Australasian Faculty of Occupational and Environmental Medicine
Recommendations from the Australasian Faculty of Occupational and Environmental Medicine on low back imaging, opioids, time off work and asbestos exposure. The Australasian Faculty of Occupational & Environmental Medicine (AFOEM) is a Faculty of the Royal Australasian College of Physicians (RACP) that connects and represents Occupational and Environmental Medicine Fellows and trainees in Australia and New Zealand.
Do not repeat chest X-rays when screening asbestos-exposed workers unless clinically indicated.
Asbestosis usually takes years to decades to develop after the initial exposure and chest X-rays cannot immediately indicate whether or not asbestos fibres have been inhaled. Given the long latency period, screening and early detection of asbestosis by chest X-ray is unlikely to confer any health advantage or psychological benefit on asbestos-exposed individuals. Moreover, there is now evidence that low-dose multi-detector CT (MDCT) rather than chest X-ray is justified for initial examination because it is more sensitive. Therefore, while it may be appropriate to obtain a baseline chest X-ray at the time of first assessment, for screening purposes the radiation risk outweighs the benefit of frequent chest X-rays.
Radiation exposure is also a concern for repeated CT scans. Further screening may be justified only if exposure to asbestos has continued and, in this case, the frequency and extent of exposure should determine the requirement for repeat screening. In addition, low-dose CT may be appropriate in individual cases, if there is considered to be an increased risk of lung cancer.
- Eisenhawer C, Felten MK, Tamm M, et al. Radiological surveillance of formerly asbestos-exposed power industry workers: rates and risk factors of benign changes on chest X-ray and MDCT. Journal of Occupational Medicine and Toxicology 2014; 9:18.
- Safe Work Australia Asbestos Guidelines
- Vierikko T, Kivistö S, Järvenpää R, et al. Psychological impact of computed tomography screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers. Eur J Cancer Prev 2009; 18(3):203-6.
- Weissman DN. Role of chest computed tomography in prevention of occupational respiratory disease: review of recent literature. Semin Respir Crit Care Med 2015; 36(3):433-48.
The College worked with the President and EVOLVE Lead Fellow of AFOEM to compile and refine a list of nine recommendations regarding low-value clinical practices in occupational and environmental medicine. This initial list served as the basis for an online survey. Based on survey responses, each of the nine recommendations was assigned a score and ranked accordingly. Based on the ranking of the initial nine, and the review of newly suggested items, these five low-value practices and interventions were chosen.
- 1 Do not request low back X-rays or other forms of low back imaging as part of a routine preplacement medical examination.
- 2 Do not order X-rays or other imaging for acute non-specific low back pain, unless there are red flags or other clinical reasons to suspect serious spinal pathology.
Do not prescribe opioids for the treatment of acute or chronic pain without assessing the patient’s clinical condition, potential side effects, alternative analgesic options, work status, and capacity to perform safety-critical activities such as driving a motor vehicle.
- 4 Do not certify a patient as totally unfit for work unless the work absence is clinically necessary and the patient is unfit for suitable alternative or restricted duties.
- 5 Do not repeat chest X-rays when screening asbestos-exposed workers unless clinically indicated.