GB 5906-1997 X-ray diagnosis of pneumoconiosis

GB 5906-1997 X-ray diagnosis of pneumoconiosis GB5906-1997 standard download decompression password: www.bzxz.net

GB5906-1997
GB5906-86 Pneumoconiosis X-ray Diagnosis Standard and Treatment Principles" has reached a high level of scientificity and practical value. In 1991, it won the "Special Award for Excellent Standards in the Opening Period" issued by the Ministry of Health. When it was promulgated, the Occupational Disease Diagnosis Standard Subcommittee proposed the requirement of timely updating of this standard based on the view that "all standards should be further revised at the same time as they are promulgated and implemented". The original standard has the following problems:
The quality of the standard film of the original standard needs to be further improved: the clarity of the chest film taken by low-voltage technology is poor; therefore, before solving the problem of updating the standard film, the problem of commercial-voltage chest film and chest film quality standards must be solved first. The original standard also has the problem of being in line with the relevant international standard, namely ILO (SH22): 1980 "International Classification of Pneumoconiosis X-ray Manifestations". Its special feature is that the latter is not a "diagnostic standard" in a formal sense, but only provides a method to observe the chest X-ray image of the lung and record the classification results in a universal way. Its "standard film" is not the basis for diagnosis, but a reference benchmark when reading and comparing films. The international practice is to adopt a "classification method" that is consistent with the country's "diagnostic rules". my country has a unique pneumoconiosis diagnosis system, which has long been familiar to the majority of medical personnel and workers. GB5906-86 fully absorbs the essence of ILO (SII-22): 1980. It adopts important technical principles such as pneumoconiosis imaging terms and definitions, image quality concepts, the method of using "standard films" and unified pneumoconiosis X-ray imaging observation methods, and incorporates them into my country's pneumoconiosis diagnosis system. At present, the high-kilovolt technology of radiography methods is standardized, which is a great step forward in the issue of integration. This situation where there are differences in meaning can be called non-equivalent adoption, which is in line with international practice. By the end of this century, the number of pneumoconiosis cases in my country will reach more than 800,000. At present, the problems of misdiagnosis and missed diagnosis are very serious, mainly due to the low quality of chest films. The quality problem of chest films at the grassroots level is no longer general but a universal problem that needs to be solved urgently and affects pneumoconiosis. Practical problems in the quality of lung diagnosis. Since the original standard was vague about the application of level 3 films, it left hidden dangers for diagnostic quality control. Therefore, it is urgent to revise the standard appendix.
The main contents of the revision of the appendix to this standard:
a) Add clear "basic requirements" for chest radiographs in Appendix B, b) Specify the judgment criteria for chest radiographs of all levels, especially level 2 films, in Appendix B; c) Clearly state in the appendix that high-voltage technology should be used for radiography; d) Clearly state the equipment requirements for radiography in Appendix D; e) Delete the original appendix that has no practical value. Appendix A, Appendix 13, Appendix C, and Appendix I of this standard are all standard appendices, and Appendix E is a proposed Appendix shown. This standard is proposed and coordinated by the Ministry of Health of the People's Republic of China.
This standard was drafted by the Institute of Labor Hygiene and Occupational Diseases, Chinese Academy of Preventive Medicine, and the participating drafting units include Tai'an Coal Mine Workers' Sanatorium, Shenyang Institute of Labor Hygiene and Occupational Disease Prevention and Control, the Third Hospital of China Medical University, Shanghai Institute of Labor Hygiene and Occupational Disease Prevention and Control, Anshan Iron and Steel Company Labor Hygiene Institute. Occupational Disease Hospital of West China University of Medical Sciences, and the Affiliated Hospital of Jiangxi Medical College. The drafting units of the revised draft of the appendix to this standard are: Sichuan Institute of Labor Hygiene and Occupational Diseases, Anshan Iron and Steel Company Labor Hygiene Institute, Chinese Academy of Preventive Medicine Institute of Labor Health and Occupational Diseases, Institute of Radiology, Banzhou Medical College, Health and Epidemic Prevention Station of Zhenjiang City, Jiangsu Province, Institute of Labor Health and Occupational Diseases, Liaoning Province, Shanghai Institute of Labor Health and Occupational Disease Prevention and Control, Jian Province Institute of Labor Health and Occupational Disease Prevention and Control, Guangxi Zhuang Baizhi District Occupational Disease Prevention and Control Institute. This standard was first issued in 1986 and revised for the first time in June 1997. The Institute of Labor Health and Occupational Diseases, Chinese Academy of Preventive Medicine, the technical authority responsible for this standard, is responsible for interpretation. National Standard of the People's Republic of China
X-ray Diagnosis of Pneumoconiosis
Roentgeno-diagnosis of pneumoconiosesCB5906—1997
e(S-H22):1988
Replaces GB 5908 86
Pneumoconiosis is a diffuse fibrotic systemic disease of the lung tissue caused by long-term inhalation of industrial dust and its retention in the lungs. 1 Scope
This standard specifies the X-ray diagnostic standard for pneumoconiosis. This standard applies to the diagnosis of various pneumoconiosis specified in the national "list of occupational diseases". 2 Diagnostic principles
Pneumoconiosis X-ray examination is the main diagnostic method for determining pneumoconiosis and staging. X-ray diagnosis and staging should be made based on a detailed and reliable occupational history, a technically qualified posteroanterior chest radiograph (see Appendix B (Appendix to the standard)], reference to necessary dynamic observation data and the epidemiological survey of pneumoconiosis in the unit, and comparison with the pneumoconiosis diagnostic standard film [see Appendix C (Appendix to the standard)]. In addition to X-ray diagnosis and staging, the clinical diagnosis of pneumoconiosis should also be combined with the patient's medical history, symptoms, signs, clinical tests and necessary special examinations to make differential diagnosis, early detection of complications, and assessment of compensatory function level. 3 Diagnosis and grading standards
3.1 No pneumoconiosis (code 0)
a) 0: No X-ray manifestations of pneumoconiosis:
b) 0+, X-ray manifestations are not enough to be diagnosed as "I". 3-2 stage pneumoconiosis (code 1)
a) I: There are small circular shadows with a density of level 1. The distribution range is at least one in each of the two lungs, and the diameter of each is not less than 2cm; or there are small irregular shadows with a density of level 1, and the distribution range is not less than two lung areas: b) "+ The number of small shadows has increased significantly, but one of the density and distribution range is not enough to be classified as "II". 3.3 Stage II pneumoconiosis (code 1)
a) Ⅱ: There are small circular or irregular shadows with a density of 2, and the distribution range exceeds four lung areas, or there are small shadows with a density of 3, and the distribution range reaches four lung areas,
b) 【+: There are small shadows with a density of 3, and the distribution range exceeds four lung areas; or there are large shadows that are not enough to be classified as "dish". 3.4 Stage III pneumoconiosis (code heavy)
a) 1: There are large shadows, and their long diameter is not less than 2cm and the wide diameter is not less than 1cm. b) Ⅱ,: The area of ​​a single large shadow, or the sum of the areas of multiple large shadows exceeds the area of ​​the upper right lung area. 4 Treatment principles
Drug treatment should be combined with ideological work, regular life, and appropriate physical labor and physical exercise. Combined with anti-tuberculosis work, comprehensive measures should be taken to delay the progression of the disease and alleviate symptoms. Active prevention and treatment of pneumoconiosis complications should be carried out, especially strengthening the prevention and treatment of pneumoconiosis tuberculosis.
5 Labor capacity assessment
GB 5906-1997
It should be determined according to the patient's diagnosis stage combined with the compensatory function status. 6 Requirements for health examination
Workers exposed to dust should undergo employment health examinations and regular health examinations. The purpose of regular health examinations is to promptly detect pneumoconiosis patients and observe changes in their condition. The inspection period is determined by local health departments based on the situation. The principle is that those with severe exposure should be examined every two years, those with mild exposure should be examined every two to three years, and some cases can be examined every five years.
7 Occupational contraindications
a) Active tuberculosis:
l) Chronic lung disease, severe chronic upper respiratory tract or bronchial disease;) Pleural and thoracic diseases that significantly affect lung function;) Severe cardiovascular system diseases,
A1 Lung area
GB5906-1997
(Standard Appendix)
Terms of X-ray diagnosis of pneumoconiosis and their determination methods
The method of dividing lung areas is to divide the vertical distance from the apex of the lung to the top of the diaphragm into three equal parts, and the horizontal line of the equal division point divides each side of the lung field into upper, middle and lower three areas.
A2 Small shadow
Small shadow refers to a shadow with a diameter or width not exceeding 1 cm. A2.1 Small circular shadows
are circular or nearly circular in shape, with regular or irregular edges. They can be roughly divided into three categories according to their diameter: a) P: diameter about 1.5 mm or less
h) q: diameter about 1.5~3mmz
c) r: diameter about 3~10mm.
A2.2 Small irregular shadows
A group of dense shadows of different thickness, length and shape. They can be unconnected or randomly intertwined, showing a network, sometimes in a honeycomb shape. They can be roughly divided into one category according to their width: a) : width about 1.5 mm or less; b) t: width about 1.5~3mm; c) u: width about 31 m
A3 Small shadow density
The number of small shadows in a certain range. The density is divided into three levels. The grading standards are shown in the standard film in the appendix ((Standard Appendix! 1. A3.1 Density of small circular shadows
a) Level 1: Quantitative and definite small circular shadows. The lung texture is clearly visible. (For example, p, there are about 10 shadows within a diameter of 2 cm.
b) Level 2: A large number of small circular shadows. Lung texture is generally recognizable. c) Level 3: A large number of small circular shadows. Lung texture is partially or completely disappeared. A3.2 Density of irregular small shadows
a) Level 1: A considerable number of small irregular shadows. Lung texture is generally recognizable. h) Level 2: A large number of small irregular shadows. Lung texture is usually partially disappeared. c) Level 3: A large number of small irregular shadows. Lung texture is usually completely disappeared. A4 Density and range determination method
It is necessary to make a comprehensive determination of the density of all small shadows appearing in each lung area. a) To determine a lung area, the small shadows must occupy two-thirds of the area of ​​the area; b) The distribution range is the number of lung areas with small shadows: c) The density in most lung areas is the main basis for determination! () The higher level of density with a distribution range of not less than two lung areas is the main basis for determination. A5 Large shadows
Large shadows refer to shadows with a longest diameter of more than 1 tm. A6 Large shadows not classified as "Ⅱ"
GB5906-1997
a) Small shadows gather and have not yet formed a uniform and dense block shadow; b) Large shadows have not yet reached 2cm×1cm;
c) "Patch strips or white areas" appear. A7 Pleural changes
Pneumoconiosis may have different degrees of pleural thickening, adhesions and calcification. If the changes are obvious, they can be recorded in the additional code column. Pleural plaques refer to those with a thickness greater than 3 mm Localized pleural thickening. In asbestosis with irregular small shadows as the main lung manifestation, when the lung changes to 0, if there are localized pleural plaques on both sides of the chest wall, it can be determined as "1\; if the lung changes to ", and the pleural plaques have involved part of the heart edge and septum, making it blurred, it can be determined as \1"; the lung changes have been determined as I, although there are no large shadows required by "", but the pleural plaques are widespread and have even involved the heart edge, making a considerable part of it appear messy, it can be determined as "【".
A8 About each stage (ten)
In order to facilitate the dynamic observation of the disease, 0+, 1+, Ⅱ-, ear+ are added in each stage respectively, which are not independent stages. A9 Complications of pneumoconiosis
a) Pulmonary tuberculosis: refers to active pulmonary tuberculosis such as infiltration, proliferation, caseation, cavitation, bronchial or hematogenous spread, etc. Lesions that are erythrocyte-derived, indurated, or calcified are not considered to be combined with tuberculosis; b) Pulmonary pneumonia and cor pulmonale: diagnosed and graded according to the diagnostic criteria of the Chinese Medical Association's Respiratory Diseases Society; c) Respiratory system inflammation: refers to bronchial dilatation, various acute and chronic lung inflammations; d) Spontaneous pneumothorax; e) Tumor: refers to inflammation caused by exposure to asbestos dust. Pulmonary epilepsy and pleural mesothelioma, A10 additional code
a) bu: bullae,
b) ca: prostate tumor or pleural mesothelioma:
c) cP: swollen heart disease;
d) cy: cavity:
e) ef: pleural effusion;
em: emphysema;
g) es lymph node eggshell calcification;
h) pc: pleural calcification;
i) p: pleural thickening,
j) px: pneumothorax:
k) rp: rheumatoid pneumoconiosis;
1) tb: active pulmonary tuberculosis.
B1 Chest X-ray quality
B1. 1 Basic requirements
GB 5906—1997
Appendix B
(Standard summary)
Chest X-ray quality and quality assessment
a) The lung apices and costovertial angles on both sides, the sternoclavicular joints are basically symmetrical, and the shadows of the shoulder bones do not overlap with the lung sections; b) The film number, date and other markings are correct, arranged neatly and positioned appropriately; c) The photographs are free of artifacts, light leakage, contamination, scratches, water stains and images of external objects. B1.2 Analysis of landmarks
a) The lung textures on both sides are clear and sharp, extending to the outer zone of the lung field; b) The heart edge and transverse plane are sharply imaged;
c) The chest wall on both sides is well displayed from the lung apex to the costophrenia angle; d) The outlines of the trachea, carina and main bronchi on both sides are visible, and the chest contour can be displayed; e) Thick lung textures can be seen in the posterior cardiac area;
f) The right side of the neck is generally located at the level of the first and rear ribs. B1.3 Optical density measurement
a) The highest density in the upper and middle lung fields is 1.45~1.75b) The lowest density below the diaphragm is less than 0.30.
c) The density of the directly exposed area is greater than 2.50. www.bzxz.net
B2 Chest X-ray Quality Grading
B2.1 Class I (Excellent)
a) Meets the basic quality requirements of chest X-rays;
b) Anatomical landmarks are clearly visible;
) The depth measurement value meets the requirements of 1.
B2.2 Class II (Good)
Does not fully meet the quality requirements of Class I, but is not yet downgraded to Class III quality. B2.3 Class III (Poor)
A Class III film that meets any of the following conditions cannot be used for initial diagnosis of lung cancer. a) Does not fully meet the basic requirements of chest radiographs, and the sum of the areas of the diagnostic areas affected by its defects is between half a lung area and one lung area; h) 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 diagnostic areas affected is between half a lung area and one lung area;
) The lateral chest wall between the lung apex and the costophrenic angle on both sides is not well displayed, the tracheal ring is blurred, and the lung textures in the posterior cardiac area are difficult to identify; d) Insufficient inspiration, the right apex is located at the eighth posterior level; e) The photo is dark, that is, the highest density of the upper and middle lung fields is between 1.85 and 1.90; The photo is white, that is, the highest density of the upper and middle lung fields is between 1.30 and 1.40; The gray fog is high, that is, the density below the diaphragm is between 0.40 and 0.50; The highest density of the direct exposure area is between 2.20 and 2.30. B2.4 Level 4 film (waste film)
Chest radiographs that do not meet the quality requirements of level 3 films are level 4 films and cannot be used for pneumoconiosis diagnosis. C1 Relationship between standard films and standard provisions
GB 5906-1997
Appendix C
(Appendix to the standard)
Standard films for pneumoconiosis diagnosis
Standard films for pneumoconiosis diagnosis are a set of 32 films, which are part of the standard for pneumoconiosis diagnosis. In the process of pneumoconiosis diagnosis, especially when determining the shape and density of small shadows, the chest X-ray film of the examinee must be compared with it. C2 Copyright of standard films
The copyright of standard films belongs to the state.
C3 Scope of application of standard films
Standard films highly summarize the various manifestations of pneumoconiosis X-ray images. After practical verification, they are applicable to various pneumoconiosis specified in the current national "Occupational Disease List".
C4 Diagnostic criteria of standard films
Standard films are compiled according to the diagnostic starting point. Various forms of "difficult films" express the image of "sure starting point". C5 Standard film density and distribution range
The density and distribution range of small shadows are closely related and cannot be considered in isolation, let alone understood in terms of arrangement and combination. The issuance of C6 standard film
The standard film copy is reviewed by the National Occupational Disease Diagnosis Group Pneumoconiosis Group and is issued after being numbered and stamped. Appendix D
(Standard Appendix)
Technical requirements for X-ray examination
High-kilovolt photography technology must be used for pneumoconiosis X-ray examination. Those who do not meet the following equipment technical requirements cannot conduct pneumoconiosis X-ray examination.
D1 Photographic equipment
D11 X-ray machine
The output voltage of the Sheng pipe is not less than 125 kV and the power is not less than 20kw. D1.2 X-ray tube and window filter
a) Rotating anode:
b) Focus not less than 1.2 mm;
c Window total filter 2.5~3.6 mm lead. 31.3 Filter grid
) Grid density: not less than 40 lines/cm;
b) Grid ratio: not less than 10:1;
c) Grid focal length, 1.8m;
d) Specifications match the film.
D1.4 Intensifying screen, dark box
a) Generally use medium-speed intensifying screen;
b) The intensifying screen is spotless;
GB5906.1997
c) The resolution of the intensifying screen is not less than 7 line pairs/mmd) The intensifying screen and the film are in close contact;
e) The dark box does not leak light.
D1.5X-ray film
a) Generally use general-purpose (hand-held, machine-displayed) film, and it is recommended to use special film suitable for chest photographyb) Blue film base;
) Background fog is less than 0.20;
d) Specifications: 356 mmX356 mm (14\×14\) or 356 mmX432 rrm (11\×17\),D1-6 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 voltage drop is not more than 10%.
D2 Photography technology
D2.1 Adjustment of photographic conditions
When photographing, the photographic conditions should be adjusted with reference to the past chest films. D2.2 Equipment and body position requirements
a) The examinee should keep the chest wall close to the photographic stand, with the feet naturally apart and the arms internally rotated so that the shoulder blades are not aligned with the lung field; b) Focus-film distance 1.80 m
c) Adjust the position of the tube, with the center line at the level of the sixth thoracic vertebra: d) Exposure should be performed after full inspiration:
e) The posteroanterior chest film shall prevail, and lateral, oblique or tomographic photography shall be added when necessary. D2.3 Photographic conditions
a) Use 120-140 kV for chest photography according to the specific conditions of the X-ray machine; b) Determine the exposure amount according to the chest thickness, generally use 2-8 mnAs, and the exposure time shall not exceed 0.18. D3 Darkroom technology
D3. 1 The darkroom must meet the work requirements.
D3.2 Manual hand washing:
a) In principle, constant temperature and timing are required, and the liquid temperature should be controlled between 20 and 25℃C: developing time 3~~~5min; b) Fixing should be sufficient and running water rinsing should be thorough: e) Qualified special safety lamps must be used: d) Replace the developer and fixer in time.
D3.3 Automatic film processor:
Strictly follow the procedures required by the automatic film processor. E1 Definition of pneumoconiosis
GB 5906-1997
Appendix E
(Suggestive Appendix)
Instructions for the correct use of the standard
This drink is revised. According to the requirements for standard writing, the definition of pneumoconiosis is added in the standard introduction as a standard introduction. This definition is consistent with the ILO definition of pneumoconiosis in accordance with the principle of international integration. E2 About the diagnosis principles of pneumoconiosis
It is added that the high-kilovolt chest radiograph must be used as an element of "qualified chest radiograph" in the diagnosis principles. In the future, small chest radiographs will no longer be used for screening of pneumoconiosis.
E3 About the diagnosis of first-stage pneumoconiosis
In addition to diagnostic indicators, the diagnosis of first-stage pneumoconiosis should also have "technical indicators for chest radiograph quality requirements and quality control indicators controlled by technical professional agencies."
E4 About the use of standard films
Before the introduction of high-kilovolt standard films, the old standard films will continue to be valid. E5 About the labor capacity assessment of pneumoconiosis
It should be consistent with the "Standards for the Assessment of Worker Injuries and Occupational Diseases". E6 Large shadows that are not defined as "large"
After the implementation of high-kilovolt radiography technology, the original three situations will change. They can all be treated as large shadows that are less than 2cmX1cm, or they can be generally referred to as large shadows that are less than "sub-large". E7 About chest radiograph quality
E7.1 About scapula shadow
The basic requirements for chest radiograph quality stipulate that "scapula shadow should not overlap with lung field", while the position requirements for chest radiographing technology stipulate that "...make the scapula not overlap with lung field as much as possible". This subtle difference in description expresses the concept that a good chest radiograph should exclude the interference of overlapping scapula shadow; but in actual application, there are indeed a few people whose scapula shadow overlaps with lung field to a certain extent due to age, local tissue pathological conditions and other reasons, which is difficult to avoid completely. Under the premise that the bone shadow of high-voltage chest radiograph is faded, if the width of overlapping scapula shadow on both sides is within 1 cm, it will not affect the evaluation result of the first-level film. E7.2 Regulations on insufficient inspiration
It is not perfect to use the top of the umbilicus as the only indicator for judging insufficient inspiration. Therefore, it is called "aiming at the top". In actual application, judgment should be made after comprehensive observation.
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