August 18, 2009

Michael J. Hodgson, MD, MPH
Office of Public Health and Environmental Hazards
U.S. Dept. of Veterans Affairs, Veterans Health Administration
810 Vermont Avenue, NW
Washington, DC 20420

Dear Dr. Hodgson:

Thank you for your letter, May 19, 2009, to the Occupational Safety and Health Administration (OSHA), Office of Federal Agency Programs, within the Directorate of Enforcement Programs (DEP). Your letter has been referred to DEP's Office of Health Enforcement for an answer to your specific questions regarding medical exams and chest roentgenograms (or x-rays) under OSHA's Asbestos standards. This reply letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not detailed within your original correspondence. Your paraphrased questions and our replies are below.

Question 1: Is the use of digital radiography a permissible method of compliance with the OSHA Asbestos standards, which require employers to use traditional film-screen chest x-rays for medical surveillance exams, if the digital images are interpreted and classified by an experienced radiologist or physician and eventually compared to digitized reference images when they become available?

Reply 1: No. OSHA recognizes that x-ray technology is advancing, but the Asbestos standards still require traditional chest roentgenograms for medical surveillance exams. See 29 CFR 1910.1001(l)(2)(ii) and Appendix E to §1910.1001, 29 CFR 1926.1101(m)(2)(ii)(C) and Appendix E to §1926.1101, and 29 CFR 1915.1001(m)(2)(ii)(C) and Appendix E to §1915.1001. Paragraph (c) of mandatory Appendix E to §1910.1001 states, "All interpreters, whenever interpreting chest roentgenograms made under this section, shall have immediately available for reference a complete set of the ILO-UIC International Classification of Radiographs for Pneumoconioses, 1980." See also paragraph (c) of Appendix E to §1926.1101 and to §1915.1001.

The International Labour Organization (ILO), in collaboration with the National Institute for Occupational Safety and Health (NIOSH) and the American College of Radiology, is now developing officially-approved ILO standard reference images obtained by digital radiography. Those reference images will ultimately be available for purposes of classifying digital radiographs. Reference images ensure accurate diagnoses because patients' chest films are directly compared to reference images from known cases of pneumoconioses. OSHA expects that the ILO and the other organizations working on this will soon develop recommendations for using digital radiographic imaging in the recognition and classification of pneumoconiosis, possibly by 2010. Further information on this effort can be found at http://www.cdc.gov/niosh/topics/chestradiography/breader.html.

Until ongoing research is complete and steps are taken to standardize digitized reference images, radiologists or physicians must continue to use traditional film-screen radiographs and standards to comply with the medical surveillance provisions of the OSHA Asbestos standards.

Question 2: If an employee has not been exposed to asbestos at or above an OSHA exposure limit within the last 12 months, but the employer decides to perform medical surveillance for that employee based on past exposures, including a chest x-ray, must the employer provide a traditional film-screen chest x-ray and interpretation and classification in accordance with the OSHA Asbestos standards?

Reply 2: Please consult the following provisions of the Asbestos standards to determine if the employees in question are covered by medical surveillance requirements: 29 CFR 1910.1001(l)(i)(i) and 1910.1001(l)(4)(i); 29 CFR 1926.1101(m)(1)(i)(A) and 29 CFR 1915.1001(m)(1)(i)(A). If they are not covered by those medical surveillance provisions, any exams you provide are in excess of OSHA requirements and need not adhere to the provisions requiring the use of traditional radiography. Please note, however, that, at this point in time, images created using digital radiography cannot be used to satisfy any of the employer's obligations to provide chest roentgenograms under the Asbestos standards.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website, http://www.osha.gov. If you have any more questions, please contact the Office of Health Enforcement, 202-693-2190.

Sincerely,



Richard E. Fairfax, Director
Directorate of Enforcement Programs