Workers at risk of silica dust exposure need both x-ray and lung function screening, warns HSE

The Health and Safety Executive (HSE) has urged organisations to review their health surveillance programmes for workers who have a high risk of developing respiratory diseases to ensure that screening is sufficient.

Speaking to the Society and Faculty of Occupational Medicine’s annual scientific conference this week, Dr Steve Forman, principal medical adviser at the HSE, said workers who are exposed to, or at risk of exposure to, crystalline silica dust should regularly undergo both x-ray screenings and lung function tests – not one or the other.

He said industries with a high risk of developing a respiratory disease, such as construction, often only carried out lung function tests to look for the symptoms of silicosis – which can sometimes develop after 10 years’ exposure to legal levels of silica.

Because symptoms can take so long to manifest they can therefore be missed by lung function tests. But X-ray testing can help to identify signs of silicosis much earlier on.

“One of the things we have seen is people picking one over the other, and a common misconception is that if you do lung function testing… you’ll pick up silicosis. But that’s not true except for later on in the disease” he said.

“Many people are asymptomatic, wandering around with a dust disease, but their x-rays tell us otherwise.”

Annual lung function tests were still recommended in identifying other illnesses, such as COPD, which chest x-rays don’t usually pick up on.

“The two things need to be done concurrently to make the health surveillance programme adequate,” Forman advised.

The importance of a robust health surveillance programme was also emphasised, especially the need to consider the steps to be taken in the event that an employee is diagnosed with a condition.

Staff need to be informed about why and how tests are being done, and those using the equipment need to understand how the results should be interpreted.

“It’s all well and good having a health surveillance programme that you run for a few years and you find no abnormalities. But what if all of a sudden someone with disease pops up – how are you going to manage that? It shouldn’t be a surprise. There should be a clear route to manage those individuals,” Forman explained.

3 Responses to Workers at risk of silica dust exposure need both x-ray and lung function screening, warns HSE

  1. Avatar
    Philomina Osili 18 Jul 2018 at 1:54 pm #

    I totally agree with you. More awareness is needed. I have always known it is important for the two to be done at least at initially at pre employment. This helps to have a baseline to work with for subsequent surveillance.
    When suggested to employers, they look at the cost and the probability of it happening forgetting that it can happen over a long period of time.

    • Avatar
      Chukka Johnson 23 Jul 2018 at 12:46 pm #

      I fully agree with you. Here in Middle East we need more awareness. I’ll inform our Occupational Doctor to do X-Ray also along with lung function test. From my experience though we call it as HSE, but most of the employers are concentrating on S – Safety, H seems to be silent as it’s mostly Chronic, doesn’t happen instantly like Safety does.

  2. Avatar
    John M 23 Jul 2018 at 1:05 pm #

    Seems to be at odds with the HSE’s existing guidance given to asbestos workers:
    “A full size PA chest X-ray may only be justified on individual clinical grounds”
    “The appointed doctor should consider the medical and occupational history, respiratory symptoms and findings on clinical examination, together with the potential information which could be obtained through radiography and its clinical relevance.”
    “This means that routinely obtaining a chest X-ray at every examination cannot be justified”

    The solution, rather than potentially unnecessary (?) exposure to radiation, would be the proposal already made by the European Parliaments EMPL committee’s for “introducing an obligation for employers to conduct health surveillance for all workers, even after they have left a company” for particular CMR’s

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