2005 across 900 brick yard workers.

Since 2016 we have conducted over 6000 CXR’s on workers across high risk sectors identified by the HSE

2 consultant chest radiologists – now the most experienced experts in reading films to the ILO pneumoconiosis standard.

What is Silicosis?

Occupational Lung Disease resulting from inhalation of fine silica dust particlesRCS lodges in smallest part of lungsLungs become scarred (fibrosis)Breathing becomes impaired

Can be life threatening

Silicosis is a recognised OLD

Silicosis can increase the risk of lung cancer and COPD

Healthy Lung

Lung with Silicosis

Silicosis can also increase your risk of other serious and potentially life-threatening conditions, including:Tuberculosis (TB) and other chest infectionsPulmonary Hypertension

ArthritisHeart FailureKidney DiseaseChronic Obstructive Pulmonary Disease (COPD)Lung Cancer

Further Problems

Incident Figures

According to the Industrial Injury Disablement Benefit (IIDB) Scheme there were:

95 cases of Silicosis in 2007

85 cases of Silicosis in 2008

14

deaths

from Silicosis in 2006

7 deaths

from Silicosis in 2007

HSE have stated that 5 in 100 lifetime risk (45 years) at 50% of the WEL (0.05mg/m3) or 30 in 100 at the WEL (0.1mg/m3)

HSE have stated exposure to RSC increases lifetime risk of lung cancer in males from 8 in 100 to 13 in 100

HSE Guidance

January 2016www.hse.gov.uk/pubns/indg463.pdf

HSE Defined

High-Risk Occupations to be Considered for Health Surveillance

Construction

Foundry Work

Brick Work

Tile Work

Ceramics

Slate

Manufacturing

Quarries

Stone Work

Service schedule:

Annual Respiratory Health Surveillance

Baseline, (1 year repeat), 15 year CXR, 3 yearly repeat CXRs (after 15 years exposure)

RCS Health Surveillance

Employer’s responsibility to consider a chest X-ray programMost implement at 50% of the WEL (5 in 100 lifetime risk) High Risk25% of WEL Medium Risk10% of WEL Low RiskMost consider previous exposure, if still exposed

Best practice

demonstrated by following HSE guidance

Chest X-rays agreed as the only definitive method of fine opacity (Silicosis) identificationStill a requirement for Respiratory Health Questionnaire and Spirometry (lung function tests)

annually

Normal Chest X-Ray

Early / Mild Silicosis

Three Stage Pathway

A chest X-ray is a powerful screening tool but does

NOT

provide a definitive diagnosis of silicosis alone

Three Stage Pathway

to positively identify and manage cases of silicosis

Chest X-ray Screening

Second Opinion via the Multi-Disciplinary Team (MDT)

Further investigation including CT scan via Occupational Lung Disease Centre or NHS respiratory specialist to provide diagnosis

Outcome Pathways

Stage 1 - Screening

1 month from referral to report

Onward Referral Management

STAGE 2 – Second Opinion

Onward Referral Management

STAGE 3 – Occupational Lung Disease Centre

Occupational Disease Centre (ODC) Referral:

Referral to regional Specialist Occupational Disease Centre

Via GP or direct access referral

Aberdeen

Birmingham

Liverpool

London

Manchester

Newcastle

Nottingham

Sheffield

STAGE 3 – Occupational Lung Disease Centre

8 weeks after referral

Benefit to Health

Detailed image taken of entire chest

Early detection of

ALL AND ANY

abnormalities Appropriate onward referral for medical advice and attention

Benefit to

health

and life expectancy

for occupational and non-Occupational Lung Disease

Medical Findings include:

CA Lung

Paralysed diaphragm

Collapsed lung

Emphysema

Coincidental findings:

Dextrocardia, foreign bodies, fractured ribs

Total number for CXR

Total number complete pathway

Total referred to MDT

Total CT

Total confirmed cases67415645166

85

10

100%84%

2.9%

11.8% (0.015% of complete pathways)

0.18%

Global Silicosis and Serious Disease cases to date

Total number for CXR

Total GP

2WW

Cardiomegaly

Emphysema

Collapsed lung

Enlarged heart

Clinical

Correlate

6741

751

81

29

32

15

4

22

100%

11%

11% (1.2%)

2.9%

(0.4%)

4.26%

(0.5%)

2% (0.035%)

0.53% (0.05%)

2.93% (0.32%)

Largest cohort of currently exposed employeesIncidence of disease in “newer” employees (exposed since controls introduced)

Research Into Occupational Lung Disease

- Consent taken at the point of X-ray

- Industry and exposure level against CXR results

- Control for smoker incidence

This service will generate data that is of significant future importance

Consent sought for research for all participants

Thank you!

Contact:Industrial Diagnostics Company Ltd.Carrie Cashmore, Imaging Services Managerimaging@industrial-diagnostics.com

08450 775512