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(h) “New miner” meeans any individual who began working in or at an underground coal mine for the first time subsequent to December 30, 1969, but does not include any surface worker who does not have direct contact with underground coal mining or with coal processing operations.

(i) "Operator" means any owner, lessee, or other person who operates, controls, or supervises an underground coal mine.

(j) “ILO Classification" means the extended form of the 1968 revision of the International Labour Office's scheme for classifying the pneumoconioses.

(k) “CICC,Cincinnati Classification" means the classification of the pneumoconioses devised in 1968 by a Working Committee of the International Union Against Cancer. $ 37.3 Chest roentgenograms required for miners and new miners.

(a) Every operator shall provide to each miner presently working in or at any of its underground coal mines an opportunity for:

(1) An initial chest roentgenogram by June 30, 1971, provided that this requirement will be considered as having been fulfilled with respect to any miner for whom is submitted a chest roentgenogram which meets the require ments of $ 37.20 (d) and which was taken on or after June 30, 1969:

(2) A second chest roentgengram by June 30, 1974; and

(3) Such subsequent chest roentgenograms as the Secretary prescribes in this subsection. (b) Every operator shall provide to each new miner presently working or subsequently employed in or at any of its underground coal mines :

(1) An initial chest roentgenogram as soon as possible but in no event later than 6 months after commencement of his employment;

(2) A second chest roentgenogram 3 years following the initial roentgenogram if the miner is still engaged in underground-coal mining; and

(3) A third chest roentgenogram 2 years following the second chest roentgenogram is the miner is still engaged in underground-coal mining and if the second chest roentgenogram shows any evidence of dust retention;

(4) Such subsequent chest roentgenograms as the Secretary prescribes in this subsection. (c) The operator shall provide the chest roentgenograms in accordance with a plan which meets the specifications of this subpart and which is approved by the Secretary pursuant to $ 37.5. $ 37.1 Plans for initial chest roentgenographic examinations.

(a) Every plan for initial chest roentgenographic examination of underground coal miners and new miners shall be submitted in writing on such forms as prescribed by the Secretary to the Bureau by September 19, 1970, and shall include:

(1) The name(s) and address (es) of the operator or group of operators participating in the plan;

(2) A time schedule for the required roentgenograms which include the number of miners to be given or offered roentgenograms under the plan;

(3) The location(s) at and time (s) during which roentgenograms will be given, in sufficient detail to enable a determination of compilance with 8 37.20(a) to be made :

(4) The names and qualifications, including specialty training and experience, of the individual(s) who will give, read and classify the chest roentgenograms, the office address(es). State license number(s) and date of last State, county, or city radiation protection inspection of the roentgenographic equipment to be used ; a listing of any deficiencies that were noted during the course of such inspection and what action was taken to correct the deficiencies.

(5) A description of the technical factors to be employed in accordance with the specifications in $37.20 (d) (1), (2), and (3) and $ 37.20(e) (2) and (3).

(6) A statement of the steps that have been taken to assure confidentiality of medical records and roentgenographic findings. (b) The operator shall advise the Bureau of any change in its plan. $37.5 Approval of plans.

(a) If, after review of any plan submitted pursuant to this subpart, the Secretary determines that the action to be taken by the operator or group of operators meets the specifications of this subpart and will effectively achieve its purpose, the Secretary will forward written notice of his approval of such plan to the operator (s) submitting the plan. Such approval may be conditioned upon such terms as the Secretary deems necessary to carry out the purpose of section 203 of the Act.

(b) Where the Secretary has reason to believe that he will deny approval of a plan he will, prior to the denial, give reasonable notice in writing to the operator(s) and opportunity to amend the plan. The notice shall specify the ground upon which approval is proposed to be denied.

(c) If a plan is denied approval, the Secretary shall advise the operator (s) in writing of the reasons therefor. $ 37.6 Roentgenographic examinations conducted by the Secretary.

(a) The Secretary will give chest roentgenograms or make arrangements with an appropriate person, agency or institution to give the chest roentgenograms or supplemental examinations required under this subpart in the locality where the miner resides, at the mine, or at a medical facility in a town easily accessible to a mining community or mining communities, under the following circumstances :

(1) Where, in the judgment of the Secretary, due to the lack of adequate medical or other necessary facilities or personnel at the mine or in the locality where the miner resides, the required roentgenographic or supplemental examination cannot be given.

(2) Where the operator has not submitted an approvable plan.

(3) Where, after commencement of an operator's program pursuant to an approved plan, the Secretary, after notice to the operator of his failure to follow the approved plan and, after allowing 30 days to bring the program into compliance, the Secretary determines and notifies the operator that the

operator's program still fails to comply with the approved plan. (b) The operator of the mine shall reimburse the Secretary or such other person, agency, institution, as the case may be, for the actual cost of conducting each examination made in accordance with this section. 8 37.7 Transfer of affected miner to less dusty area.

(a) Any miner who, in the judgment of the Secretary based upon reading of a chest roentgenogram or the result of other medical examinations, shows category 2(2/1) pneumoconiosis or development of category 1(1/0) pneumoconiosis in less than 10 years (ILO or UICC/Cincinnati Classification) shall be afforded the option by the operator of transferring from his position to any position in any area of the mine where the concentration of respirable dust in the mine atmosphere is not more than 2.0 mg/m of air.

(b) Effective December 31, 1972, the option of transferring shall be to any area. in the mine where the concentration of respirable dust in the mine atmosphere is not more than 1.0 mg/m of air, or, if such level is not attainable in such mine, to a position in the mine where the concentration is the lowest attainable below 2.0 mg/m of air.

(c) Any transfer under this section shall be for such period or periods as may be necessary to prevent further development of pneumoconiosis, and during such period or periods, the miner shall receive compensation for his work at not less than the regular rate of pay received by him immediately prior to his transfer.

SPECIFICATIONS FOR GIVING CHEST ROENTGENOGRAMS

$ 37.20 General provisions.

(a) The chest roentgenographic examination shall be given in the locality in which the miner resides or in a location that is equivalent with respect to convenience of time and place. Examinations at the mine during, immediately preceeding, or imediately following work and a “no-appointment" examination at a medical facility in a town easily accessible to a mining community or mining communities shall be considered of equivalent convenience for purposes of this section,

(b) The initial chest roentgenographic examination shall be supplemented by a completed miner's identification document (Form ECA-108) furnished by the U.S. Public Health Service.

(c) A roentgenographic examination shall be given by or under the super. vision of a physician who regularly takes chest roentgenograms and who has demonstrated his ability to take high quality chest roentgenograms in accordance with section 37.21. (d) Every chest roentgenogram shall

(1) Be a posteroanterior view on a 14'' x 17" or 14'' x 14" film;

(2) Be taken with a diagnostic X-ray machine having a rotating a node tube;

(3) Have a broad range of contrast such as that which is produced by using 70–78kV without grid or 110-145kV with grid :

(4). Permit the study of pulmonary detail as well as an adequate viewing of the mediastinum; and

(5) Show the (i) date of exposure; (ii) hospital, clinic, or other facility where the roentgenogram was taken; and (iii) social security number of

the miner. (e) To ensure high quality chest roentgenograms: (1) the maximum exposure time shall not exceed 1/20 of a second ; (2) minimum source to film distance shall not be less than 5 feet; and (3) medium speed film and medium speed intensifying screens shall be used.

(f) Upon notification by the Secretary that a film or group of films is not adequate for the purpose for which they were intended, the mine operator shall make provision for additional films or supplemental examinations as may be deemed necessary by the Secretary.

(g) No payment may be required of any miner in connection with any examination or test given to him under the Act. 8 37.21 Ability to take high quality chest roentgenograms.

Ability to take high quality chest roentgenograms shall be demonstrated by submitting from the physician's files to the panel of radiologists six sample chest roentegenograms which are of acceptable quality to the Panel. These shall have been taken within the last 12 months and shall identify the hospital, clinic, or other facility where each film was taken. These may be the same roentgenograms submitted pursuant to 8 37.31 (a) and will be returned to the physician. $ 37.22 Protection against radiation emitted by roentgenographic equipment.

Fixed roentgenographic equipment, its use and the facilities in which such equipment is used, shall conform to the recommendations of the National Council on Radiation Protection and Measurements in NCRP Report No. 33 "Medical X-ray and Gamma-Ray Protection for Energies up to 10 Mev-Equipment Design and Use" (issued Feb. 1, 1968) which document is hereby incorporated by reference and made a part hereof. This document is available for examination at the Bureau, ALFORD, the Bureau of Occupational Safety and Health, 5600 Fishers Lane, Rockville, Md., and at the Public Health Service Information Center or Regional Office Information Centers as listed in 45 CFR 5.31. Copies of the document may be purchased for $1 each from NCRP Publications, Post Office Box 4867, Washington, D.C. 20008. An official historic file of NCRP Report No. 33 will be maintained at the Bureau of Occupational Safety and Health, 5600 Fishers Lane, Rockville, Md.

SPECIFICATIONS FOR READING, CLASSIFYING, AND SUBMITTING FILMS 8 37.30 Reading and classifying chest roentgenograms.

(a) The interpretation of chest roentgenograms shall be classified in accordance with the ILO or UICC/Cincinnati Classification System and recorded on Form ECA-116.

(b) Reading and classification shall be performed only by a physician who reg. ularly reads chest roentgenograms and who has demonstrated proficiency in the use of the ILO or UICC/Cincinnati Classification Systems in accordance with $ 37.31. $ 37.31 Proficiency in the use of the ILO or UICC/Cincinnati Classifications.

Proficiency in the use of the ILO or UICC/Cincinnati Classification Systems shall be demonstrated by either:

(a) Submitting from the physician's files six recent sample chest roentgenograms taken within the last 12 months to the panel of radiologists which are considered properly classified by the panel. The submission shall consist of two without pneumoconiosis, two with simple pneumoconiosis, and two with

complicated pneumoconiosis and will be returned to the physician. (These may be the same roentgenograms submitted pursuant to $ 3721) or;

(b) Successful completion of a course approved by the Bureau in the ILO or VICC/Cincinnati Classification Systems. 8 37.32 Submitting required chest roentgenograms.

All chest roentgenograms required to be taken under this part, together with their interpretations and the miner identification documents shall be submitted immediately after classification to ALFORD and become the property of the U.S. Public Health Service. § 37.33 Notification to miners of abnormal findings.

Findings or suspected findings of enlarged heart, tuberculosis, lung cancer, or any other significant abnormal findings other than pneumoconiosis shall be communicated by the physician reading and classifying the roentgenogram to the miner or new miner or to his designated physician, as indicated on the miner's identification document, and a copy of the communication shall be submitted to ALFORD.

NOTE: Guidelines for the selection of equipment and recommendations for the technique for obtaining high quality roentgenograms are available to any interested person. Requests should be directed to the Bureau of Occupational Safety and Health, 1014 Broadway, Cincinnati, Ohio 13202. Approved : August 12, 1970.

ELLIOT L. RICHARDSON,

Secretary. NOTE: The incorporation by reference provision in this document was approved by the Director of the Federal Register on July 7, 1970.

[F.R. Doc. 70–10794 ; Filed, Aug. 18, 1970 ; 8:45 a.m.] Senator WILLIAMS. You have a target date of June 30, 1971, for the chest examination or X-ray for coal miners?

Dr. Key. That is correct.
Senator WILLIAMS. Chest examination?

Dr. Key. Chest roentgenograms, X-rays of the chest of 90,000 coal miners. Senator Williams. That is a little less than a year from now.

a Dr. KEY. That is right.

Senator WILLIAMS. What are your main problems in getting to the miners to perform these X-ray examinations? You said the difficulty of getting into the smaller mines. You don't get into the smaller mines to do that?

Dr. Key. It is more convenient from the miners' standpoint if the examinations are done at the changehouse. Because of road conditions, it is frequently difficult to get X-ray equipment up to the small mine. We have been successful, I am happy to report, in being able to contract for the examinations in a number of the coal mining States, including the major coal-producing States of Pennsylvania, West Virginia, and Kentucky, so that the Public Health Service will not have to use its mobile units in these States. We can concentrate our activities on some of the other States.

Senator WILLIAMS. You are now in the process of making these examinations. Just how is it working out? What happens, for example, when you find a man, say, age 40 and the reading shows trouble? How is that handled ?

Dr. KEY. In the national study of coal workers' pneumoconiosis, which began last August, we have examined almost 2,400 miners. These exams will be counted as complying with the act, even though many of them were given before the act. We do not see the necessity of going back and reexamining the men just to comply with the letter of the law. Thus far none of these men has been transferred to a less dusty mine area, but we anticipate that this action will follow in the next month or two.

Senator WILLIAMS. Mr. Popick?

Mr. POPICK. I was going to add on a going basis we would expect that if Dr. Key's studies and X-rays in the individual cases suggested that the man had a condition which would make him eligible for black lung benefits under the benefits portion of the program, that he would be referred to us or we would get a notice of this, so that the question of his right to benefits could be considered on a systematic basis.

So, we expect to tie in our activities very closely here on that point.

Senator WILLIAMS. I was interested in the new development in uniform procedures in X-ray. You mentioned the ILO, I believe, as one of the agencies creating this.

Dr. KEY. Yes. This is an international uniform system for reading and classifying X-ray films of the chest, so that

Senator WILLIAMS. What does "classified" mean in this context?

Dr. KEY. “Classified” relates to the degree of pneumonconiosis seen by chest X-ray and whether it is simple or complicated. This is needed for a standardized handling of the classification on which legal action may be taken, such as transfer of a miner or awarding black lung benefits.

Senator Williams. When you mention ILO, at least their work in that area, do you communicate with the international medical societies on questions such as black lung?

Dr. Key. Yes, we do. A number of the Public Health Service consultants in radiology served on both the International Labor Organization Committee which developed their classification system, and the International Union Against Cancer Committee, which developed an earlier classification system. These are very closely comparable for the purpose of the Coal Mine Health and Safety Act in regard to transfer to a less dusty area and in regard to awarding black lung benefits based on statutory provision of complicated pneumoconiosis.

Senator WILLIAMS. We only have one staff member who has any working history with the International Labor Organization and he is not here right now. I am sure he would be interested in this, Gene Mittelman. He regularly visits the ILO conventions.

A question is suggested on the confidentiality of medical examinations. This is a sensitive area, isn't it?

Dr. Key. Yes, sir.
Senator Williams. Can you give us the picture as you see it?

Dr. Key. As I mentioned in the testimony, we had two meetingsone in January and one in February—on the content and conduct of medical examinations. At the early meeting, I supported the situation that had existed between management and the union for a number of years, in that we would require an expressed consent from the local union before the members could be examined by a company doctor. The industrial physicians in those companies with captive mines objected to this policy, pointing out that industrial physicians are not less ethical than other physicians and that the practice of industrial medicine is accepted in the rest of industry in the United States.

I asked the advice of the Office of General Counsel in HEW, and finally decided that since the operators had been given the responsi

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