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< 大宰府へ行っていきました | メイン | 塵肺関連の写真でを集めてみたかったんです... >
2009.05.24 21:00 |  診療  |  医療制度 / 行政  |  その他（一般）  |  その他（医療関連）  |  ミチバ  | 推薦数 : 2

じん肺の管理区分とレントゲン分類

・本日は、３日間も病院を留守にしていたので、「出勤」し、入院患者さんの診察とたまっている書類の整理。患者さんは、比較的落ち着いており安心。（途中状態が悪化した人もありましたが、留守を守ってくれていたDr.の適切な対応で回復）医局へのお土産は、梅の枝餅。日直のDr.（結構グルメ）が食べておいしかったと。賞味期限は、明日なのでみんなに明日中に食べてもらわないと。（Dr.Ｊ曰く、自分の辞書に賞味期限の文字はない・・・ちょっと脚色）着てくして、家の周囲の草刈（刈り払い機使用）と溝掃除。（今度地域の溝掃除があるのですが、出張で出られないので、先にしておきました）ほんと疲れました。

・さて、「日記」ばかり書いているとだめなので、産業医学の話。

患者さんが時々、自分はじん肺の１だとか、３だとか言われるのですが、胸部レントゲンの１型の管理区分１を混乱されている場合があります。で、本日は、若干その説明。

・じん肺のレントゲン分類は、基本的には平面（単純）写真で行われます。日本では、じん肺法に基づいて行います。世界的にはＩＬＯ分類が用いられます。

・じん肺法では、１型～４型の四つに分類します。以下の表をご参照ください。

型エックス写真の像
第　１　型両肺野にじん肺による粒状影又は不整形陰影が少数あり、かつ、じん肺による大陰影が
ないと認められるもの
第　２　型両肺野にじん肺による粒状影又は不整形陰影が多数あり、かつ、じん肺による大陰影が
ないと認められるもの
第　３　型両肺野にじん肺による粒状影又は不整形陰影が極めて多数あり、かつ、じん肺による
大陰影がないと認められるもの
第　４　型じん肺による大陰影があると認められるもの

 

・第１型～第４型をそれぞれ、ＰＲ１、ＰＲ２、ＰＲ３、ＰＲ４と書くことがあります。

・言葉のみではわからないので、「じん肺標準エックス線フィルム」(昭和53年発行)というものがあり、それと比較して、型を決めるように推奨されています。ただ、少なくとも私は二つ問題があると思います。現在、このフィルムが手に入りにくいこと。二つ目は、標準フィルムの１型が粒状影があるんやら、無いんやらわかりにくいこと。

・ＩＬＯの分類に関しては、下記Websiteをご覧ください。（また、ＩＬＯの分類も標準フィルムがあります。）

http://www.ilo.org/public/libdoc/ilo/2002/102B09_423_engl.pdf

 

・ついでにいうと、最近ＣＴの分類も提唱されていますが、それについては、また、後日ご紹介。

・さて、次に管理区分です。これは、粉じん作業をしている労働者は、じん肺健康診断（自覚症状のチェック、肺機能、胸部レントゲン等の検査）を定期的に行い、その所見によって、管理区分を定め、事後措置をおこなうものです。下の表に、管理区分も１から４まであります。胸部レントゲンと同様に４分類ですので、患者さんが混乱しますね。（産業医学をよく知らないDr.も混乱されるでしょう）ちなみに、管理１というのは、じん肺所見がないということですから、くれぐれもお間違いなく。

 

じん肺管理区分じん肺健康診断の結果
管理一じん肺の所見がないと認められるもの
管理二エックス線写真の像が第一型で、じん肺による著しい肺機能の障害がないと認められるもの
管理三イエックス線写真の像が第二型で、じん肺による著しい肺機能の障害がないと認められるもの
ロエックス線写真の像が第三型又は第四型（大陰影の大きさが一側の肺野の三分の一以下のものに限る。）でじん肺による著しい肺機能の障害がないと認められるもの
管理四（１）　エックス線写真の像が第四型（大陰影の大きさが一側の肺野の三分の一を超えるものに限る。）と認められるもの
（２）　エックス線写真の像が第一型、第二型、第三型又は第四型（大陰影の大きさが一側の肺野の三分の一以下のものに限る。）で、じん肺による著しい肺機能の障害があると認められるもの


・じん肺健診の流れについては、下のWebsiteがわかりやすいのでは、ないかと思います。

http://www.ibarakiroudoukyoku.go.jp/kijun/kijun27.html#06

 

 

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塵肺健診で胸部単純写真みていつも思うのですが、標準写真には年齢とか喫煙による影響は考慮されてないですよね。

まあそんなこと考慮に入れたらややこしくて収拾がつかなくなるとは思いますが....

＞Paul Carpenterさま，コメントありがとうございます．
確かに，年齢，喫煙等考えていると収集がつかなくなりますね．標準フィルムを作る作業大変みたいですね．（ＩＬＯの新しい標準フィルム作りに関わったDr.の話を聞いたことが何回かあるので）
written by Paul Carpenter / 2009.05.25 17:47

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