Some standard content:
ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ70—2002
Diagnostic Criteria of Pnemoconioses
Diagnostic Criteria of Pnemoconioses Issued on April 8, 2002
Implemented on June 1, 2002
Issued by the Ministry of Health of the People's Republic of China
Article 5.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". From the date of implementation of this standard, if the original standard GB5906-1997 is inconsistent with this standard, this standard shall prevail. Pneumoconiosis is the most important occupational disease in my country. It not only has a large number of patients, but also has great harm. It is a disease that seriously reduces labor capacity, causes disability and affects life expectancy. It is also the main occupational disease compensated by the state and enterprises. Therefore, pneumoconiosis diagnosis is a highly policy-oriented work.
The "X-ray Diagnosis of Pneumoconiosis" (GB5906-1986) promulgated in 1986 is the first version of this standard. The implementation of the standard for more than 10 years has played an important role in the prevention and treatment of pneumoconiosis in my country, but there are also some obvious shortcomings, such as some high baselines for certain stages; some imaging terms are not standardized: with the development of X-ray imaging technology, new technologies have been applied to some images of past X-ray plain films, especially the understanding of standard films has been greatly improved. The diagnostic standard films developed in 1986 were not accurate in expression and were technically behind the high-kilovolt technology commonly used internationally. The GB5906-1997 version issued on June 16, 1997 only revised Appendix B and Appendix D of the 1986 version and deleted Appendix C. No comprehensive revision of the standard was made. Therefore, according to the provisions on the revision of relevant standards, this standard is proposed to be revised. The main contents of the revision are:
a) The name of the standard was changed to "diagnosis standard for pneumoconiosis". The density classification was aligned with the ILO classification, using four major levels and twelve minor levels (Appendix B); b)
In Appendix B, a method for determining the overall density was proposed; d)
In Appendix B, a method for recording the shape and size of small shadows was added; e) "Plaque strips" and "white areas" were deleted in Appendix B; Appendix B has clearer provisions for pleural plaques; Appendix E (normative appendix) "Reading requirements for pneumoconiosis diagnosis" was added; g
h) A high-range volt standard film for pneumoconiosis diagnosis was developed, and a combination film expressing the standard density of small shadows was added. Appendix A of this standard is an informative appendix, and Appendix B, C, D, E, and F are normative appendices. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Occupational Health and Poison Control Institute of China Center for Disease Control and Prevention. The participating drafting units include Shanghai Occupational Disease Hospital, Liaoning Provincial Institute of Labor Health and Occupational Diseases, Anshan Iron and Steel Company Institute of Labor Health, Shanghai Yangpu District Central Hospital, Guangdong Provincial Institute of Occupational Disease Prevention and Control, Guangzhou Institute of Occupational Disease Prevention and Control, Beijing Hospital, Beijing Center for Disease Control and Prevention, and Peking University Third Hospital.
This standard is interpreted by the Ministry of Health of the People's Republic of China. 2
Diagnostic Standard for Pneumoconiosis
GBZ70-2002
Pneumoconiosis is a systemic disease characterized by diffuse fibrosis of lung tissue caused by long-term inhalation of industrial dust in occupational activities and retention in the lungs.
1 Scope
This standard specifies the diagnostic principles of pneumoconiosis and the X-ray staging of pneumoconiosis. This standard applies to various pneumoconiosis specified in the current national occupational disease list. 2 Normative References
The clauses in the following documents become the clauses of this standard through reference in this standard. For dated references, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, parties to an agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For undated references, the latest versions shall apply to this standard.
GB/T16180
3 Diagnostic principles
Identification of the degree of disability caused by work-related injuries and occupational diseases of employees is based on reliable production dust exposure history, on-site labor hygiene survey data, and technical quality qualified X-ray posterior-anterior chest radiographs as the main basis. With reference to dynamic observation data and pneumoconiosis epidemiological surveys, combined with clinical manifestations and laboratory tests, after excluding other similar lung diseases, the diagnosis and X-ray staging of pneumoconiosis are made by comparing with the pneumoconiosis diagnosis standard film. 4 X-ray chest radiograph manifestation staging
4.1 No pneumoconiosis (0)
a) O: No pneumoconiosis manifestations on the X-ray chest radiograph,
b) Ot: Chest radiograph manifestations are not sufficient to be diagnosed as I. 4.2 Stage I pneumoconiosis (I)
a) I: There are small shadows with an overall density of level 1, and the distribution range reaches at least two lung zones. b): There are small shadows with an overall density of level 1, and the distribution range exceeds 4 lung zones or there are small shadows with an overall density of level 2, and the distribution range reaches 4 lung zones.
4.3 Stage II pneumoconiosis (I)
aIⅡI: There are small shadows with an overall density of level 2, and the distribution range exceeds 4 lung zones; or there are small shadows with an overall density of level 3, and the distribution range reaches four lung zones.
b) II: There are small shadows with an overall density of level 3, and the distribution range exceeds 4 lung zones; or there are small shadows clustered: or there are large shadows, but it is not enough to be diagnosed as II.
4.4 Stage III pneumoconiosis (II)
a) III: There are large shadows, and their long diameter is not less than 20mm and the short diameter is not less than 10mm. b) IIr: The area of a single large shadow or the sum of the areas of multiple large shadows exceeds the area of the right upper lung. 5 Treatment principles
5.1 Treatment principles
Pneumoconiosis patients should be promptly transferred away from dusty operations and receive comprehensive treatment according to their condition, actively prevent and treat tuberculosis and other complications, in order to alleviate symptoms, delay disease progression, increase patient life expectancy, and improve patient quality of life. 5.2 Other treatments
According to the X-ray staging of pneumoconiosis and the compensation of lung function, those who need to be assessed for disability should be treated in accordance with GB/T16180. Instructions for the correct use of this standard
See Appendix A (Informative Appendix), see Appendix B, C, D, E, F (Normative Appendix)3
A.1 Scope of application of this standard
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
This standard applies to the 12 types of pneumoconiosis listed in the "Regulations on the Scope of Occupational Diseases and the Treatment of Occupational Disease Patients" No. 60 of the Ministry of Health and Defense on November 5, 1987, namely silicosis, coal workers' pneumoconiosis, graphite pneumoconiosis, carbon black pneumoconiosis, asbestosis, talc pneumoconiosis, cement pneumoconiosis, mica pneumoconiosis, potters' pneumoconiosis, aluminum pneumoconiosis, welders' pneumoconiosis, and foundry workers' pneumoconiosis. A.2 Diagnostic principles
The prerequisite for the diagnosis of pneumoconiosis is that there must be a definite history of occupational dust exposure. Although pneumoconiosis patients may have varying degrees of respiratory symptoms and signs and abnormalities in certain laboratory tests, they are not specific and can only be used as a reference for the diagnosis of pneumoconiosis. The focus of clinical and laboratory tests is to exclude other lung diseases such as tuberculosis, lung cancer and other diffuse pulmonary fibrosis, sarcoidosis, hemosiderin deposition, etc. A.3 Pneumoconiosis X-ray staging
According to the degree of imaging changes on chest X-ray films, pneumoconiosis is divided into: stage I pneumoconiosis (I), stage II pneumoconiosis (II), and stage III pneumoconiosis (III). "0\" means no pneumoconiosis. The 0+, I*, II, and III added in each stage are only for better dynamic observation and health monitoring, and are not independent stages.
A.4 Determination of small shadow density
The overall density of small shadows in the pneumoconiosis X-ray staging specified in this standard is an overall determination of the density of small shadows in the whole lung based on the determination of the density of small shadows by lung area. The determination method is to use the density of the highest lung area as the overall density, expressed in 4 major grades.
According to needs, the 4 major grades can be used to determine the density of small shadows in the lung area. Or 12 small grades. A.5 About dynamic observation of chest radiographs
X-ray imaging changes of pneumoconiosis are a gradual process. Dynamic series of chest radiographs can provide a more reliable basis for diagnosis. Therefore, it is stipulated that only one chest radiograph should not be used to make a diagnosis. However, in special cases, if other diseases can be ruled out with certainty, or if there are pathological examination results, a diagnosis can also be considered. wwW.bzxz.Net
B.1 Method of lung zone division
Appendix B
(Normative Appendix)
Terms and determination methods of pneumoconiosis diagnosis standards
The vertical distance from the apex of the lung to the top of the diaphragm is divided into three equal parts, and the horizontal line of the equal division point is used to divide each lung field into three lung zones: upper, middle and lower.
B.2 Small shadows
Refers to shadows in the lung field whose diameter or width does not exceed 10mm. B.2.1 Shape and size
The shape of small shadows can be divided into two categories: circular and irregular, and each can be divided into three types according to its size. The shape and size of small shadows shall be based on the standard film.
B.2.1.1 Small circular shadows are represented by the letters p, q, and r: p: the maximum diameter does not exceed 1.5mm;
q: the diameter is greater than 1.5mm and does not exceed 3mm
r: the diameter is greater than 3mm and does not exceed 10mm.
B.2.1.2 Small irregular shadows are represented by the letters s, t, and u: s: the maximum width does not exceed 1.5mm;
t: the width is greater than 1.5mm and does not exceed 3mm; u: the width is greater than 3mm and does not exceed 10mm. B.2.1.3 Recording method
The shape and size of small shadows should be recorded when reading chest X-rays. When the small shadows on the chest X-ray are almost all of the same shape and size, their letters are written above and below the slash, for example: p/p, s/s, etc.: When there are more than two small shadows of different shapes and sizes on the chest X-ray, the letters of the main small shadows are written above the slash, and the letters of the other minor and considerable shadows are written below the slash, for example: p/q, s/p, q/t, etc.
B.2.2 Density
Refers to the number of small shadows within a certain range. The determination of the density of small shadows should be based on the standard film, and the text part is only for explanation. When reading the film, the density of each lung area should be determined first, and then the overall density of the whole lung should be determined. B.2.2.1 Four-level grading The density can be simply divided into four levels: 0, 1, 2, and 3. Level 0: No small shadows or very few, less than the lower limit of level 1. Level 1: A certain amount of small shadows.
Level 2: There are many small shadows.
Level 3: There are a lot of small shadows.
B.2.2.2 Twelve-level classification
The density of small shadows is a continuous and gradual process. In order to objectively reflect this change, each level is divided into three small levels based on the four major levels, namely 0/-, 0/0, 0/1; 1/0, 1/1, 1/2; 2/1, 2/2, 2/3; 3/2, 3/3, 3/+. The purpose is to provide more information, reflect the pathological conditions more carefully, and conduct epidemiological research and medical monitoring. The reading and recording methods are as follows: Compare the chest X-ray with the standard film and first determine the classification according to the four prescribed levels. If the density of small shadows is basically the same as that of the standard film, first record it as 1/1, 2/2, 3/3. If the density of its small shadows is compared with the standard film and it is considered that it is one level higher or one level lower and should also be seriously considered, then record it at the same time, such as 2/1 or 2/3, 6
The former means that the density belongs to level 2, but level 1 should also be seriously considered; the latter means that the density belongs to level 2, but level 3 should also be seriously considered.
B.2.2.3 Distribution range and overall density determination method a) Determining the density of a lung area requires that the distribution of small shadows occupies at least two-thirds of the area of the area: b) The distribution range of small shadows refers to the number of lung areas with small shadows with a density of level 1 (including level 1) or above c) The overall density refers to the density of the lung area with the highest density in the whole lung. B.3 Large shadows
Refers to shadows with a diameter or width greater than 10mm in the lung field. B.4 Small shadow aggregation
Refers to the obvious increase and aggregation of local small shadows, but no large shadows have yet formed. B.5 Pleural plaques
Long-term exposure to asbestos dust can cause pleural changes, such as diffuse pleural thickening and localized pleural plaques. Pleural plaques refer to localized pleural thickening with a thickness greater than 5 mm, or localized calcified pleural plaques, excluding the apex of the lung and the costophrenic angle area. For patients exposed to asbestos dust, if the chest X-ray shows 0 and pleural plaques appear, they can be diagnosed as stage I; if the chest X-ray shows I, if the pleural plaques have involved part of the heart edge or septum, they can be diagnosed as stage II; if the chest X-ray shows I, if the sum of the length of a single or multiple pleural plaques on both sides exceeds half of the length of the unilateral chest wall, or involves the heart edge so that part of it appears messy, they can be diagnosed as stage III. B.6 Additional symbols ||TT||a) BU bullae ||TT||b) CA lung cancer and pleural mesothelioma ||TT||c) CN small shadow calcification ||TT||d) CP cor pulmonale ||TT||e) CV cavitation ||TT||EF pleural effusion ||TT||g) EM emphysema ||TT||h) ES lymph node eggshell calcification ||TT||i) HO honeycomb lung ||TT||j) PC pleural calcification ||TT||k) PT pleural thickening ||TT||1) PX pneumothorax ||TT||m) RP rheumatoid arthritis Lung
n)tb Active pulmonary tuberculosis
C.1 Chest X-ray quality
C.1.1 Basic requirements
Appendix C
(Normative appendix)
Chest X-ray quality and quality assessment
a) Must include the lung apex and costophrenic angle on both sides, the sternoclavicular joint is basically symmetrical, and the shadow of the shoulder and foot bones does not overlap with the lung field; b) The film number, date and other marks should be placed above the two shoulders, arranged neatly, clearly visible, and not overlap with the lung field; c) The photo should be free of artifacts, light leakage, pollution, scratches, water ulcers and images of external objects. C.1.2 Display of anatomical landmarks
a) The lung textures on both sides are clear and the edges are sharp, extending to the outer zone of the lung field. b) The heart edge and diaphragm are sharply imaged.
The lateral chest wall on both sides is well displayed from the lung apex to the costophrenic angle. c)
d) The outlines of the trachea, carina and main bronchi on both sides are visible, and the outline of the thoracic vertebrae can be shown. e) The lung texture in the posterior cardiac area can be shown.
f) The right diaphragm top is generally located at the level of the tenth posterior rib. C.1.3 Optical density
a) The highest density in the upper and middle lung fields should be between 1.45 and 1.75; b) The optical density below the diaphragm is less than 0.28;
c) The optical density of the directly exposed area is greater than 2.50. C.2 Chest X-ray quality classification
C.2.1 Class I film (excellent film)
Fully meets the chest X-ray quality requirements,
C.2.2 Class III film (good film)
Does not fully meet the chest X-ray quality requirements, but has not yet been reduced to Class III film. C.2.3 Grade III films (poor films)
Grade III films with any of the following conditions cannot be used for initial diagnosis of pneumoconiosis: a) It does not fully meet the basic requirements of chest films, and the sum of the areas of the defects affecting the diagnosis area is between half a lung area and one lung area. The lung textures on both sides are not clear and sharp enough, or the local lung textures are blurred, and the sum of the areas of the affected diagnosis area is between half a lung area and one lung area. b)
c) The lateral chest wall from the lung apex to the costophrenic angle on both sides is not well displayed, the tracheal outline is blurred, and the lung textures in the posterior cardiac area are difficult to identify. d) Insufficient inspiration, the right diaphragm top is at the level of the eighth posterior rib. e) The photo is dark, and the highest optical density in the upper and middle lung areas is between 1.85 and 1.90; or the photo is white, and the highest optical density in the upper and middle lung areas is between 1.30 and 1.40; or the gray fog is high, and the optical density below the diaphragm is between 0.40 and 0.50; or the optical density of the directly exposed area is between 2.20 and 2.30.
C.2.4 Level 4 film (waste film)
Chest films that do not meet the quality of level 3 films are level 4 films and cannot be used for pneumoconiosis diagnosis. 8
D.1 Relationship between standard films and standard provisions
Appendix D
(Normative Appendix)
Standard films for pneumoconiosis diagnosis using X-rays
Standard films are part of the diagnostic standards for pneumoconiosis, and are mainly used to express X-ray imaging changes that are difficult to express in words. Therefore, the determination of various X-ray imaging changes in pneumoconiosis should be based on standard films, and the text part is only for explanation. D.2 Principles for the compilation of standard films
The principle for the compilation of standard films is to accurately express the density and morphology of small shadows and to facilitate their use. D.3 Composition and content of standard films
The standard film consists of two parts. The first is a combination film with a total of 8 films, which mainly expresses the density of small shadows of different shapes and sizes. The density of small shadows is compiled according to the midpoint of each density, that is, 0/0, 1/1, 2/2, and 3/3. The second is a large whole lung film with a total of 15 films, which mainly demonstrates the relationship between the density and distribution range of small shadows in each stage of pneumoconiosis. D.4 Application of standard films
When reading X-ray chest films for pneumoconiosis diagnosis and staging, especially when determining the shape and density of small shadows, it is necessary to compare with the corresponding combination standard film.
The large whole lung standard film of each stage of pneumoconiosis is a reference for diagnosis and staging. D.5 Copyright of standard films
The copyright of standard films belongs to the state.
D.6 Copying and issuing of standard films
The copying and issuing of standard films are entrusted to the National Labor Health and Occupational Disease Prevention and Control Center. After being reviewed, numbered, and stamped by the Pneumoconiosis Diagnosis and Identification Group of the National Occupational Disease Diagnosis and Identification Committee, they are issued together with the standard film instructions. 9
Appendix E
(Normative Appendix)
Technical requirements for chest X-ray examination
High-kilovolt photography technology must be used for pneumoconiosis X-ray examination. Those who do not meet the following equipment and technical requirements cannot conduct pneumoconiosis X-ray examination.
E.1 Photographic equipment
E.1.1X-ray machine
The maximum tube voltage output value is not less than 125KV, and the power is not less than 20KW. E.1.2X-ray tube and window filter
a) Rotating anode;
b) Focus is not greater than 1.2mm;
c) Window total filter 2.5-3.5mm aluminum equivalent. E.1.3 Filter grid
Grid density is not less than 40 lines/cm;
b) Grid ratio is not less than 10:1:
Grid focal length is 1.8m;
d) Specifications match the film.
E.1.4 Intensifying screen, dark box
Generally use medium-speed intensifying screen;
Intensifying screen has no stains;
b) The resolution of intensifying screen is not less than 5-6 line pairs/mm;c) The intensifying screen and film are in close contact:
d) The dark box does not leak light.
E.1.5X-ray film
a) Generally use universal (hand-held, machine-displayed) film, and it is recommended to use special film suitable for chest photography:b) Blue film base;
c) Background fog Dmin<0.20;
d) d) Specifications: 356mmx356mm(14\x14\) or 356mmx432mm(14\x17\). E.1.6 Power supply
a) The power supply should meet the rated requirements of the X-ray machine; b) The X-ray machine needs to be powered independently and not shared with power appliances: c) The power supply voltage fluctuation range is ±10%.
E.2 Photographic technology
E.2.1 Preparation and posture requirements
a) The examinee should keep the chest wall close to the photo stand, naturally separate the feet, and rotate the arms inward so that the shoulder and foot bones do not overlap with the lung field as much as possible:
b) Focus-film distance 1.80m;
c) Adjust the tube position so that the center line is at the level of the sixth thoracic vertebra; d) Exposure should be performed in the breath-holding state after full inspiration; The posterior-anterior chest X-ray is a routine examination, and lateral, oblique, tomographic photography, or CT examination may be added when necessary for diagnosis and differential diagnosis.
E.2.2 Photographic conditions
a) Use 120-140KV for chest photography according to the specific conditions of the X-ray machine; b) Determine the exposure according to the chest thickness, generally use 2-8mAs, and the exposure time should not exceed 0.1 second. c) When photographing, the photographic conditions should be adjusted with reference to past chest films. E.3 Darkroom technology
E.3.1 The darkroom must meet the work requirements
E.3.2 Manual hand washing
a) In principle, constant temperature and timing are required, and the temperature of the liquid should be controlled between 20 and 25°C: Development time 3-5 minutes: b) Fixation should be sufficient and running water rinsing should be thorough: c) Qualified special safety lamps must be used; d) The developer and fixer must be replaced in time.
E.4 Automatic film processor
To ensure the quality of chest films, automatic film processors should be used as much as possible when conditions permit, and the operating procedures required by the automatic film processor should be strictly followed.
Appendix F
(Normative Appendix)
Requirements for pneumoconiosis diagnosis and reading films
F.1 Personnel engaged in pneumoconiosis X-ray diagnosis must pass the national assessment of pneumoconiosis diagnosis readers and obtain a certificate. F.2 Pneumoconiosis diagnosis shall be based on the principle of collective diagnosis. Relevant procedures shall be carried out in accordance with the national "Regulations on the Management of Occupational Disease Diagnosis" F.3 The corrected vision of the reader should be within the normal range. When reading films, one should sit down, and the viewing light should be appropriately placed, generally 25cm (conducive to observing small shadows) to 50cm (conducive to observing the whole chest film) in front of the reader's eyes. F.4 When reading films, the dynamic changes of comparative imaging should be observed in the chronological order of the chest films. It is not appropriate to make a diagnosis with only one chest film. F.5 When reading films, reference should be made to standard films. Generally, the chest film to be diagnosed should be placed in the center of the light box, with commonly used standard films on both sides. F.6 The viewing light should have at least 3 light boxes, preferably 5. The minimum brightness of the film viewing lamp shall not be less than 3000CD, and the brightness uniformity (brightness difference) shall be less than 15%.
F.7 The film reading room should be quiet, with no other light directly shining on the film viewing lamp. The film reading speed depends on personal habits, but a break should be taken every 1 to 1.5 hours to maintain the reader's vision and mental ability to distinguish. 12
Tip: This standard content only shows part of the intercepted content of the complete standard. If you need the complete standard, please go to the top to download the complete standard document for free.