L'Abbate N, Giovanazzi A
Sezione di Medicina del Lavoro, Dipartimento di Scienze Mediche e del Lavoro, Università degli Studi di Foggia, Via Luigi Pinto c/o OO.RR., 71100 Foggia, Italy.
G Ital Med Lav Ergon. 2008 Jul-Sep;30(3 Suppl):144-8.
The occupational physician, specifically trained in radiation protection, has to consider different criteria, such as psycho-physical ability, biological fitness and worker's validity to formulate judgement of fitness to work in exposure to ionizing radiation (IR). According to National Legislations (D.Lgs. 230/95; DM 488/2001), there are different possible outcomes about fitness to work criteria: absolutely fit to work, partially fit to work, not fit to work and medical examination before workers exposed to IR's retirement; besides, the occupational physician has to pay particular attention to evaluate individual hypersusceptibility conditions. Stochastic somatic diseases require a "not fit to work" judgement, an occupational disease complaint to the Insurance Institute and a report obligation. Forensic-medical ascertainment of diseases caused by radiation exposure needs different criteria, particularly for stochastic effects. The most suitable criterion, applied to attribute etiologic role in stochastic effects, is "Probability of Causation" theory, deriving from scientific literature evidence. This theory is an epidemiology-based method conceived to evaluate the probability of a linkage between a specified cancer and an exposure. Judgement of fitness to work in case of neoplasia partial or complete remission should be based on objective considerations, giving particular importance to the human and social aspects.
职业医师经过辐射防护方面的专门培训，必须考虑不同标准，如心理 - 身体能力、生理健康状况和劳动者的有效性，以对从事电离辐射（IR）暴露工作的健康适宜性作出判断。根据国家法规（D.Lgs. 230/95；DM 488/2001），关于工作适宜性标准有不同的可能结果：完全适合工作、部分适合工作、不适合工作以及在从事电离辐射工作的劳动者退休前进行医学检查；此外，职业医师必须特别注意评估个体的超敏反应情况。随机性躯体疾病需要作出“不适合工作”的判断、向保险机构提出职业病投诉以及履行报告义务。对辐射暴露所致疾病进行法医鉴定需要不同标准，尤其是针对随机效应。应用于确定随机效应病因作用的最合适标准是“因果概率”理论，该理论源于科学文献证据。这一理论是一种基于流行病学的方法，旨在评估特定癌症与某种暴露之间存在关联的概率。对于肿瘤部分或完全缓解情况下的工作适宜性判断应基于客观考量，尤其要重视人文和社会方面。
