Public health

Diagnosing lung disease in miners still relies on detailed history taking

Tuesday, 28 Mar 2017

A retrospective review of CT and plain radiograph images in miners with radiological and clinical diagnosis of coal worker’s pneumoconiosis (CWP) has uncovered a variety of other lung diseases.

Seven of the 29 cases referred to a respiratory physician due to concern about pneumoconiosis were indicative of extremely early CWP, five had silicosis, two had sarcoidosis and three had emphysema.

Dr Katrina Newbigin, a radiologist at Wesley Medical Imaging in Queensland, told the conference the findings highlighted the importance of securing very detailed employment histories.

“All these miners were initially attributed to pneumoconiosis but underground minders have a lot of occupational risks.”

“The mean time underground for these miners was 23.5 years which is a significant period of time. Over their entire careers they have worked in different mines or interstate and they have likely been exposed to silica as well as coal,” she told the limbic. 

She said she was suspicious that silicosis in one case was related to work in a stone quarry early in the miner’s career rather than recent work in coalmines.

“It is important we get a really detailed history – not just people’s current jobs. We need to also ask ‘where were you 10 and 20 years ago?’”

“He could have got that scarring 30 years ago and then had no more damage. As radiologists we cannot determine when the nodules and scarring from dust exposure occurred. A CT today reflects the accumulation of a miners’ entire career. ”

“There is a lot of evidence that silica is the stronger toxic agent to the lungs compared to coal.”

Dr Newbigin, who is an accredited B reader through the National Institute for Occupational Safety and Health (NIOSH) in the US, said the severity of the CWP cases seen in her review has been of the lowest grade (ILO 1).

“This should be reassuring to coal workers that they have very minor changes,” she said.

“The recommendation is they are pulled back from the longwall to low dust surface jobs. Most miners can keep working as long as they have reduced dust exposure.”

She said the review showed that miners with the lowest lung function were also smokers and at the end of their careers.

Responding to criticism that the quality of radiological images has been poor in Queensland and contributed to missed cases of CWP, Dr Newbigin said referrals had to include a relevant history.

“There are chest X-rays that are perfectly capable of picking up lung cancer or severe pneumonia but for CWP you need to have the penetration perfect, edge enhancement, and the scapular rotated off the chest,” she said.

“There is a multi-step check list for X-rays to be consistent with the International Labour Organisation (ILO) standards.”

Dr Newbigin was speaking at the TSANZSRS 2017 meeting in Canberra.

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