Document yr4ykmNpzY10pDj317zgBb1KV
. 14 9%Z
i
M>Cbj
INTERNAL CORRESPONDENCE
CHEMICALS AND PLASTICS institute punt
--------iOT'!-------------------------------------------SftFSTtf dE?T`
0. BOX 2831, CHARLESTON, WEST VIRGINIA ,:330
To (Namel Division Location
Mr. E. B. DelGrande Building 791 Tech Center
Copy to
Mr. W. E. Ballard Mr. P. Barna Mr. L. L. Bissett Mr. C. W. Carman Mr. F. J. Casabona Mr. T. L. Collins Mr. H. D. Coombs Mr. R. J. DuBrul E. Q. Hull, M. D. (6) Mr. G. R. Kraft Mr. E. C. Shipley Mr. B. E. Tissue
Dale 31 Dec 74 Originating Dept. Medical Department - Plant 512
Answering letter date
Subject
1974 Pneumoconiosis Survey
Enclosed is the Medical Department's report on a Pneumoconiosis Survey conducted for 936 Hourly and some 938 Salary Construction Depart ment employees.
Very truly yours.
RJStpeg Enclosure
Plant Medical Director
Union Carbide Corporation Chemicals and Plastics Institute, West Virginia
Special Report Medical Department 31 December 1974
PNEUMOCONIOSIS
SUMMARY
The second annual medical surveillance program was completed by the Plant Medical Department on 85 Plant 511 employees designated as having been previously or are now at risk to materials capable of causing pneumoconiosis (asbestos and silicon dioxide). Symptoms and findings of dis ease were mostly minimal but positive x-ray interpretations by the local radiologists and some x-ray interpretations considered as "suspect" by the author indicated that 30 (3 5%) employees were labeled with a diagnosis of pneumoconiosis. An impartial out-of-town "C" reader diagnosed or implied similar diagnoses in 17 (20%) of the 30 films on the 85 employees at risk.
The number of cases of asbestosis in Construction employees is slightly increased over those diagnosed in the 1973 survey. There were also 85 employees participating then and 24 (28%) were diagnosed locally, while the "C" reader interpreted only 14 (17%) as positive for pneumoconiosis.
The problem of pneumoconiosis is still present and probably will remain a problem for some time.
CURRENT INFORMATION
The William-Steiger Occupational Safety and Health Act (Sec tion 1910. 93a (j) of Public Law 91-596) requires that this program be continued annually, so during 1974 this again was accomplished by the Plant Medical Department. The 1973 program's components and results were explained and documented in detail in a special report dated 4 Oct 73. The 1974 program was conducted essentially in the same manner with the same components and the purpose of this report is to document the observations and results of the second medical surveillance program.
Early in 1974 Construction management was requested to poll their payroll lists and provide to the Medical Department names of employees who have been or are still at risk from materials capable of causing pneumo coniosis, namely asbestos and silicon dioxide. These rosters were received and Table 1 shows the number of employees in the various crafts or work assign ments in both 1973 and 1974 believed to be at risk.
Page 2
Table 1 - Plant 511 Employees (936-938) Included in Pneumoconiosis Survey.
Craft
Compound
1973
1974
Laborer Field Insulators Painter-Sandblasters Insulation Fabrication Shop
Asbestos Asbestos Silicon Asbestos
65 50* 48 19+ 23 + 10f 9 ii
* - Includes one Construction manager and two Field Insulation Foremen t - Includes one Field Painter-Sandblaster Foreman t - Includes one Insulation Fabrication Shop Foreman - Includes one Construction manager and three Field Insulation Foremen 11 - Includes one hourly employee working now as a truck mechanic on
permanent restricted work because of Isocyanate sensitization.
As in 1973, all 85 employees that were to participate were sent orders to have chest x-rays completed as soon as possible. All chest x-rays included an anterior-posterior and right lateral views. After the chest x-ray reports interpreted by the local radiologist were received in the Medical Depart ment, the employee could schedule an appointment to complete his examination, including certain nursing procedures, some clinical laboratory procedures and examination by a physician. This information was documented in the employees' medical folder. The films of all x-ray interpretations classified as pneumo coniosis by the local radiologist and others that the author considered as "suspect" were referred to a "C" reader'*! for a second and expert interpreta tion, as in 1973.
The local radiologist ("A" reader) diagnosed or implied a diag nosis of pneumoconiosis in 19 of the 85 employees at risk. The author considered an additional 11 cases as suspect; therefore, chest x-ray films on 30 employees (35%) were sent to the "C" reader for interpretation. The "C" reader diagnosed
*1 In 1973, the report on this subject contained erroneous implications on the definitions of "A" and "B" readers because in that survey "A" implied the first reader and "B" implied the second reader. The author has learned that any radiologist can be an "A" reader, while a "B" reader is a radiologist who has completed special studies, takes a special examination and if successful has a title bestowed as "B" reader by the American College of Radiology. A "C" reader is an authority on the subject, such as Doctor Benjamin Felson of the University of Cincinnati Medical School, an internationally recognized authority on pneumoconiosis and other physicians, such as Doctor L. J. Bristol, Trudeau Institute, and Doctor G. Jacobson, Los Angeles, California.
Page 3
T a b le 2. - R a d io g ra p h ic P n e u m o co n io h c C la s s ific a tio n s , T e n ta tiv e D iagnoses and F in a l D ia g n o stic Im p re s s io n s on C o n s tru c tio n E m p lo ye e s a t R is k
a o
Isa 2m
x vc cn
co I 8
X10 U
co
TJ - ^
axw
tfl 4
c
rt
u
*<
o
^54
fa
-- I, N 0U
.i" o
o 3 *o4 +>
ma*
4 4 *0 *n
Xo
*r x
m'o
Tv3
4
4"c
2 ">5>
wa
h3 eO* mw 4_
o < oj C vV
. 4 ~ 4
TJ -rS* L4) Qo,
5f X-14
X*u
Va)
x
X-Vc .2 * >o
av
o3o x*
O'
ao *o* nk
~Z
*A * q
^
0
MV
X*-
'fM1 s,,l
4
u
x *NTT c
** -- t a"
c it J2 rt
1 M-s
g- V > B2O
..2. ^f-1
s ?5
o "_
c ^-O<5 T5i
T3 N U
C
<.
h
a4
si-:
s
o - i) O ^ 0
242* **30 s-3 :-
g .-
" Xu 4
?O. LO, --a Oo.
! Sf- 1 o4 t-3
2 *> H O* JJ
T a b le 2. - C ontinued
* R a d io g ra p h ic appearances o f pneum oconiosis (in c lu d in g a sb e sto sis) a re c la s s ifie d in to fo u r c a te g o rie s : 0. 1, 2 and 3 and s u b c la s s ifie d in to codes.
Thus C a te g o ry 0 includes 0 /- , 0 /0 and 0 /1 . The n u m b e r le ft o f the s la n t m a rk is the C a te g o ry and the n u m b e r to the rig h t, the degree o r extent.
C a te g o ry 1 in clu d e s 1 /0 , 1 /1 , and 1 /2 , C a te g o ry 2 in clu d e s 2 /1 , 2 /2 and 2 /3 and C a te g o ry 3 is graded in to 3 /2 , 3 /3 and 3 /4 . T yp e s re p re s e n t the
size of the o p a city; i. e ., rounded o p a c itie s a re graded as p, q o r r and irre g u la r o p a c itie s a re graded a, t o r u.
Page 4
T a b le 2. - C ontinued
ECS CHS RBS
w cs
WST CAT CKC
resslon disease
(0
A 0
c
-3
Cl E
"fa 0 -C a3fa
wC
Q Da
U) v> 0 C 0 r^ C0j Xa 3
0. <
A A O G O >N U
^4 CC X3 3fa fa C Da Qa
fa c V c
cH
VI VCI J Q
o* -4
fa y 4fa c:
1*o, Uo
VI OcCl ci
H >>& fa -OCD
N orm al
<n Otfaj fa Xirt < Co o
i A
D ia g n o s is estionable eum oconiosi
fa V 4u
H fa0 9
cO ro H
fa y 4
oO
VI Occo
2 *r
H
fa
W*Ot3 wV fafa>
fag*-- iO tQ*;C-
*4
15
ai e' o
p*-
1 o a C3 M (O fai O' 0*0r
f"
As
(rt A
EA 0
j>r o10
<n fa
X
4 X"
DUa a4?!
tn
Oo -o
44 fa fa 71 z
1
cc
T? fa
*f3a
X
-3
^ -z
rt 4 E 2
Oo
c
m-- fsl in O-r
o o
oo O'
v
Page 5
U) 9)
A O
<on
cc
J>Ts Ou
-3
fa 0 a 2
fa fa X
13 Cfa fca
-C- 3 fa fa 3
O Q Da
Q^
<0
4Ccfa z
0
f(aA Xtrt
<
X
<
3
9) m 0 c r 3 fa 0 11 fa fa c C Da
01
X
<2
*4
Sk
ia
o u
ou
Da Z
xao
CO
Co
4u
X 4
h
vu j ;
S o *i ec
O
K
S
V
25f>oJll
o
5C,
hMSg-
3,"
c
a o
0
2
3(0 1e
32 x*# 4*
*o *T ^
4C X00w^ f> * 45
O ^
-- o o
PP PM
to u - N. 3,
"* V Z? fa
,x ^ o 5 o *
4
afma
(A A 0
>N A
"5. fa
r.i
X(A <
u
(A 3
0
A 0 "
irt fa
</> oo
In 2 4M
< 1
<X
A cr - 0.-
o * ----
Cl
N orm al
s s 3 ,,
9U r xU ^c B
O
X
5 mu
~acv
*JK2 uam
5 >.:
04
1 <3C fa mo (3 om2*s G O *4J1 HU
a 5 o o
X? fa
E
X
3
A
A 0
A fa XA <
m itte d
tn A x> .2
e (A
la V
2
c5.2"-0c aJO*S J?CUi CMMa ?Mfar
isX
3
*V4a <c0j U *o* c. C 0c u 0.
va> a3 fa fa O Da
X
*cU
4
w u v
c
f4faa r^*r
J*S3i X*fa
*4c0
m
M
_^e
4
2o V-a a. 5O?
cr
- o*
x Oi^v r
ww
;a
z PM PM
2
PM fl
o co
o Q.
fa *s
C C 34
27=OC16,. 5X-CS,,3s-3<TM_Su"MI1
*o
*
4fa
(A
o
a4 <A
fa o
fa X(A
4
0
2< 2
cr
(A
2 2
X fa ,
h 2
S . *
0 --a*
(A fa
p.
5U2
XIA <
.2 > E4SSl fa O
,
c
aw 39
ca *o** a *
CO X
-i -5
oc o
oo
o- g
fa 4 T*J O
cc
CO
C L,
(L
O
& aw. x*o *>j*
4 3-
r- 00 pn
XvOPOM'
0o--M0
r---i CM
OoO
J 5in
CM OO-a''
XU 4
pm
X 4*
94
* N
2<L foa *c ao
4M fa *
5f 4 _ .2 u o 'g
o o &Z o _ 60
a "c
U K H Ua .JJ
rOsj
PM
PM PM
r**i PM
(4M*
1973
1974
uC
CL CL
>. o
<I Il)
UC
Ci CL
cI
Cv <11 c c a-
3V oc CL
o vntmnr
JD -
9-
nt
C--r-t
--om
-- t-
rWwt
vi 4> 3 4/
W X 41 v>
aJ,
<
aT,"
X
q
S<> o cU
rsl o f\l --
-
a3
.
|
C 41
oc U CL
w 71 71 V 41 -2
*- <0 *-
*
3
CO
3 U>
<
CO
<
X o
Page 6
a o
jfl a *s
x 41 fl
S)
c a
^O}
J41! 41 hv
! s
j-sfc
2 'S -r <cd jj>sp m
r_t. i. 05
*0 41 _
V) 5e x- :^> Ut f\| o
U M 9
** 41
b
*5 O
O P O *.
,3C.
c
41 41 *3 m
t
o <*>? 2 2 *"j 5(9 Swo L00
>s , V
hi 0
3
V04
00
w41
>s U
41
0 *2 2 u oo ~
. 41 41 O s.
Uo
*3 4*
S* -32
<9
00 '-- 41
o N U
*c c
- 3 h
C ^3
c
<9
<M
3
(e9
.*
41 X
M
N
o ** ~*s
44>)
x?
v X
S. ^ t- c
41 41
C?L ;
CO
CO T. 4)
U o a
41
h,
U 41
5*
.2 S 3 <9
-2
Xr: --** * 41 <9 --
00 hi *3 0
C 41 J3 <9
15 % U *0
3
C
C --
41 *3
g
CU
r, 41 S 60
X b,,
*2 Hn oo 2J;
2O . 44J <_9
a
or' o.
O *0 A.* V p c c; 0
5g-
4c1
*O*^
-nu
_
*0
a g
w* ^
9
^^ 0
4) ^ U
y
g 1 o ;
<i" j
uOD
O- C > J Uu * 3U o 2 . c a
a "
2 S'- M t >>f
2 o O o _ 00 *;c X tt H O #
Page 7
or implied a diagnosis of pneumoconiosis in 17 (20% of the 85) of the 30 cases sent to him. The author studied the radiographic pneumoconiosis classifications and diagnoses advanced by the. "A" and "C" readers for the two surveys. This led to the column titled "Impression" in Table 2 and represents the author's conclusions.
Table 3.
A concise summary of the data in Table 2 is contained in
Table 3. Summary Classifications of Diagnoses of 30 Employees at Risk
Diagnosis
Definitely Pneumoconiosis
Probably Pneumoconiosis Normal or Probably Normal Other Disease Uncertain
Total
#
14
3 7 1 5 30
Case #'s (from Table 2)
1, 3. 5, 6, 10, 11, 12, 17, 21, 22, 23, 29., 30 18, 19, 27 2, 4, 7, 8, 9, 15, 24 20 13, 14, 25, 26, 28
The data in Tables 2 and 3 show that as a minimum 17 of the 85 employees at risk have been diagnosed as definite or probable pneumo coniosis. Of this group, 13 are insulators with many years at risk, one is an Insulation Fabrication Shop insulator, two are painter-sandblasters and the remaining one is a laborer. To the author, it is not surprising that insulators with more than 20 years at risk have developed pneumoconiosis. It is also not surprising that the Insulation Fabrication Shop insulator has developed pneumoconiosis after 25 years of exposure. However, it is cer tainly surprising that other insulators working in this same shop have not developed pneumoconiosis.
It is equally not surprising that painter-sandblaster employees who work regularly at sandblasting have developed pneumoconiosis but again it is surprising that there are a large number of painter-sandblasters who have not developed pneumoconiosis. One painter-sandblaster's data is of special interest (Table 2, #29). This employee's x-ray interpretation by the local radiologist in both 1973 and 1974 indicated that the radiologist believed this employee had pneumoconiosis. In 1973 the "C" reader was not told which x-ray films were those of insulators and which were painter-sandblasters, but this was done in 1974. The "C" reader was told erroneously that CMW (Table 2, #2 9) was an insulator. The "C" reader in 1974 advised that CMW did have pneumoconiosis but it was silicosis rather than asbestosis or coal worker's pneumoconiosis. The "C" reader was correct. This painter-sandblaster should have silicosis, not asbestosis.
Page 8
Table 2 shows that nine of the entries (it's 1, 5, 7, 10, 11, 18, 19, 20 and 22) were included in the 1973 medical surveillance program but their chest x-ray films and examination findings did not warrant the "C" reader interpreting their x-ray films. Two of the entries (#'s 6 and 25) in Table 2 were not listed on the 1973 roster and were not included at all. J.n 1974 some of the chest films of the above 11 employees were now interpreted as pneumoconiosis by the local radiologists but there were also some x-ray reports that included some abnormality in the radiologist's interpretation that made them "suspect" and thus warranted their review by the "C" reader.
The reader of this report, who studies Table 2 carefully, will probably be surprised to note that the "C" reader (the same "C" reader was used in 1973 and 1974) completely reversed his diagnosis in several of the 1974 diagnoses when compared to his diagnoses of 1973; e. g. #'s 4, 14, 15 and particularly 26. Because of the late writing of this report, there was not sufficient time to again submit the films to the same "C" reader for reevaluation. However, in the 1975 survey the 1973-74 "C" reader will be requested to pay particular attention to these cases and they will also be referred in consultation to other "C" readers for diagnosis. Eight of the eleven cases were diagnosed by the "C" reader as pneumoconiosis ( #'s 1, 5, 6, 10, 11, 18, 19 and 22).
After reviewing the classifications; i. e. , codes and types, advanced by both the "A" and "C" readers in the years 1973 and 1974, the author decided that a final diagnostic impression should be included. This lead to the column titled "Impression" and further lead to the summary in formation contained in Table 3. There are many features included in the individual x-ray interpretations that were not included in Table 2 because of lack of space and these features are not pathognomonic in themselves. Inclusion of all of these findings would be lengthy and would only confuse the layman. However, there are x-ray findings and also findings on physical examination that would be of interest to both the physician and the layman that can be described in case histories. Therefore, three selected case histories are presented in detail to emphasize pertinent findings that may be of interest to both business administrators and physicians.
CASE HISTORIES
Case No. 1 - ECS (33489) (Table 2, # 17), is a 53-year-old insulator supervisor who has had approximately 30 years at risk to materials containing asbestos. His medical history reveals that he has never used tobacco, that he has never had any serious illnesses, and until 1973, his chest x-rays have been normal. His pulmonary function testing results were excellent; i. e, , his Vital Capacity is 98% of predicted and his FEV j q is 94% of predicted. He has no complaints except that recently he has noticed an intermittent non-productive cough. As he terms it, "dry and hacking."