Some standard content:
ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ97-2002
Diagnostic criteria of radiogenic neoplasms2002-04-08 IssuedWww.bzxZ.net
Ministry of Health of the People's Republic of China
Implementation on 2002-06-01
Chapters 2, 3 and 4 of this standard are mandatory, and the rest are recommended GBZ97-2002
This standard is specially formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". In case of any inconsistency between the original standard GB16386-1996 and this standard, this standard shall prevail
The purpose of formulating this standard is to make etiological judgments on tumors caused by occupational radiation exposure and to provide treatment. Appendix A and Appendix B of this standard are informative appendices. This standard is proposed by the Ministry of Health of the People's Republic of China and is under the jurisdiction of the drafting units of this standard: China Institute of Radiation Protection and Institute of Radiation Medicine, Chinese Academy of Medical Sciences. Drafters of this standard: Sun Shishiquan, You Zhanyun, Wang Jixian This standard shall be interpreted by the Ministry of Health of the People's Republic of China. 1 Scope
Diagnostic criteria for radioactive tumors
GBZ97-2002
This standard specifies the judgment criteria and treatment principles for radioactive tumors. Radioactive tumors refer to malignant tumors that occur after exposure to ionizing radiation and have a certain degree of etiological connection with the exposure. This standard is applicable to the etiological diagnosis of tumors that occur after occupational exposure. Malignant tumors that occur after non-occupational exposure can also be judged by referring to this standard. Malignant tumors that occur after voluntary medical exposure are not within the scope of application of this standard. 2 Judgment basis
2.1 There is a history of exposure to a certain dose of certain radiation and the monitoring records of the legal personal dose of exposure. 2.2 The occurrence of the following specific types of primary malignant tumors after a certain latent period of exposure and clinical diagnosis. 2.2.1 Lung cancer that occurs after exposure to hydrogen protons. 2.2.2 Leukemia (excluding chronic lymphocytic leukemia) after exposure to X-rays or Y-rays; thyroid cancer and breast cancer (female).
2.2.3 Bone malignancies after exposure to radium-226a rays. 2.3 According to the patient's gender, age at exposure, onset latency and exposure dose, calculate the probability of causation (PC) of the malignant tumor caused by the exposure according to the methods listed in Chapter 3 and Appendix A. 2.4 PC ≥ 50% can be judged as a radioactive tumor. 3 Calculation of the probability of causation of irradiation-induced malignant tumors 3.1 To calculate the probability of causation (PC), the following information needs to be provided by the relevant medical departments and professional dose monitoring departments: 3.1.1 The patient's name, gender, age, cancer diagnosis (including cytological type), cancer diagnosis basis, diagnosis date and diagnosis unit.
3.1.2 The absorbed dose of the target organ when the person is exposed to the relevant radiation, the type of radiation received, the irradiation conditions, the start time of irradiation and the duration of irradiation obtained from the personal dose file or relevant records. When there is occupational exposure to chemical carcinogens, the type of carcinogen, exposure level and exposure time should be explained. 3.2 Based on the above information, use the calculation method and parameters provided in Appendix A to calculate the PC of the cancer caused by previous irradiation.
3.3 When diagnosing a certain occupational cancer caused by occupational exposure to combined chemical carcinogens, the PC of the combined exposure can be calculated using the additive model using their respective risk factors. 4 Judgment of occupational radiation tumors
4.1 Radioactive tumors caused by occupational irradiation can be diagnosed as occupational radiation tumors. GBZ97-2002
4.2 Occupational exposure combined with occupational chemical carcinogenic exposure, where the relative contribution of radiation carcinogenesis to the increased risk is greater than 1/2, and the total causal probability PC ≥ 50% is also diagnosed as occupational radiation tumor. 5 Principles of treatment of radiation tumors
According to the type, type and development stage of the malignant tumor, the same methods as similar general tumors should be adopted for active treatment and management.
A1 Calculation method of etiology probability
Appendix A
Calculation method of etiology probability, calculation parameters and calculation examples (informative appendix)
GBZ97-2002
The etiology probability PC represents the possibility that an individual's cancer is caused by a certain dose of radiation in the past. It is the ratio of the increase in cancer probability after a certain dose of radiation to the total probability of cancer. It is calculated using the cancer relative risk increase value R: PC=R/(1+R)
R-FXTXK
FF(D): is the irradiation factor, which is a function of the absorbed dose D. For external irradiation, the average target organ absorbed dose cGy (rad) is taken. For chronic irradiation, the annual average target organ absorbed dose over the years during the irradiation period should be provided. Thyroid cancer and breast cancer conform to the linear dose-effect model, so F=D; leukemia conforms to the linear square model, F=D+D2/116. For hydrogen progeny F, WLM is used to represent it, and the annual cumulative WLM value over the years is given. 1WLM=170WL·h=3.5×10-3J·hm3. When hydrogen daughters are also exposed to low-LET rays, such as Y-ray exposure in mines, the low-LET exposure dose can be converted to WLM according to 6cGy=1WLM and then added to the daughter cumulative WLM, and PC is calculated according to the total WLM.
T-T(Y): is the latent period correction factor, which is the probability of being diagnosed after Y years of exposure. For lung cancer, thyroid cancer and breast cancer, when diagnosed 0-4 years after exposure, T=0; at 59 years, they are 0.074, 0.259, 0.500, 0.741, 0.926 respectively; when it is more than 10 years, T=1.0. T(Y) of chronic myeloid leukemia is given by A2.2. The T value of acute leukemia is related to the age of exposure A1, and T(AI, Y) is given by A2.3.
K=K(AI,S): is the relative risk increase coefficient for the occurrence of the cancer at age A, exposure, and sex S (male m, female f). When F=1, T=1, K=R. A2.1 gives the K(A1,S) values for thyroid cancer and breast cancer (female). The K value for leukemia also depends on the age at diagnosis, A2, and is calculated from the formula KE/I. E=E(Ai,S) is the increased probability of cancer for sex S at age A, exposed to F=1; E=I(A2,S) is the baseline incidence rate of the cancer for sex S at diagnosis age A2. E(AI,S) and I(A2,S) are given in A2.2 and A2.3. The K of hydrogen progeny-induced lung cancer is taken as a constant value of 0.015. When WLM receives multiple exposures, for example, two exposures with doses of D and D, the interaction additive model is used. The total relative risk increase is the sum of the relative risk increases of each, that is, R(D, D2)=R(D)+R(D2)
.. (3)
The calculation of PC of chronic occupational radiation carcinogenesis also adopts this method: in units of years, receive one exposure equivalent to the annual cumulative dose each year, add up the R values obtained in previous years, and calculate the PC of all exposures using formula (1). When irradiating D with chemical factor Z, the total R value is also calculated according to the additive model. R(D, Z)=R(D)+R(Z)
GBZ97-2002
The risk increase coefficient K(Z) of the compounded chemical carcinogens cannot be given in the appendix of this standard and needs to be provided through other channels.
When voluntary exposure is combined, the carcinogenic contribution of voluntary exposure should be deducted. The PC of involuntary exposure under combined voluntary exposure is given by the method of handling two exposures in reference (1) of A.2.7. The parameters for calculating PC listed in Tables A1 to A4 include common age groups and time groups. If the given limits are exceeded, the parameters of all age groups and time groups can be obtained from the references listed in A.2.7. A2
Parameters and calculation examples for calculating the probability of cause
A2.1 Parameters and calculation examples for calculating the probability of cause of thyroid cancer and breast cancer. Table A1 Parameters K(A1, S) for calculating the PC of thyroid cancer and breast cancer [Thyroid cancer is taken from reference (1) given in A.2.7, and breast cancer is taken from reference (2)] Age of exposure
Thyroid cancer
Breast cancer
Calculation example 1: Male (m), thyroid was irradiated with 25 cGy Y-ray at the age of 25, and thyroid cancer was diagnosed at the age of 33, i.e. 8 years later. Calculate the probability of cause from the exposure received. F(D)-F(25)=25
T(Y)=T(8)=0.741
(Linear dose model)
(Self-Table A1)
K(Ai,S)=K(25,Male)=0.0139
(White Table A1)
R=F×TXK=25×0.741×0.0139=0.26PC-R/(1+R)=0.26/(1+0.26)=0.206=20.6% Calculation Example 2: Female (f) was engaged in radiation work between the ages of 35 and 38. She received breast doses of 4.2, 4.2, 2.0, and 2.0 cGy. She started working at the age of 47 and developed breast cancer 12 years later. Calculate the probability of the cause being from occupational radiation. Age, years
Dose, cGy
T(12)=1.000
T(11)=1.000
T(10)=1.000
T(9)-0.926
K(Ai,S)
K(35,f)-0.009833
K(36,f)-0.009370
K(37.f)=0.008702
K(38,f)-0.007885
R(total)=0.0413+0.0394+0.0174+0.0146=0.113PC=R/(1+R)=0.113/(1+0.113)=0.102=10.2%A2.2 Calculate the probability parameters and calculation example of the cause of chronic myeloid leukemia. R(FxTxK)
Table A2 Calculation of parameters for chronic myeloid leukemia T(Y), E(A,S), I(A2,S) [Taken from parameter data (1) given in A2.7] Y
E(Ar,S)
GBZ97—
Calculation Example 3: A male, at the age of 30, received 10 cGy of X-ray irradiation to his bone marrow. He was diagnosed with chronic myeloid leukemia 45 years later, or 15 years later. Calculate the probability of the cause being due to the irradiation. F(D)=F(10)=10+10-/116=10.86 (linear square model) T(Y)-T(15)-0.024 (from Table A2)
E(A1,S)=E(30,m)=1.05 (from Table A2) I(A2,S)-I(45,m)-1.16 (from Table A2) K(A1,A2，S)-E/I=1.05/1.16=0.905 R=FXTXK=10.86X0.024X0.905=0.236 PC-R/(1+R)-0.236/(1+0.236)=0.191=19.1% A2.3 Parameters and calculation example for calculating the probability of the cause of acute leukemia. Table A3 Parameters T(A,Y) for calculating PC of acute leukemia [Taken from reference given in A.2.7 (1) Y
0.0000962
0.0000887
0.0000818
GBZ97-2002
Continued Table A3
GBZ97—2002||tt| |Continued Table A3
GBZ97—2002
0.0000296
0.0000216
0.0000156
Continued Table A3
0.0000078
0.0000054
0.0000037
0.000 771
0.0000025
Table A4 Parameters E (A, S), I (A2, S) for calculating PC of acute leukemia GBZ97-2002
0.0000017
0.0000011
0.0000543
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.