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4.10 Medical Standards for Workers in Nuclear Installations. l.c. Van Oudenhove de St Gery

4.10 Medical Standards for Workers in Nuclear Installations. l.c. Van Oudenhove de St Gery

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896
SAMEDIESETYDSKRIF
5DESEMBER1981
appearedtobe
adequate
inthe
one
caseinwhich
it
wasapplied(workerG),beingcombinedwith
other
laboratorytestsbeforeadecisionwasraken.
Addendum
As
of
June
1981a
ZPP
reading
of
20
j.1g1
g
Hb,
thought
tocorrelatewitha
Pb-B
value
of
70
j.1g1dl,was
adopted
as
thecriterionforremovalfromexposure.
REFERENCES
I.
Zielhuis,
R.
L.andWibowo,
A.
E.
E.
(1978):Ned.T.Geneesk.,I22,793.
2.
Waldron,H.
A.
(1978):J.soc.Occup.Med.,28,27.
3.
Moore,M.R.,Campbell,
B.
C
andGoldberg,
A.ill
Lenihan,
J.
andFletcher,W.W.,ed.(1977):
TheChemicalEm,iromnenr
(EnvironmentandMan,vol.6),p.
89.
Glasgow:Blackie
&
Son.
4.
Commission
of
InquiryonOccupationalHealth(1976):Report(RP55).
Pretoria:
Government
Printer.
5.
Proceedingsofthe1974Conferenceon
Standards
of
OccupationalLeadExposure(1975):J.occup.Med.,
17,98.
6.
Gross,
S.
B.
(1979):
Oraland[nhalarionLeadExposllres
in
Hi/manSlIbjecrs.
NewYork:LeadIndustriesAssociation,Inc.
7.
Hernberg,
S.
in
Zenz,
C,
ed.(1975):
OcwparionalMedicine,Principles
and
PracricalApplicarions,
chapt.
30.
Chicago:YearbookMedicalPublishers.
8.
Irving,L.
M.,
Harrison,W.
0.,
Webster,
1.
er
0/."(1978):Lancet,
1,4.
9.
Lane,
R.
E.,
Hunter,D.,
Malcolm,D.
er
at.
(1968):Brit.med.
J.,
4,501.
10.
Baker,
E.
L.,Landrigan,P.
J.,
Harbour,
A.
G.
er
at.
(1979):Brit.J.industr.Med.,
36,
314..
11.
Hammond,P.
B.,
Lerner,S.J.,Garrside,
P.
S.
er
al.
(1980):
J.
occup.Med.,22,475.
12.
WorldHealthOrganization(1977):
Lead
(EnvironmentalHealthCriteria,no.3).Geneva:
WHO.
13.
Benson,G.
J.,
George,H.H.S.,Lichfield,
M.H.
er
al.
(1976):Brit.J.industr.Med.,33,
29.
14.
Piomelli,S.,Davidow,B.,Guinee,
V.
F.
er
al.
(1973):Pediatrics,
SI,
254.
15.
Lamola,A.A.,Joselow,
M.and
Yamane,F.(1975):
Gin.
Chem.,
21,93.
16.
Tomokuni,K.,Osaka,
1.
and
Ogata,M.(1975):Arch.environm.
Hlth,
30,588.
17.
Fischbein,A.,Eisinger,
J.
andBlumberg,
E.
W.(1976):
Mt
Sinai
J.
Med.,43,294.
18.
Joselow,M.M.andFlores,G.(1977):Amer.industr.Hyg.Ass.
J.,
38,63.
19.
Herber,
R.
F.M.andWibowo,
A.
E.
E.
(1980):
T.
soc.Geneesk.,
58,425.
20.Grandjean,P.(1979):Brit.J.industr.M.ed.,36,52.21.Zielhuis,
R.
L.
and
Wibowo,
A.
E.
E
(1978):
T.
soc.Geneesk.,56,676.22.
lee,
W.
R.
(1981):J.ray.CoIl.PhyensLond.,
15,48.
23.Hesley,
K.
L.andWimbish,G.H.(1981):Amer.industr.Hyg.Ass.
J.,42,42
.
Medicalnuclearstandards
for
installations
workers
In
L.
C.VAN
OUDENHOVE
DEST
G ~ R Y
HistorySummary
SouthAfrica
is
moving
into
thenuclearenergy
age,and
mostpractitioners
are
probablynot
aware
of
theimplications
inmedicalpractice.
Thedemandsuponworkersinthis
areaareverystrict,and
the
doctor
whomay
have
to
examine
them
must
beaware
of
this.
Thisarticleisdesigned
tooutline
theprocedures
necessaryin
examiningcandidatesfor
employment
in
the
nuclearenergyindustry.
S.
Atr.med.
J.,
60,896
(1981).
Verystrictinternationalsrandardshavebeenestablishedfornuclearpersonnel
and
madeapplicablebytheAtomicEnergy
Board
to
any
South
Africanlicenceholder(corporate
or
individual).
The
basicinvestigation
of
anycandidateforemploymentinanuclearplantasa'radiationworker'consists
of
apersonalhistory,physicalexamination
and
complementaryexaminations.809
Medical
Centre,
Hererengracht"CapeTown
L.
C.
VAN
OUDENHOVE
DE
ST
GERY,
M.D.
Datereceived:
21
April1981.
Only
personsover
the
age
of
18
maybeemployedatnuclearinstallations
and,
in
principle,women
under
theage
of
50cannot
be
employed
as
radiationworkersatnuclearinstallations,
althoughof
course
they
maybeemployedin
departments
outside.Acompletefamilyhistory
is
necessaryaswellasahistory
of
previousworkwithparticular
attention
totoxic,
dusty,
noisy
~ d
glaryjobs
and
anypreviousexposuretoionizingradiation(whichwouldincludeanyexposuretomedicalradiologicalapparatus).Alldosimetricinformation
must
berecordedaccurately
and
transmittedtoanaccreditedhealthphysicist.
In
taking
the
patient'shistory,it
is
importantto,rememberthat
everydetail
is
wonh
takingnote
of
and
thatenquirymust
bemadesystematically,systembysystem.Everyexposure
of
skintotoxins
anddust
mustbe
noted,
withspecialreferenceto
chronic
skindisease
of
any
naturethat
couldbemadeworse
or
reactivated
by
ionicradiation.Inabilitytorrear
any
skincondirionsuccessfully
is
ground
forrejection,
and
any
skinchangedue
to
previousradiationconstitutes
~ n
absolutecontraindicationtoemployment.
Cardiovascular
system.
As
regardsthecardiovascularsystemall
the'
conventionalcontraindicationstoindustrial
employment
arevalid,fortheprincipleinvolved
is
not
so
muchthat
theseconstitutea
bar
to
employment
but
that
theworkinanU,clearinstallationrequiresthemostcompletestate
of
fitnesspossible.Any
chronic
disease
of
therespiratorysystem
that
 
couldenhancethedanger
of
internalcontamination
or
beaggravatedbysuchcontamination
is
acontraindication.
Digestive
system.
Basically,disorders
of
thedisgestivesystemwhichareconrraindicationsroworkinanuclearplantarethesame
as
thoseinnormalindustry;it
is
clearthatchronicintetinalulceration
or
any
chronicinflammaroryconditionwouldbeacontraindication
ro
acceptance.
In
s o ~ e
casesthecandidatemaybereviewed3monthslater,aftertreatment.
Nervous
system.The
condition
of
thenervoussystem
must
becarefullyreviewed
and
in
doubtful
casesthecandidate
should
bereferredforneurological,psychological
or
psychiatricinvestigation.
The
emotionalbalance
of
theworker
is
of
primary
importance,as
is
hisabilityroobservestrictdisciplineandworkinateam.
Renal
d i s e a s ~
is
usuallya
bar
toemployment.
Ears,
nose
andthroat.
Anypreviouschronic
or
acuteinflammatoryconditionaffectingtheear,nose
and
throat
must
be
enquired
after
and
ifnecessarytreatedbeforeafinaldecisionabouremployment.Hearing
must
betested.
Endocrine
system.In
theendocrinesystemthecriticalorgan·isthethyroid,
on
accounr
of
possiblecontamination
by
iodine-131.Uncontrolleddiabetes
is
an
absolute
contraindication.
Scars
and
wounds.
Surgicalscars
must
beinvestigatedfromtwoangles:
(1)
asurgicalscarimpliespreviousdisease,
about
which
enquiry
shouldbemade;and
(ii)
anyscarenhancestheeffect
of
contamination
and
is
ahandicaptodeconramination.Any
woundthat
may
causeproblems
withskeletal
contamination
is
areasonfortemporaryexclusionfromworkinaradiation
or
contaminationzone.Specialattentionmustbepaid
ro
fractures,especiallyrecentfractures,
on
account
ofthe
strontium-90
effect-
on
callus.
The
presence
of
anymalignant
tumour,
past
or
present,constitutesanabsolutecontraindication
ro
employment.
The
blood.
Enquiry
must
bemadeintoanypastdisorder
of
thebloodintheapplicant
or
hisfamily;this
is
anarearequiringcarefulinvestigation,sinceanyblooddisorderconstitutesacontraindicationroradiationwork.
Enquiry
must
alsobemade
about
previousradiotherapy,
and
thedosimetricresults
must
becommunicatedto
and
discussedwithanaccreditedhealthphysicist.
Clinicalexamination
This
must
beprolonged,complete
and
systematic;inview
of
theresponsibilityinvolved
and
therules
that
must
bestrictlyappliedtonewworkers,thisexaminationcanneverbetoostrict.
Skin.
Anyskinlesions
must
belookedfor,especially
on
theface,scalp,neck,
hands
and
trunk.Chronic
and
resistantacne,ifwidespread,constitutesareasonforrejectionbecause
of
therisk
of
repeatedcontamination
of
thearea.Skintumours
or
degenerativechangesintheskinshould
be
carefullynoted.
If
thecandidateshowssigns
of
bitinghisnails,he
must
bewarned
about
thedanger
of
contamination
through
thisandrejected
ifhe
persistswiththehabit.Skinlesions
due
toradiationmayconstituteareasonfor
temporary
or
permanent
suspension.
Cardiovascular
system.
Examination
of
theheart
and
bloodvessels
is
thesame
as
ingeneralmedicalexaminations,
bur
it.is
usefultohavea
pre-employment
ECG
and
to
repeatthisatintervals.
Examination
of
the
respiratory
system
is
basicallythesame
as
inallindustrialmedicine,
bur
inadditionlungcapacity
must
beassessed.
Chronic
bronchitis,
asthmaor
emphysema
is
areasonforrejection,
and
tuberculosis
is
of
courseacompletebar.
Abdomen.
Apart
fromgeneralabdominalexamination,careshouldbetaken
to
lookforhernias,liverenlargementandsplenicenlargement,all
of
whicharegroundsforrejection.Any
interruption
of
themucosa
membrane
of
thegastro-intestinaltract
such
as
apeptic
or
intestinalulcer
is
acontraindication.
The
SA
MEDICALJOURNAL
5
DECEMBER
1981897
urinary
and
genitalsystems
must
alsobeinvestigated.
Ears,
nose
and
throat.
Chronic
infections
of
thethroat
or
noseconstitutereasonsforrejection.
The
condition
of
theears
must
belookedinro,withparticularemphasis
on
perforation
of
the
eardrum.
Anyperforation
or
chronicinflammation
of
theexternalaudirorymeatus
is
ground
forrejectionunlesstheindividualundergoesasuccessfultympanoplasty
or
other
curativeoperation.Basichearingcapacitymustbetested;
if
in
doubt
thecandidate
must
bereferred
ro
anETspecialist.
In
anycaseanaudiogram
is
obtainedannually.Loss
of20
dBattheentranceexaminationmakesacandidateunacceptable.
Eyes.There
arenoactualstandardsforvisualacuiry,
but
thegeneralrule
is
that
if
the
candidate
is
wearingglassesheshouldbeabletoexecuteessentialmanoeuvresathisplace
of
workintheshortestpossibletimeeven
under
themostcomplexcircumstances,
and
hemustbeabletowearamaskor
other
protectivegearprescribedforworkincontaminatedareas.Glassesmaybereplacedbyspecialplasticunbreakableglassesadapted
to
theprotectivegear.Certainjobssuch
as
telemanipulationsina
hot
cell
or
inthefuelpool
demand
perfectvision
and
absolute
depth
dimensionview.
The
importance
of
colourvisionvariesfrom
department
to
department
andfromjobtojob.Colourblindnesswouldnotconstituteanabsolutefactorfordisqualification
and
mustbeweighedupagainstthedemands
of
thejob.
The
significance
of
narrowing
of
thevisualfieldwoulddependuponthetasks
ro
beperformedandthecause
of
theimpairment.
Nervoussystem.
The
neurologicalbalancesheet
is
probablythemost
importantpart
of
apre-employmentexamination.Anyseriousabnormalityconstitutesanabsolutecontraindication,
and
this
includes
the
psychologicalfield,inwhichclaustrophobia,forexample,woulddisqualifyaradiationworker.Balance
is
of
particularimportancesincetheworker
must
beableroclimbsteps
and
laddersandworkatheights
without
dangertohimself,andanycandidatewithattacks
of
dizziness
or
faintingwouldthereforebedisqualified.Sincemostworkers
must
beabletodoshiftworkdisorders
of
sleepwillconstituteabar,andanylack
of
co-ordinationandreactionspeedalsodisqualifieshim.
Femalepersonnel
For
obviousreasonsit
is
thegeneralpolicynortoemployfemalestaffinaradiationarea.
If
theyhavetobeemployedwomenshouldbeexaminedjust
as
systematicallyasmen,
and
agynaecologicalexaminationshouldbeperformedifthere
is
anyindication
of
uterine
or
ovariandisease
or
of
pregnancy.Mostfemalepersonnelare
of
courseemployedoursidethecontrolledzone;neverthelessformedical,legalandpsychologicalreasonsit
is
highlyadvisablenottoemployfemale
staffwithout
aninitialcompletemedicalbalancesheet,
as
wellasrepeatexaminationswhenrequired.
Complementaryexaminations
These
examinationsare
intended
tocoverthespecialrisks
and
responsibilitiesinanuelearinstallation
and
arethereforeas
important
as,ifnormore
importanr
than,thegeneralclinicalexamination.
Two
of
thesystemicexaminationsarecompulsory(thebiologicalbalancesheet
and
theophthalmologicalbalancesheet)
and
one
is
optional(chestradiography).
Biological
balancesheet
The
most
importantcomponent
of
thebiologicalbalancesheet
is
thehaematologicalexamination.
This
willincludeacomplete
blood
co-unt
and
the
other
standard
haematological
examinations.
The
redcell
count
shouldnotbebelow3,8x

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