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Safety_Series_025_1968 - gnssn - International Atomic Energy ...

Safety_Series_025_1968 - gnssn - International Atomic Energy ...

This publication is no

This publication is no longer validPlease see http://www.ns-iaea.org/standards/detailed description of such examinations is unnecessary here sincethe investigations usually made in good industrial medical practiceshould be sufficient. Thus, anthropometrical data (weight, height,morphology) and the results of examination of the main organs andfunctions (cardiovascular system, digestive system, respiratorysystem, nervous system and endocrine glands, blood and haematopoieticorgans, liver and kidneys, locomotor system, skin and senseorgans, genital system) should be recorded.These examinations should be supplemented by radiologicalexaminations and biochemical tests of certain characteristics of theblood and urine. The fact that the workers in question are exposedto irradiation hazards is no reason for neglecting to make the necessaryradiological examinations (lungs and other).In the medical care of radiation workers, it is of course themost radiosensitive organs and their functional or haematologicalcondition which present the greatest interest. It will therefore benecessary to give particular attention to the blood and bone marrow,the skin, lungs, digestive tract, sense organs and genital system.4. 2. 2 . 2. 2. Haematological examinations. It should be rememberedthat the sensitivity of ordinary haematological methods of examinationis grossly insufficient for the detection of radiation effectsat levels at or slightly above maximum permissible levels. However,the purpose of these examinations is on the one hand to provide ageneral picture and on the other to detect the smallest anomaliesof the blood that might possibly be due to irradiation. Investigationsshould cover both the peripheral blood and the blood-formingorgans, but for all regular inspections before or during employmentit is recommended that examination be confined to the peripheralblood only. Examination of the blood-forming organs proper shouldbe considered only in cases of over-exposure or considerable radioactivecontamination.Examinations of the peripheral blood include , not only bloodcounts but also the study of morphological or functional changesin the blood cells. The blood count should give the number per cubicmillimetre of erythrocytes, reticulocytes, total leucocytes, granulocytes,(neutrophils, basophils, acidophils, [ eosinophils]), lymphocytes,monocytes and thrombocytes. In addition, Arneth's formulaefor granulocytes are recommended. However, in calculating theeffect of radiation on numerical changes in the white blood count,account must be taken of the fact that the day-to-day variation of an104

This publication is no longer validPlease see http://www.ns-iaea.org/standards/individual's white blood count is about 15% and the technical errorin an average case is estimated at 1 0 % even with carefully standardizedtechniques. Changes in blood count only become manifest withrelatively high doses, and consequently cannot be used as a sensitivetest to evaluate the effects of moderate or low-level irradiation.Attention should also be given therefore to morphological changessuch as anisocytosis and poikilocytosis in erythrocytes, abnormalcytoplasmic granulation in granulocytes, bi-lobed nuclei and chromophilegranulation in lymphocytes, and changes of size or structurein thrombocytes. A careful watch should also be kept for immatureform s of the red or white series. These examinations should besupplemented by tests of the functional capacity of the circulating,blood. It is necessary to determine the haemoglobin concentration,haematocrit reading and blood-coagulation factors, and to makethrombo-elastrography. These haematological examinations shouldbe made before employment and at sufficiently regular intervalsduring employment to make it possible to follow trends in a givenhaematological condition. However, some of these examinations,especially those regarding morphological changes, can only becarried out in research laboratories and are not indicated as routinemeasures.In cases of over-exposure, it may be necessary to perform asternal puncture, so as to obtain a myelogram, including both countand formula. This test is of particular interest if a prognosis hasto be made, or therapeutical indications given for an over-exposedworker. Occasionally, and much more rarely, adenograms maybe made in addition.4. 2. 2. 2. 3. Cytological examinations. Great interest is now shownin the fundamental cytological changes which can be related to exposure.These are mainly the concern of chromosomal examinations,but such studies, on blood cells in particular, present serious difficultiesfrom the practical point of view as well as in regard to interpretation.Therefore, in our present state of knowledge theyshould be considered only in cases of over-exposure following anaccident.4. 2. 2. 2.4. Examination of the skin. Dermatological examinationsare of value in that they provide information on the state of an organwhich, generally speaking, is sensitive to radiation and, moreover,runs the greatest risk of exposure. In all cases of exposure to soft105

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