Medical surveillance of workers exposed to ionizing radiations.

The principal directives on radiation protection (ICRP, EEC, national regulations) are the basis of a critical analysis of the concrete aspects, as typically found, of medical surveillance of exposed workers. It is shown how doctrinal, regulatory and legal hypertrophy produced by radiation protection often results in poor medical surveillance. This situation also arises by virtue of the rigid application of the ALARA principle (primary prevention) that considers workers in most cases as "virtually exposed". National regulations tend to privilege diagnostic exploration of deterministic damage, applying selective criteria to "slices" of the "state of health", whereas a global evaluation is required by the ICRP and by EEC regulations. In this context, there is a veiled intention, by now historically consolidated, to use such diagnostic tests as biodosimetric indicators. Another and persistent cause for concern is the practice of acquiring data on the radiosensitivity of some organs and systems for the (unlikely) occurrence of an accident. Instead, less consideration seems to be given to the early diagnosis of stochastic damage (leukemia and solid tumours). The physician has to confront not only the possible tumours due to occupational irradiation, but inevitably and prevalently (and often exclusively) the so-called "spontaneous" tumours that lead to an estimated mortality of 25% or more. Both radio-induced and spontaneous are in the end clinically observed in their globality, without distinction. In this context, medical surveillance undoubtedly acquires obligations with regard to tumour prevention (secondary prevention), considering also that sites with a high coefficient of risk of tumoral radio-induction basically coincide with the most frequently occurring cancers in the average population. Based on the above considerations, a diagnostic protocol is proposed that reconciles, with due economy but with the right balance, the real requirements of medical surveillance, reducing as far as possible undesirable effects such as "damage from excessive protection" (often of a formal character) and patient/physician delay, which is extremely dangerous for the early diagnosis of tumours.