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pense in the same manner as if it were submitted under an operator's plan. Any change in the miner's transfer rights under the act which may result from this examination will be subject to the terms of $37.7.

837.20 Miner identification document.

As part of the roentgenographic examination, a miner identification document which includes an occupational history questionnaire shall be completed for each miner at the facility where the roentgenogram is made at the same time the chest roentgenogram required by this subpart is given.




at a time, a written notice of the arrangements will be sent to the operator who shall post the notice on the mine bulletin board.

(d) Operators of mines selected by ALOSH to participate in the National Study of Coal Workers' Pneumoconiosis (an epidemiological study of respiratory diseases in coal miners) and who agree to cooperate will have all their miners afforded the opportunity to have a chest roentgenogram required hereunder at no cost to the operator. For future examinations and for mandatory examinations each participating operator shall submit an approvable plan. $37.7 Transfer of affected miner to

less dusty area. (a) Any miner who, in the judgment of the Secretary based upon the interpretation of one or more of the miner's chest roentgenograms, shows category 1 (1/0, 1/1, 1/2), category 2 (2/1, 2/2, 2/3), or category 3 (3/2, 3/3, 3/4) simple pneumoconioses,

complicated pneumoconioses (ILO Classification) shall be afforded the option of transferring from his or her position to another position in an area of the mine where the concentration of respirable dust in the mine atmosphere is not more than 1.0 mg/m3 of air, or if such level is not attainable in the mine, to a position in the mine where the concentration of respirable dust is the lowest attainable below 2.0 mg/m3 of air.

(b) Any transfer under this section shall be in accordance with the procedures specified in part 90 of title 30, Code of Federal Regulations. [43 FR 33715, Aug. 1, 1978; 43 FR 38830, Aug. 31, 1978, as amended at 44 FR 23085, Apr. 18, 1979; 49 FR 7563, Mar. 1, 1984) $37.8 Roentgenographic examination

at miner's expense. Any miner who wishes to obtain an examination at his or her own expense at an approved facility and to have submitted to NIOSH for him or her a complete examination may do so, provided that the examination is made no sooner than 6 months after the most recent examination of the miner submitted to ALOSH. ALOSH will provide an interpretation and report of the examinations made at the miner's ex

$37.40 General provisions.

(a) The chest roentgenographic examination shall be given at a convenient time and place.

(b) The chest roentgenographic examination consists of the chest roentgenogram,



complete Roentgenographic Interpretation Form (Form CDC/NIOSH (M) 2.8), and miner identification document.

(c) A roentgenographic examination shall be made in a facility approved in accordance with $37.42 by or under the supervision of a physician who regularly makes chest roentgenograms and who has demonstrated ability to make chest roentgenograms of a quality to best ascertain the presence of pneumoconiosis.

$37.41 Chest roentgenogram specifica

tions. (a) Every chest roentgenogram shall be a single posteroanterior projection at full inspiration on a film being no less than 14 by 17 inches and no greater than 16 by 17 inches. The film and cassette shall be capable of being positioned both vertically and horizontally so that the chest roentgenogram will include both apices and costophrenic angles. If a miner is too large to permit the above requirements, then the projection shall include both apices with minimum loss of the costophrenic angle.



(b) Miners shall be disrobed from the waist up at the time the roentgenogram is given. The facility shall provide a dressing area and for those miners who wish to use one, the facility shall provide a clean gown. Facilities shall be heated to a comfortable temperature.

(c) Roentgenograms shall be made only with a diagnostic X-ray machine having a rotating anode tube with a maximum of a 2 mm. source (focal spot).

(d) Except as provided in paragraph (e) of this section, roentgenograms shall be made with units having generators which comply with the following: (1) The generators of existing roentgenographic units acquired by the examining facility prior to July 27, 1973, shall have a minimum rating of 200 mA at 100 kVp.; (2) generators of units acquired subsequent to that date shall have a minimum rating of 300 mA at 125 kVp.

NOTE: A generator with a rating of 150 kVp. is recommended.

(e) Roentgenograms made with battery-powered mobile or portable equipment shall be made with units having a minimum rating of 100 mA at 110 kVp. at 500 Hz, or of 200 mA at 110 kVp. at 60 Hz.

(f) Capacitor discharge and field emission units may be used if the model of such units is approved by ALOSH for quality, performance, and safety. ALOSH will consider such units for approval when listed by a facility seeking approval under $37.42 of this subpart.

(g) Roentgenograms shall be given only with equipment having a beamlimiting device which does not cause large unexposed boundaries. The beam limiting device shall provide rectangular collimation and shall be of the type described in part F of the suggested State regulations for the control of radiation or (for beam limiting devices manufactured after August 1, 1974) of the type specified in 21 CFR 1020.31. The use of such a device shall be discernible from an examination of the roentgenogram.

(h) To insure high quality chest roentgenograms:

(1) The maximum exposure time shall not exceed 1/20 of a second except that with single phase units with a rating less than 300 mA at 125 kVp. and subjects

with chests over 28 cm. posteroanterior, the exposure may be increased to not more than 110 of a second;

(2) The source or focal spot to film distance shall be at least 6 feet;

(3) Medium speed film and medium speed intensifying screens ommended. However, any film-screen combination, the rated “speed" of which is at least 100 and does not exceed 300, which produces roentgenograms with spatial resolution, contrast, latitude and quantum mottle similar to those of systems designated as “medium speed" may be employed;

(4) Film-screen contact shall be maintained and verified at 6 month or shorter intervals;

(5) Intensifying screens shall be inspected at least once a month and cleaned when necessary by the method recommended by the manufacturer;

(6) All intensifying screens in a cassette shall be of the same type and made by the same manufacturer;

(7) When using over 90 kV., a suitable grid or other means of reducing scattered radiation shall be used;

(8) The geometry of the radiographic system shall insure that the central axis (ray) of the primary beam is perpendicular to the plane of the film surface and impinges on the center of the film;

(9) A formal quality assurance program shall be established at each facility.

(i) Radiographic processing:

(1) Either automatic or manual film processing is acceptable. A constant time-temperature technique shall be meticulously employed for manual processing.

(2) If mineral or other impurities in the processing water introduce difficulty in obtaining a high-quality roentgenogram, a suitable filter or purification system shall be used.

(j) Before the miner is advised that the examination is concluded, the roentgenogram shall be processed and inspected and accepted for quality by the physician, or if the physician is not available, acceptance may be made by

the radiologic technologist. In a case of time with the same technique as the a substandard roentgenogram, another roentgenograms submitted and procshall be immediately made. All sub- essed at the facility for which approval standard roentgenograms shall be is sought. At least one chest roentclearly marked as rejected and prompt- genogram and one test object roently sent to ALOSH for disposal.

genogram shall have been made with (k) An electric power supply shall be each unit to be used hereunder. All used which complies with the voltage, roentgenograms shall have been made current, and regulation specified by the within 15 calendar days prior to submanufacturer of the machine.

mission and shall be marked to iden(1) A densitometric test object may tify the facility where each roentgenobe required on each roentgenogram for gram was made, the X-ray machine an objective evaluation of film quality used, and the date each was made. The at the discretion of ALOSH.

chest roentgenograms will be returned (m) Each roentgenogram made here- and may be the same roentgenograms under shall be permanently and legibly submitted pursuant to $37.51. marked with the name and address or

NOTE: The plastic step-wedge object is deALOSH approval number of the facility

scribed in an article by E. Dale Trout and at which it is made, the social security

John P. Kelley appearing in “The American number of the miner, and the date of Journal of Roentgenology, Radium Therapy the roentgenogram. No other identi- and Nuclear Medicine," Vol. 117, No. 4, April fying markings shall be recorded on 1973. the roentgenogram.

(c) Each roentgenographic facility [43 FR 33715, Aug. 1, 1978, as amended at 52

submitting chest roentgenograms for FR 7866, Mar. 13, 1987)

approval under this section shall com

plete and include an X-ray facility doc$37.42 Approval of roentgenographic ument describing each X-ray unit to be facilities.

used to make chest roentgenograms (a) Approval of roentgenographic fa- under the act. The form shall include: cilities given prior to January 1, 1976, (1) The date of the last radiation safety shall terminate upon August 1, 1978 un- inspection by an appropriate licensing less each of the following conditions agency or, if no such agency exists, by have been met:

a qualified expert as defined in NCRP (1) The facility must verify that it Report No. 33 (see $37.43); (2) the defistill meets the requirements set forth ciencies found; (3) a statement that all in the regulations for the second round the deficiencies have been corrected; of roentgenographic examinations (38 and (4) the date of acquisition of the XFR 20076) and it has not changed equip- ray unit. To be acceptable, the radiment since it was approved by NIOSH. ation safety inspection shall have been

(2) From July 27, 1973, to January 1, made within 1 year preceding the date 1976, the facility submitted to ALOSH of application. at least 50 roentgenograms which were (d) Roentgenograms submitted with interpreted by one or more “B” readers applications for approval under this not employed by the facility who found section will be evaluated by the panel no more than 5 percent of all the roent- of "B" Readers or by a qualified radiogenograms unreadable.

logical physicist or consultant. Appli(b) Other facilities will be eligible to cants will be advised of any reasons for participate in this program when they denial of approval. demonstrate their ability to make high (e) ALOSH or its representatives may quality diagnostic chest roentgeno- make a physical inspection of the apgrams by submitting to ALOSH six or plicant's facility and any approved more sample chest roentgenograms roentgenographic facility at any reamade and processed at the applicant fa- sonable time to determine if the recility and which are of acceptable qual- quirements of this subpart are being ity to the Panel of “B” readers. Appli- met. cants shall also submit a roentgeno- (f) ALOSH may require a facility pegram of a plastic step-wedge object riodically to resubmit roentgenograms (available on loan from ALOSH) which of a plastic step-wedge object, sample was made and processed at the same roentgenograms,



Publications, P.O. Box 30175, Washington, DC 20014.



Roentgenographic Facility Document for quality control purposes. Approvals granted hereunder may be suspended or withdrawn by notice in writing when in the opinion of ALOSH the quality of roentgenograms or information submitted under this section warrants such action. A copy of a notice withdrawing approval will be sent to each operator who has listed the facility as its facility for giving chest roentgenograms and shall be displayed on the mine bulletin board adjacent to the operator's approved plan. The approved plan will be reevaluated by ALOSH in light of this change. [43 FR 33715, Aug. 1, 1978; 43 FR 38830, Aug. 31, 1978]

$37.50 Interpreting and classifying

chest roentgenograms. (a) Chest roentgenograms shall be interpreted and classified in accordance with the ILO Classification system and recorded on a Roentgenographic Interpretation Form (Form CDC/NIOSH (M)2.8).

(b) Roentgenograms shall be interpreted and classified only by a physician who regularly reads chest roentgenograms and who has demonstrated proficiency

classifying the pneumoconioses in accordance with $37.51.

(c) All interpreters, whenever interpreting chest roentgenograms made under the Act, shall have immediately available for reference a complete set of the ILO International Classification of Radiographs for Pneumoconioses, 1980.



$ 37.43 Protection against radiation

emitted by roentgenographic equip

ment. Except otherwise specified in $37.41, roentgenographic equipment, its use and the facilities (including mobile facilities) in which such equipment is used, shall conform to applicable State and Federal regulations (See 21 CFR part 1000). Where no applicable regulations exist, roentgenographic equipment, its use and the facilities (including mobile facilities) in which such equipment is used shall conform to the recommendations of

the National Council on Radiation Protection and Measurements in NCRP Report No. 33 "Medical X-ray and Gamma-Ray Protection for Energies up to 10 MeVEquipment Design and Use" (issued February 1, 1968), in NCRP Report No. 48, “Medical Radiation Protection for Medical and Allied Health Personnel” (issued August 1, 1976), and in NCRP Report No. 49, "Structural Shielding Design and Evaluation for Medical Use of X-rays and Gamma Rays of up to 10 MeV" (issued September 15, 1976). These documents are hereby incorporated by reference and made a part of this subpart. These documents are available for examination at ALOSH, 944 Chestnut Ridge Road, Morgantown, WV 26505, and at the National Institute for Occupational Safety and Health, 5600 Fishers Lane, Rockville, MD 20857. Copies of NCRP Reports Nos. 33, 48, and 49 may be purchased for $3, $4.50, and $3.50 each, respectively, from NCRP

NOTE: This set is available from the International Labor Office, 1750 New York Avenue, NW., Washington, DC 20006 (Phone: 202 376-2315).

(d) In all view boxes used for making interpretations:

(1) Fluorescent lamps shall be simultaneously replaced with new lamps at 6-month intervals;

(2) All the fluorescent lamps in a panel of boxes shall have identical manufacturer's ratings as to intensity and color;

(3) The glass, internal reflective surfaces, and the lamps shall be kept clean;

(4) The unit shall be so situated as to minimize front surface glare.

[43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7564, Mar. 1, 1984)

$37.51 Proficiency in the use of sys

tems for classifying the

pneumoconioses. (a) First or "A" readers:

(1) Approval as an “A” reader shall continue if established prior to (insert) effective date of these regulations).

(2) Physicians who desire to be “A” readers must demonstrate their proficiency in

classifying the pneumoconioses by either:

(i) Submitting to ALOSH from the physician's files six sample chest roentgenograms which are considered properly classified by the Panel of “B” readers. The six roentgenograms shall consist of two without pneumoconiosis, two with simple pneumoconiosis, and two with complicated pneumoconiosis. The films will be returned to the physician. The interpretations shall be on the Roentgenographic Interpretation Form (Form CDC/NIOSH (M) 2.8) (These may be the same roentgenograms submitted pursuant to $37.42), or;

(ii) Satisfactory completion, since June 11, 1970, of a course approved by ALOSH on the ILO or ILO-U/C Classification systems the UICC/Cincinnati classification system. As used in this subparagraph, “UICC/Cincinnati classification" means the classification of the pneumoconioses devised in 1968 by a Working Committee of the International Union Against Cancer.

(b) Final or “B” readers:

(1) Approval as a “B” reader established prior to October 1, 1976, shall hereby be terminated.

(2) Proficiency in evaluating chest roentgenograms for roentgenographic quality and in the use of the ILO Classification for interpreting chest roentgenograms for pneumoconiosis and other diseases shall be demonstrated by those physicians who desire to be “B” readers by taking and passing a specially designed proficiency examination given on behalf of or by ALOSH at a time and place specified by ALOSH. Each physician must bring a complete set of the ILO standard reference radiographs when taking the examination. Physicians who qualify under this provision need not be qualified under paragraph (a) of this section.

(c) Physicians who wish to participate in the program shall make application on an Interpreting Physician Certification Document (Form CDC/ NIOSH (M) 2.12). [43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7564, Mar. 1, 1984)

$37.52 Method of obtaining definitive

interpretations. (a) All chest roentgenograms which are first interpreted by an “A” or “B” reader will be submitted by ALOSH to a “B” reader qualified as described in $37.51. If there is agreement between the two interpreters as defined in paragraph (b) of this section the result shall be considered final and reported to MSHA for transmittal to the miner. When in the opinion of ALOSH substantial agreement is lacking, ALOSH shall obtain additional interpretations from the Panel of “B” readers. If interpretations are obtained from two or more “B” readers, and if two or more are in agreement then the highest major category shall be reported.

(b) Two interpreters shall be considered to be in agreement when they both find either stage A, B, or C complicated pneumoconiosis, or their findings with regard to simple pneumoconiosis are both in the same major category, or (with one exception noted below) are within one minor category (ILO Classification 12-point scale) of each other. In the last situation, the higher of the two interpretations shall be reported. The only exception to the one minor category principle is a reading sequence of 0/1, 1/0, or 1/0, 0/1. When such a sequence occurs, it shall not be considered agreement, and a third (or more) interpretation shall be obtained until a consensus involving two or more readings in the same major category is obtained. (43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7564, Mar. 1, 1984; 52 FR 7866, Mar. 13, 1987)


$ 37.53 Notification of abnormal

roentgenographic findings. (a) Findings of, or findings suggesting, enlarged heart, tuberculosis, lung cancer, or any other significant abnormal findings other than pneumoconiosis shall be communicated by the first physician to interpret and classify the roentgenogram to the designated physician of the miner indicated on the miner's identifcation document. A copy of the communication shall be submitted to ALOSH. ALOSH will notify

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