Detection method of pulmonary asbestos

Diagnostic criteria of pneumonia

GBZ70-2002

Pneumoconiosis is caused by long-term inhalation of productive dust in occupational activities, which stays in the lungs and diffuses in lung tissue.

Systemic diseases dominated by fibrosis.

1 range

This standard specifies the diagnostic principles and X-ray staging of pneumoconiosis.

This standard is applicable to all kinds of pneumoconiosis specified in the current national occupational disease catalogue.

2 normative reference documents

The clauses in the following documents become the clauses of this standard by reference. For dated reference documents,

All subsequent modifications (excluding errata) or revisions are not applicable to this standard. However, adherence to this standard is encouraged.

The parties to the agreement will study whether the latest versions of these documents can be used. For undated reference documents, the latest edition

Applicable to this standard.

GB/T 16 180 identification of the degree of disability caused by work-related injuries and occupational diseases.

3 diagnostic principles

According to the reliable exposure history of productive dust and on-site occupational hygiene investigation data, X-ray chest films with qualified technical quality are used.

Based on the dynamic observation data and epidemiological investigation of pneumoconiosis, combined with clinical manifestations and laboratory examination,

After excluding other similar lung diseases, pneumoconiosis was diagnosed and X-ray staging was carried out according to the standard film of pneumoconiosis diagnosis.

4 x-ray chest film staging

-4. 1 No pneumoconiosis (0)

A) 0: X-ray chest film shows no pneumoconiosis.

B)0+: The chest X-ray is not enough to diagnose as I.

-4.2 Primary pneumoconiosis (Ⅰ)

A) I: There are small shadows with the overall density of 1, and the distribution range reaches at least two lung areas.

B) Ⅰ+:small shadows with a total density of 1, distributed in 4 lung regions or with a total density of 2,

The distribution range is up to 4 lung areas.

-4.3 Stage II Pneumoconiosis (Ⅱ)

A) Ⅱ: There are small shadows with overall density of Grade 2, distributed in four lung regions; Or there are small shadows with an overall density of 3,

The distribution range reaches four lung regions.

B) Ⅱ+:There are small shadows with the overall density of Grade 3, which are distributed over 4 lung areas; Or there are small shadows gathering; Or have a big shadow,

But not enough to be diagnosed as grade ⅲ.

-4.4 Stage III Pneumoconiosis (Ⅲ)

A) iii: there is a big shadow, the major diameter of which is not less than 20mm and the minor diameter is not less than 10mm.

B) Ⅲ+:The sum of single large shadow area or multiple large shadow areas exceeds the right upper lung area.

5 handling principle

-5. 1 handling principle

Pneumoconiosis patients should get rid of dust work in time, and carry out comprehensive treatment according to the needs of their illness, and actively prevent and treat complications such as tuberculosis.

In order to relieve symptoms, delay the progress of the disease, improve the life span of patients and improve the quality of life of patients.

-5.2 Other treatment

According to the X-ray staging of pneumoconiosis and pulmonary function compensation, those who need to be disabled shall be treated according to GB/T 16 180.

6 Instructions for the correct use of this standard

See appendix a (informative appendix) and appendices b, c, d, e and f (normative appendix).

Appendix a

(Information Appendix)

Instructions for the correct use of this standard

A. 1 scope of application of this standard

This standard is applicable to the personnel listed in 1987 1 1.5 Weifang Zi No.60 Provisions on Occupational Disease Scope and Treatment Measures for Occupational Disease Patients.

12 kinds of pneumoconiosis, namely silicosis, coal worker's pneumoconiosis, graphite pneumoconiosis, carbon black pneumoconiosis, asbestos pneumoconiosis, talc pneumoconiosis, cement pneumoconiosis and mica dust.

Lung, Potter's pneumoconiosis, aluminum pneumoconiosis, welder's pneumoconiosis, foundry's pneumoconiosis.

A.2 diagnostic principles

The prerequisite for diagnosing pneumoconiosis is to have an accurate history of occupational dust exposure.

Pneumoconiosis patients may have different degrees of respiratory symptoms and signs and some laboratory abnormalities, but it is not clear.

Specificity, so it can only be used as a reference for pneumoconiosis diagnosis. Clinical examination and laboratory examination focus on excluding other lung diseases,

Such as tuberculosis, lung cancer and other diffuse pulmonary fibrosis, sarcoidosis, hemosiderosis and so on.

A.3 X-ray staging of pneumoconiosis

According to the degree of X-ray imaging changes, pneumoconiosis can be divided into primary pneumoconiosis (Ⅰ), secondary pneumoconiosis (Ⅱ) and tertiary pneumoconiosis (Ⅲ).

"0" means no pneumoconiosis. The increase of 0+, I+, II+ and III+ in each period is only for better dynamic observation and health monitoring, not.

The period of independence.

A.4 determination of small shadow density

The total density of small shadows in X-ray staging of pneumoconiosis stipulated in this standard is based on the measurement of small shadow density in lung area.

General judgment of small shadow density in the whole lung. The judgment method is to take the density of the highest lung area as the total density and divide it into four grades.

Express delivery. According to the need, four grades or 12 grades can be used to determine the density of small shadows in the lung area.

A.5 dynamic observation on chest radiograph

X-ray imaging changes of pneumoconiosis are a gradual process, and dynamic series of chest radiographs can provide more reliable basis for diagnosis, so it is stipulated that

Only one chest X-ray is not suitable for diagnosis. However, under special circumstances, if it is determined that other diseases can be ruled out, or there are pathological examination results, it can also be done.

Consider making a diagnosis.

Appendix b

(normative appendix)

Standard terms and judgment methods of pneumoconiosis diagnosis

B. 1 lung area division method

The vertical distance from the apex of lung to the top of diaphragm is divided into three parts, and each lung field is divided into upper, middle and lower lung areas by equal horizontal lines.

B.2 small shadow

Refers to the shadow with a diameter or width not exceeding 10mm in the lung field.

B.2. 1 morphology and size

Small shadows can be divided into two types: round and irregular, and can be divided into three types according to their size. The shape and size of the small shadow are subject to the standard film.

B.2. 1. 1 small circular shadows are represented by letters p, q and r:

P: the maximum diameter shall not exceed1.5mm; ;

Q: The diameter is greater than 1.5mm and not greater than 3 mm;

R: the diameter is more than 3mm and not more than 10 mm.

B.2. 1.2 Irregular small shadows are represented by letters S, T and U:

S: the maximum width shall not exceed1.5mm; ;

T: the width is greater than 1.5mm, but not greater than 3 mm;

U: the width is more than 3mm and not more than 10mm.

B.2. 1.3 recording method

When reading the chest radiograph, record the shape and size of the small shadow. When the small shadows on the chest radiograph are almost the same shape and size,

Write letter symbols above and below the diagonal, such as p/p, s/s, etc. There are more than two tables and large sizes on the chest radiograph.

For small shadows, the letter symbols of the main small shadows are written on the diagonal, and quite a few others are written on the diagonal.

Below the diagonal, for example: p/q, s/p, q/t, etc.

B.2.2 density

Refers to the number of small shadows in a certain range. The determination of small shadow density should be based on standard film, and the text part is only for explanation.

Use. When reading a film, we must first determine the density of each lung area, and then determine the overall density of the whole lung.

B.2.2. 1 Four-level grading density can be simply divided into four levels: 0, 1, 2 and 3.

Level 0: No small shadow or small shadow, less than the lower limit of 1 level.

1 level: there is a certain amount of small shadow.

Level 2: There are many small shadows.

Level 3: There are many small shadows.

Twelve-level classification

The density of small shadows is a continuous and gradual process. In order to objectively reflect this change, on the basis of four levels, we put

Each level is divided into three sub-levels, namely 0/-, 0/0 and 0/L; 1/0, 1/ 1, 1/2; 2/ 1,2/2,2/3; 3/2, 3/3, 3/+, purpose

The purpose is to provide more information, reflect the pathological changes in detail, and carry out epidemiological research and medical monitoring.

The reading and recording methods are as follows:

Compare the chest radiograph with the standard chest radiograph and grade it according to the prescribed four grades. If the density of the small shadow is basically the same as that of the standard radiograph,

Let's record it as11,2/2, 3/3. If the small shadow density is compared with the standard film, it is considered that the higher or lower level should also be paid attention to.

If it is considered, it should be recorded at the same time, such as 2/ 1 or 2/3. The former means that the density belongs to grade 2, but 1 grade should also be seriously considered. the latter

It shows that the density belongs to grade 2, but grade 3 should also be seriously considered.

B.2.2.3 Determination method of distribution range and total density

A) judging the density of lung area requires that the distribution of small shadows should account for at least two-thirds of the area;

B) The distribution range of small shadows refers to the number of lung areas where the density of small shadows is above 1 (including 1).

C) Total density refers to the density of the lung area with the highest lung density.

B.3 big shadow

Refers to the shadow with a diameter or width greater than 10mm in the lung field.

B.4 small shadow gathering

Refers to the obvious increase and aggregation of local small shadows, but has not yet formed a large shadow.

B.5 pleural plaque

Long-term exposure to asbestos dust can cause pleural changes, such as diffuse pleural thickening and localized pleural spots. Pleural plaque refers to the resection of lung apex.

Localized pleural thickening or localized calcified pleural spots, the thickness is greater than 5 mm outside the department and costal diaphragm angle area.

Exposure to asbestos dust, chest X-ray shows 0+, if pleural plaque appears, it can be diagnosed as stage I; Chest x-rays show I+, such as chest.

Membranous plaque has involved some cardiac margin or diaphragm, which can be diagnosed as stage ⅱ; Chest radiograph shows ⅱ+,such as the length of single or multiple pleural spots on both sides.

The sum of the two is more than half of the length of unilateral chest wall, or the heart margin is involved, which makes some parts appear untidy, which can be diagnosed as stage ⅲ.

B.6 additional symbols

A) pulmonary bullae

B)ca lung cancer and pleural mesothelioma

C)cn small shadow calcification

pulmonary heart disease

E)cv hole

F) pleural effusion

Em emphysema

H) eggshell calcification of lymph nodes

I) honeycomb lung

J) pleural calcification

K)pt pleural thickening

L)px pneumothorax

Rheumatoid pneumoconiosis

Active pulmonary tuberculosis

Appendix c

(normative appendix)

Chest radiograph quality and quality evaluation

C. 1 chest radiograph quality

C. 1. 1 basic requirements

A) It must include the lung apex and costal diaphragm angle on both sides, the sternoclavicular joint is basically symmetrical, and the shadow of scapula does not overlap with the lung field;

B) Signs such as film number and date should be placed above the shoulders, neatly arranged and clearly visible, and do not overlap with the lung field;

C) The photo is free of artifacts, light leakage, pollution, scratches, water collapse and external images.

C. 1.2 anatomical landmark display

A) The lungs on both sides have clear texture and sharp edges, extending to the lung field.

B) Clear imaging of cardiac margin and diaphragm.

C) The chest wall on both sides shows well from the lung apex to the costal diaphragm angle.

D) The contours of trachea, carina and bilateral main bronchi can be seen, and the contours of thoracic vertebrae can be displayed.

E) The lung texture in the posterior region of the heart can be displayed.

F) The right diaphragmatic crest is usually located at the level of the tenth posterior rib.

C. 1.3 optical density

A) The highest density of upper and middle lung fields should be between 1.45— 1.75;

B) The subphrenic optical density is less than 0.28;

C) The optical density of the directly exposed area is greater than 2.50.

C.2 chest radiograph quality grading

C.2. 1 first-class film (excellent film)

It completely meets the quality requirements of chest radiograph.

C.2.2 Secondary membrane (good membrane)

It doesn't completely meet the quality requirements of chest radiograph, but it hasn't been reduced to grade three.

C.2.3 Grade III film (inferior film)

One of the following situations is a three-level film, which cannot be used for the initial diagnosis of pneumoconiosis.

A) It does not completely meet the basic requirements of chest radiograph, and the sum of the areas affected by the defect is between half a lung area and one lung area.

B) The lung texture on both sides is not clear and sharp enough, or the local lung texture is blurred, which affects the sum of diagnostic areas between half lung area and one lung area.

C) The lateral chest wall from the lung apex to the costal diaphragm angle on both sides is not well displayed, the trachea contour is blurred, and the lung texture in the posterior cardiac region is difficult to recognize.

D) Inhalation is insufficient, and the right diaphragmatic crest is located at the level of the eighth posterior rib.

E) The photo is dark, and the highest optical density in upper and middle lung areas is between 1.85— 1.90; Or the photo is white, and the highest optical density is in the upper middle part of the lung.

1.30 ——1.40; Or the fog is high, and the optical density under the diaphragm is between 0.40 and 0.50; Or that optical density of the directly expose area is between 2.20 and 2.30.

C.2.4 film (waste film)

The quality of chest radiograph is not up to grade 3, which is grade 4 and cannot be used for the diagnosis of pneumoconiosis.

Appendix d

(normative appendix)

X-ray diagnostic standard film of pneumoconiosis

D. 1 relationship between standard film and standard terms

Standard film is an integral part of pneumoconiosis diagnostic criteria, which mainly expresses X-ray imaging changes that are difficult to express in words. Pneumoconiosis

The determination of various X-ray image changes should be based on the standard film, and the text part is only an explanation.

D.2 compilation principles of standard films

The principle of standard film editing is that the density and shape of small shadows are accurately expressed and easy to use.

D.3 composition and content of standard film

Standard film consists of two parts. 1. Eight combined films, mainly showing the density of small shadows with different shapes and sizes. Small shadow

The density of is compiled according to the midpoint of each density level, namely 0/0,11,2/2, 3/3. The second is lung mass 15, which mainly demonstrates pneumoconiosis.

The relationship between the density and distribution range of small shadows in different periods.

D.4 application of standard film

When reading the X-ray chest film of pneumoconiosis diagnosis and staging, especially when judging the shape and density of small shadows, it must be corresponding.

Combined standard film control. Large-scale standard films of the whole lung in each stage of pneumoconiosis are the reference for diagnosis and staging.

D.5 standard film copyright

The copyright of standard films belongs to the state.

D.6 reproduction and distribution of standard films

The reproduction and distribution of standard films are entrusted to the National Occupational Disease Prevention and Control Center, and the National Occupational Disease Diagnosis and Appraisal Committee is responsible for pneumoconiosis.

After being checked, numbered and stamped by the diagnosis and appraisal team, it will be distributed together with the standard film description.

Appendix e

(normative appendix)

Technical requirements for chest X-ray examination

X-ray examination of pneumoconiosis must use high kv photography technology. Do not meet the following equipment and technical requirements, can not carry out X-ray examination of pneumoconiosis.

E. 1 photographic equipment

E. 1. 1 X-ray machine

The maximum tube voltage output value is not less than 125KV, and the power is not less than 20KW.

E.1.2 x-ray tube and window filtering

A) rotating the anode;

B) The focal length is not more than1.2mm; ;

C) The total window filtration is 2.5-3.5 mm aluminum equivalent.

E. 1.3 grid

A) The grid density is not less than 40 lines/cm;

B) Grating ratio is not less than10:1;

C) The focal length of the grating is1.8m; ;

D) the specifications are matched with the film.

E. 1.4 intensifying screen and cassette

A) Medium-speed intensifying screen is generally adopted;

There is no stain on the intensifying screen;

B) The resolution of the intensifying screen is not less than 5-6 line pairs/mm;

C) The intensifying screen is in close contact with the film;

D) the film box does not leak light.

E.1.5 x-ray film

A) Generally use general-purpose (hand-displayed and machine-displayed) films, and advocate the application of special films suitable for chest photography;

B) a blue film substrate;

Background fog dmin

D) Specification: 356mm× 356mm (14 inch× 14 inch) or 356mm× 432mm (14 inch×17 inch).

E. 1.6 power supply

A) the power supply shall meet the rated requirements of the X-ray machine;

B) The X-ray machine needs independent power supply and does not share power supply with electrical equipment;

C) The fluctuation range of power supply voltage is 65438 00%.

E.2 photography technology

E.2. 1 preparation and posture requirements

A) The client should stick the chest wall on the photo frame, separate his feet naturally and rotate in his arm so that the scapula does not overlap with the lung field as much as possible;

B) The focal length is1.80m; ;

C) Adjust the position of the tube so that the center line is at the level of the sixth thoracic vertebra;

D) Exposure shall be carried out in a breath-holding state after full inhalation;

E) Routine examination should adopt anterior chest radiograph, and when necessary, lateral position, oblique position, tomography or CT examination should be added for diagnosis and differential diagnosis.

E.2.2 photographic conditions

A) According to the specific conditions of the X-ray machine, use 120 ~ 140 kV for chest photography;

B) Determine the exposure according to the chest thickness, generally 2 ~ 8 mas, and the exposure time shall not exceed 0. 1 sec.

C) When taking photos, adjust the shooting conditions with reference to previous chest radiographs.

E.3 darkroom technology

E.3. 1 darkroom must meet the work requirements.

E.3.2 Hand washing

A) In principle, constant temperature and timing are required, and the temperature of liquid medicine should be controlled between 20 ~ 25℃; Developing time is 3-5 minutes;

B) Fixation shall be sufficient, and running water shall be washed thoroughly;

C) Qualified special safety lights must be used;

D) Replace the developer and fixing agent in time.

E.4 automatic film processor

In order to ensure the quality of the chest radiograph, an automatic processor should be used as far as possible, and the operating procedures required by the automatic processor should be strictly observed.

Appendix f

(normative appendix)

Requirements for reading films for pneumoconiosis diagnosis

F. 1 Personnel engaged in X-ray diagnosis of pneumoconiosis must pass the national examination for pneumoconiosis diagnostic film readers and obtain certificates.

F.2 The diagnosis of pneumoconiosis adopts the principle of collective diagnosis. Relevant procedures shall be implemented in accordance with the national management measures for occupational disease diagnosis.

F.3 The corrected vision of readers should be within the normal range. When watching a movie, you should sit still, and the position of the viewing lamp should be appropriate, usually in the reader.

25cm (for observing small shadows) to 50cm (for observing the whole chest radiograph) in front of eyes.

F.4 The dynamic changes of comparative imaging should be observed according to the time sequence of chest radiographs. Only one chest X-ray is not suitable for diagnosis.

F.5 When reading movies, you should refer to standard movies. Generally, the chest radiograph to be diagnosed should be placed in the center of the light box, with commonly used standard radiographs on both sides.

F.6 The observation lamp shall have at least 3 light boxes, preferably 5. The minimum brightness of the viewing lamp is not less than 3000CD, and the brightness uniformity (brightness difference) is less than 65438 05%.

F.7 The film reading room should be quiet, and there is no other direct light to the film viewing lamp. The reading speed of movies depends on personal habits, but it should be in

Take a rest every 1 to 1.5 hours, so as to keep the reader's vision and brain power in good resolution.