The Canadian Journal of Medical Radiation Technology (1998)
Darkroom disease
is a term used to describe an illness affecting radiology workers. It is
caused by exposure to x-ray processing chemistry though the biomechanisms of
this allergic-type illness are not well understood. A number of research
studies have found that radiology workers are presenting with dermal and
respiratory symptoms when measured levels of airborne chemistries are well
within permissible limits. Glutaraldehyde, a processing additive, is
suspected of being at the root of this illness, but other processing chemistry
should not be overlooked. After reviewing published studies investigating
this illness, discussion explores persistent issues surrounding DD including:
challenges in quantifying and preventing illness; cross-reactivity;
institutional and corporate inertia; and gender bias. Darkroom disease is
a preventable illness. Radiology workers need adequate information
necessary to make informed decisions concerning possible health risks in their
environment.
Introduction
Darkroom Disease (DD) is a term used to describe a variety of irritant or
allergic-type reactions reported by radiology workers.* Symptoms reported
include headaches, skin rashes, and shortness of breath, and, while this
illness continues to pose certain diagnostic challenges, it has been linked
with exposure to processing chemicals. Darkroom Disease is somewhat of a
misnomer because those who do not employ a darkroom per se, remain exposed to automatic processor and storage
tank emissions, to processing chemistry leaks, and to skin contact and
off-gassing from processed film. [1]
A global increase in radiology workers' reported symptoms and a growing concern
about the safety of their working environment has prompted a number of
investigative research studies over the past 20 years. These research
publications will be reviewed and discussion offered concerning persistent issues
surrounding DD.**
*The term "radiology workers" is
employed to encompass technologists, darkroom technicians, radiologists, and
office staff who have all reported this occupational illness.
**It is not within the scope of this article to
define detailed means of prevention or to attempt to describe the underlying
biomechanisms of DD as these important topics merit comprehensive
representation.
Background
Much of the information brought to the attention of technologists, world wide,
has been due to the efforts of Marjorie Gordon, a new Zealand technologist who
was forced to give up her clinical career in 1983 because she became severely
sensitized to x-ray processor chemicals, developing, among other things,
arrhythmia and tachycardia, hoarseness and extreme fatigue. During a
visit to Europe, Gordon discovered that other technologists were having similar
experiences and while visiting the Agfa-Gevaert plant in Belgium she learned
that if their factory employees suffered any signs of respiratory illness they
were transferred immediately away from chemical sources. From that point
on, until her (accidental) death in 1996, Gordon devoted herself to raising
awareness about the safe use of processing chemistry.
A seminal publication regarding DD was the Spicer/Hay/Gordon Report of 1986. [2] A postal survey of 367 New Zealand
radiographers was analyzed, and frequently noted workplace symptoms correlating
with time spent in the darkroom were identified as the following:
severe headaches, sore throat/hoarseness; nasal discharge; sore eyes;
unexpected fatigue; sinus problems; nausea; painful joints; bad taste in mouth;
mouth ulcers; catarrh (inflammation of the nasal mucous membranes); tinnitus;
tight chest; skin rash; lip sores; shortness of breath; unusual heart rhythms;
chest pains; and numb extremities.
Although certain statistical challenges are
acknowledged, the report recommended that further investigation was warranted
including a review of toxicity information, air sampling and ventilation,
equipment inspection and maintenance, health monitoring and staff training in
order to, as the authors concluded, "provide radiographers with the
health-related information to which they are entitled, and the basis for
informed action where necessary to minimize health risks."
In 1991 the Society of Radiographers in London carried out a similar survey to
which 2804 of their members (almost 25%) responded with 39.4% reporting the
following symptoms in descending order of frequency:
headaches, sore throat/hoarseness, unexpected fatigue, sore eyes, chemical
taste, sinus problems/nasal discharge, persistent cold-like symptoms, catarrh,
painful joints, mouth ulcers, skin rash, chest pains/breathing difficulties. [3]
If processing chemistry is at the root of this illness, one may very well
wonder why DD symptoms have been reported only in recent history. With
the advent of rapid processing in 1967 the temperature of the developer had to
be raised to achieve the same amount of development within a shorter
period. To help maintain emulsion-to-film adherence at these new
temperatures, glutaraldehyde was added to the developer and the emulsion as a
hardening agent. Of prime concern to Gordon was that the addition of
glutaraldehyde was not accompanied by clear warnings to users concerning
potential health hazards. [4]
Meanwhile, it is since that time that symptoms we now know as DD began to
manifest themselves.
Glutaraldehyde is an aliphatic dialdehyde with a slightly acidic and powerful
odour, (perceptible at 0.16 mg/m3), which causes nasal and eye irritation at
levels above 1.23 mg/m3. [5]
The United Kingdom Health and Safety Executive's National Interest Group for
the Health Service has identified glutaraldehyde as a substance that should be
given particular consideration when making assessments under the Control of
Substances Hazardous to Health (COSHH) Regulations 1988 within hospitals.
The reasons given for highlighting glutaraldehyde was a steadily increasing
number of health problem reports from users, including skin and respiratory
sensitization and irritant effects. [6]
Glutaraldehyde is also used in animal hide tanning, in embalming fluids, and is
widely used in the cold sterilization (e.g. CIDEX¨) of sensitive surgical
instruments such as endoscopes. It is a microbicidal agent noted for its
effectiveness against HIV. Concurrent with a rise in claims of DD have
been claims of occupational illness developed in users of these sterilization
systems. [7] Consequently, research studies
often combine a patient population from both radiology and endoscopy
departments.
Although glutaraldehyde ranks high in the list of suspected agents, several
authors have cautioned that other hazardous chemicals in film processing should
not be disregarded. Hewitt classifies processing chemicals as
"probable, possible, or unlikely" to cause irritant or allergic
reactions, with acetic acid, ammonia, glutaraldehyde, hydrogen sulphide,
sulphur dioxide being included as "probable" and di-ethylene glycol
being classified as "possible." [8]
Concerns for synergistic effects will be discussed below.
Publication Review:
Early publications suggesting a causal link between symptoms and exposure to
processing chemistry includes one by William Rea in Annals of Allergy, 1978. Rea described a 38 year old physician
who, after each exposure to x-ray processor fumes, had a broad spectrum of
symptoms related to smooth muscle sensitization, including g.i. upset, urinary
urgency, chest tightness and peripheral arterial spasm. Withdrawal from
this environment resulted in cessation of the arrhythmias, while at least 20
separate re-exposures resulted in premature ventricular contractions. [9]
In 1981 Fisher published a first report of allergic contact dermatitis in a
radiologist and x-ray technician due to handling films containing
glutaraldehyde. [10]
Acting on Fisher's article, his own personal experience, and the results of a
survey, Zach, in a 1982 letter publish in American Family Physician, warned that severe contact dermatitis, rhinitis,
and occupational asthma are "much more common than the medical profession
now recognizes." Noting also the wide use of glutaraldehyde in cold
sterilization, Zach recommended taking necessary steps to address this
"preventable occupational hazard." [11]
Publications issuing from the occupational health field have attempted to
correlate environmental factors in processing areas with reported occupational
illness. In 1982 Frielander et al.,
performed an epidemiological investigation of a 1964 cohort of 478 photographic
processors in 9 Eastman Kodak Colour Print and Processing labs in the US.
The results showed no significant excess mortality, sickness-absence, or cancer
incidence. [12] In
1986 Kipen et al. examined
respiratory abnormalities among 3 photographic developers, one of whom had
worked 2 years in a cardiac catheterization lab, and who experienced headaches,
tiredness, nasal hypersecretion, sore throat, nausea, and two episodes of
severe left chest pain. [13]
Noting the individual irritant potential of acetic acid, sulphur dioxide,
formaldehyde, and hydroquinone, the authors suggest:
"Thus, although the air level of each individual chemical might be
below the threshold limit value (TLV), the influence of exposure to
combinations may result in adverse effects at levels that would be tolerable if
exposure were only to a single compound."
Referring to Frielander's Kodak survey, they
comment:
"One remains perplexed at their finding of a significantly reduced
relative risk for respiratory disease in a setting of known irritants and
sensitizers. An effect in this direction does not seem biologically
plausible." [14]
In 1987 a UK study by Ide, senior Employment Medical Advisor, Health and Safety
Executive, found that female darkroom technicians had a greater sickness
absence than matched controls, even though the difference did not reach
statistical significance. The author concluded that while occupational
hygiene assessments indicated chemical contaminants to be within limits,
further evaluation to determine the cause of sickness absence was recommended. [15]
In a 1998 Swedish study, Norback compared a group of 39 workers exposed to
glutaraldehyde in cold sterilization compared to an unexposed group of 68
subjects. [16] The
investigation revealed irritative skin and airway effects and headache
occurring at glutaraldehyde exposure levels far below the present Swedish
short-term occupational exposure limit (0.8mg/m3). He recommended
adequate ventilation, local exhaust when indicated, and the use of protective
gloves. In a similar UK study by Jachuk (1989) et al. the airborne glutaraldehyde in the work area of
effected endoscopy staff was also found to be below the UK occupational
exposure limit (also at 0.8mg/m3). They advised those with a history of
rhinitis, asthma and allergic dermatitis to avoid contact with the solution or
vapour. [17]
In 1989, Bakke et al, published two
articles concerning a Norweigan x-ray department where 24 out of 30 employees
experienced workplace symptoms involving the eyes, upper and lower respiratory
tract, as well as headache and fatigue. Analysis of the work environment
showed "constant extensive exposure of the employees to chemicals over a
long period." After making improvements, health problems were
"reduced appreciably, but not nullified. Some personnel had acquired
permanent impairments. Bronchial hyperreactivity was discovered in 19 of
the personnel, 13 of who had subjective symptoms of obstruction and asthma but
no manifestation of allergy." [18]
Burge, Director of Occupational Lung Disease Unit of East Birmingham published
a review article in The British Medical Journal in 1989 warning that glutaraldehyde at low concentration has been
established as the cause of respiratory, nasal, and skin problems in several
hospital workers. [19]
In 1992, Cullinan et al., in Lancet reported occupational asthma in two radiographers,
one apparently caused by glutaraldehyde, the other to fixer containing acetic
and hydrochloric acids and ammonium thiosulphate. [20]
Verification of illness by respiratory function testing, skin testing, and,
most recently, by immunological examination continues to present challenges and
equivocal results. Responding to Calder et al, 1992, who found that 33% of endoscopy workers
suffered irritant effects, Waldron in a survey of 150 glutaraldehyde-exposed
staff found that only 9% complained of wheezy chest and none had abnormal lung
function tests. [21]
However, the same year Trigg et al.
published a case report of a 39 year old male radiographer who demonstrated
reduced lung function on blinded exposure to processor chemicals.
Occupational asthma was diagnosed and the subject was retrained for an
alternative career. [22]
In addition to Rea's early article on cardiac findings, Connaughton in a 1993
letter to the editor of the Medical Journal of Australia, describes a further 7 patients occupationally
exposed to glutaraldehyde and who presented with either palpitations or
tachycardia. [23] No
other causative factors were identified from their history, physical
examination, or ECGs. Monitoring during exposure documented these
symptoms and when exposure ceased through change of job or workplace
modification, symptoms ceased. An earlier article by Gordon also
described chest findings in three radiographers and one radiologist
including: chest pain with loss of consciousness; arrhythmia;
tachycardia; and recurring chest infections and lymphoma. [24]
In 1993, Leinster, et al. published
their research assessing exposure to glutaraldehyde in cold sterilization and
x-ray film processing areas in 14 locations at 6 South East England
hospitals. Again, findings indicated that, in all areas, measurements
indicated airborne glutaraldehyde concentrations within the current UK
occupational exposure limit. The authors point out that other processing
components, acetic acid and diethylene glycol, are present in greater amounts,
are also more volatile, and are likely to present a greater inhalation exposure
risk than glutaraldehyde. Nevertheless, the authors make nine recommendations
to reduce exposure, "as the current occupational limit for this compound
may not be appropriate." [25]
In 1993 Kodak published several articles in response to "alleged adverse
health effects." [26]
They created worse-case scenarios by disconnecting room ventilation and
processor exhaust ducts but found that measured air concentrations remained
below Permissible Exposure Limits (PELs). They conclude that when used
properly "Kodak x-ray processing chemicals used to process Kodak films
should not present a health or safety risk," but noted that
"some employees may have specific medical conditions, such as asthma or
other respiratory diseases, that may require special consideration."
Peter Hewitt, professor of Occupational Hygiene at the Centre for Occupational
Health, University of Manchester was asked to investigate and present an expert
legal report regarding two radiographers who had been diagnosed with
occupational asthma. In his subsequent articles "Occupational health
problems in processing of x-ray photographic films" (1993), and
"Reducing the risks in X-ray film processing," (1994), he points to
the increasing reports of respiratory and skin problems since the early 1980's
and to common faults observed in various sites, including the positioning of
extract fans being such that fumes released from processors pass into the
operator's breathing zone before being discharged. After making twelve
safety recommendations Hewitt concludes that the number of reported cases and
the common features of the conditions described cannot be ignored, that consequences
of this illness are enormously distressing to the persons concerned, and that
the current state of knowledge leaves much more to be learnt. [27]
In 1994 Gannon et al. described a
further eight cases of occupational asthma due to glutaraldehyde in hospital
workers, three of which were radiology workers, including a secretary who
reacted to newly developed film when placed on her desk. Investigation
was by serial measurement of peak expiratory flow (PEF) and specific bronchial
provocation tests. Measurements in six x-ray darkrooms were less than
0.009 mg/m3 and the mean level of glutaraldehyde during the challenge tests was
0.068 mg.m3, about one tenth of the short term occupational exposure standard
of 0.7 mg/m3. The diagnosis of occupational asthma was confirmed in seven
workers including two of the radiology workers. Furthermore, three
subjects had positive tests to formaldehyde suggesting cross reactivity between
the two substances. [28]
In 1996, Curran, et al. reported the
first evidence of immunologic sensitization in workers exposed to
glutaraldehyde who were either diagnosed as having occupational asthma or who
described work-related respiratory symptoms. However, because of
glutaraldehyde's low molecular weight, the authors warn that specific
antibodies can be detected in only a small percentage of effected workers and
that further work is required in this area.
In 1996, Scobbie, et al in the UK,
conducted an air quality survey at six x-ray units in four hospitals and
revealed the main airborne contaminants to be sulphur dioxide and acetic
acid. Glutaraldehyde was not detected except directly above the
developer. Although none of the sites measured were sites where illness
had been reported, worse-case conditions were created by switching off the room
ventilation. While concentrations of all chemicals remained well within
occupational exposure limits, acetic acid and sulphur dioxide were about five
times that of the other areas measured, and the investigating team found the
conditions "considerably more uncomfortable than in the typical processing
units." [29]
Butyraldehyde, a severe irritant, was detected at low concentrations in the
film processor exhaust duct and was also a main component above the developer
solutions. [30] In
trying to determine the cause of darkroom disease the authors conclude that
acetic acid and sulphur dioxide are unlikely because exposure to higher
concentrations in other industrial environments have not apparently caused
health effects similar to DD. They question whether past systems of hand
mixing may have caused increased exposure to glutaraldehyde and butyraldehyde
but that not enough is known about the health effects of the latter to be able
to judge its potential contribution to illness.
In 1996 Smedley and Coggon in the UK examined the health surveillance of
employees exposed to respiratory sensitizing agents, including x-ray
departments. [31] They
found that many departments had no written policies and that only a minority of
departments had made arrangements for communicating the collective results of
screening to employees. In another article published the same year, the authors
determined the prevalence of symptoms among radiographers compared with a
control group of physiotherapists. [32]
They found work related symptoms suggesting irritation of the eyes and upper
airways to be more common in radiographers than controls, and, that follow-up
assessment would be required to assess the prevalence of occupational asthma in
this group.
Discussion:
The historical review above offers but a cursory look at the complex subject of
DD. Many challenges remain including understanding the biomechanisms of
commonly reported symptoms such as tinnitus, fatigue, and arrhythmias, and
defining better means of quantifying this occupational illness.
Meanwhile, given the research to date, establishing that a majority or even a
significant number of radiology workers are symptomatic, should no longer be
necessary; early reports of DD-like symptoms in any department should prompt
supportive measures and an investigation into hygiene practices to prevent the
progression of more-debilitating health issues, such as
asthma.
A recurring finding in the literature underlines one of the dilemmas in
qualifying darkroom disease: exposed personnel are developing occupational
illness at chemical air concentrations well below occupational safety
levels. Chessor and Svirchev, in their occupational-health investigation
of several Canadian radiology sites where health problems had been reported,
also found this to be true. They cautioned: "Some use these results
to argue that processor chemicals cannot be responsible for the health problems
experienced by radiographers." Indeed, the experience of technologists
indicates a persistent reliance by authorities on these air measurements to
determine if there is a causal relationship between the workplace and ill
health. Addressing these air-level findings, several authors have
proposed that synergistic effects may be the means by which individual
toxins–each within permissible concentrations–when in combination
with others, provide a more dangerous mixture. [33]
Another theory addressing the low-air-level issue, proposes that a significant,
if not greater, exposure to glutaraldehyde occurs through skin absorption when
handling processed film. In an unpublished study from the University of
Bristol Safety Office, 1988, N. H. Pearce employed a semi-portable mass
spectrometer, and detected glutaraldehyde vapour arising from radiographers'
hands after handling freshly processed film. [34] Compared to other testing systems, the
portable mass spectrometer is relatively insensitive, and the radiographer's
hands were the only place were glutaraldehyde was detected. However, the
spectrometer gives an instant reading of what is present, whereas other methods
require at least a 15-minute sampling time, and transient high exposures may be
averaged down yielding barely detectable levels.
Supporting this skin-absorption theory is the case of two Canadian
technologist's who were tested by having small pieces of film taped to their
skin. Their standard patch tests had been normal except for positive
reactions to perfumes. Upon wearing the film patches, they developed
similar skin, chest, g.i., and lymphatic reactions experienced previously with
workplace exposures. [35]
In Beachamp's 1992 "Critical Review of the Toxicology of Glutaraldehyde,"
animal studies showed that 3.3 to 13.8% of topically applied glutaraldehyde
penetrated the skin. Also, approximately 3% of glutaraldehyde in cotton
pellets was absorbed systemically after being imbedded in animal tissue for
only 5 minutes; subsequent dose excretion was 8% through urinary and 4% through
pulmonary excretion. [36]
Bearing in mind the low-air-level dilemma, Hewitt, Scobbie, and others have questioned
the value of air monitoring systems and, instead, better methods of reducing
exposure form a major aspect of their preventative guidelines. These
include: searching for safer chemical alternatives; reducing emissions
into worker's breathing space through adequate room ventilation and by
more-efficient direct processor extraction; and the use of personal protective
gear. [37] A Canadian study noted that
manufacturers' instructions often do not include the rate of air flow from
processor exhaust, leaving this to guesswork for hospital engineering staff and
other processor owners. They suggest that until appropriate documentation
is made available, manufacturers should post information for all models on the
Internet. [38] As an
additional safety measure, Hewitt recommends a health surveillance system to
rapidly identify evidence of adverse dermal or respiratory effects because
"it will often be necessary to remove the affected person until a proper
solution has been found." [39]
Another challenge in DD is determining a reliable means of quantifying this
occupational illness. Affected employees may face a barrage of medical
tests, some of which may be inadequate; regardless, tremendous weight is given
to "normal" findings in substantiating compensation claim
rejections. Bronchial challenge tests may be normal even though the
subject experiences workplace-related asthma-like symptoms. A study by
Metso et al. of 23 patients with early
asthma-suggesting symptoms, found that even the best test, histamine challenge,
had a sensitivity of only 48%. [40]
Hayes and Fitzgerald have reported that:
"an association between symptoms and exposure to a sensitizing agent
may not be apparent because asthma caused by low molecular weight chemicals
[including glutaraldehyde and ammonium thiosulphate] may induce atypical
non-specific symptoms such as cough or chest discomfort. More classic
symptoms such as wheeze and chest tightness may not occur until late in the
evening or during the night after exposure." [41]
Furthermore, both Kipen and Hayes describe an important variable intrinsic to
health-care work which may complicate awareness and monitoring of suspected
illness: radiology work involves, not only a variety of shifts and days,
but also long hours, making the task of correlating delayed symptoms with
workplace exposure more difficult. Consequently, a symptom diary may be
of assistance. Also, regular peak flow measurements, via a small portable
flow meter, are recommended to quantify expiratory volume during and after work
hours. [42] Results should be monitored by a
physician.
Skin patch tests are commonly employed as a means of determining sensitivity to
specific chemicals, and these are often not conclusive though variations in
testing methods are noted. [43]
In a 1984 Portuguese study all 5 cases of Cidex¨ users reacted to patch tests
and none of the 42 controls reacted, suggesting that glutaraldehyde is a strong
allergen. [44] In contrast,
a Swedish study found that none of the 7 individuals with skin symptoms
demonstrated contact allergy, suggesting that response was more likely caused
by "primary irritative effects" rather than allergic response. [45] A Canadian study examining 13
health care workers found a positive patch test response more often at 96
hours, and, unlike other studies, also found evidence of responses to
formaldehyde in 3 out of 13 subjects; however it was felt that this could be
due to concomitant sensitization rather than cross-reaction since exposure to
formaldehyde could be documented in the course of the subjects' work. [46] A US study found that 20 subjects
who tested positive to 1 % aqueous glutaraldehyde did not react to 2 %
formaldehyde. [47] A UK
study found that 3 subjects who had a positive specific bronchial challenge to
glutaraldehyde bronchial testing also reacted to formaldehyde challenge. [48]
The cross-reactivity suggested above is an important issue needing further
exploration because those affected with DD often report new sensitivities to
chemicals in addition to those found in processor chemistry. These
multiple sensitivities may further compromise their employability and can have
profound effect on their lives. [49]
Physician and occupational health advisor, Gerald Batchelor describes that DD
sufferers may cross-react particularly to other aldehydes: diesel exhaust
(contains more aldehydes than gas exhaust); organic solvents; perfumes;
formaldehydes in new carpets and clothes, and chip-board; as well as to
cigarette smoke and some food preservatives. [50] Gordon described a subject whose
symptoms returned when re-employed in an environment with particle board
containing formaldehyde. [51]
From the perspective of the affected employee, many struggles exist for
validation, effective treatment, and for compensation. Unfortunately,
they often report lack of support from medical, professional societal, or
managerial authorities. As is noted by Bill Glass, an associate professor
of occupational health in New Zealand:
"The problems are known internationally and they've been well reported,
but being known in medical journals doesn't mean they're known to GPs or
hospital managers or users. It's a long process educating everyone." [52]
In March of 1997 a New Zealand conference on DD was held in honour of Marjorie
Gordon who died due to complications from a car accident in 1996.
Speakers included representatives from manufacturers interested in finding
alternatives, technologists and physicians who presented case reports and
research findings, and occupational health professionals with safety
advice. Hopefully, such meetings will serve to promote safe practices and
further research.
While a broader awareness concerning DD would clearly be of benefit, it is
worthwhile recognizing that the inertia of conventional beliefs exhibits
considerable resistance. Similarly, when pondering the apparent slow
progress of DD awareness in the North American radiology community, one would
be wise to consider the degree to which economic concerns or corporate
sponsorship interests may be informing resistances to change.
For example, the survey referred to in Zach's early articles on darkroom
disease was never completed. The US university who were to fund the
13,000-postcard survey asking x-ray personnel about the first manifestations of
DD, changed their minds due to fear of "losing philanthropic support,"
and they formally dissociated themselves from Zach's research. [53] Unfortunately, the lack of such a
North American survey, and the relative isolation experienced by affected
radiology workers informs a complacent belief that DD does not exist. [54]
In considering other means by which DD has been disregarded, the role of gender
bias should not be overlooked–given the female-dominated realm of
radiology work. It has been well-documented that the biomedical field is
not exempt from the social and cultural forces that inform our thinking, and,
consequently, nor is it exempt from gender bias. [55] For example, instead of expressing
concern regarding the workplace illness experienced by six Canadian
technologists, a hospital insurance representative cautioned them that their
ongoing symptoms may be interpreted as a "hysteria reaction."
Elsewhere, a female technologist's concerns about poor ventilation were not
addressed by management until a male engineer experienced asthma. [56] Other female employees' symptoms
have been ascribed to being "pre-menopausal" or due to
"anxiety" even when their age and symptoms clearly did not warrant
this judgment.
Conclusion
Although more research is needed to clarify remaining issues in the
understanding of darkroom disease, results to date have prompted radiology
departments around the world to reconsider occupational hygiene
practices. Glutaraldehyde has proven to be an irritant and sensitizer
and, since 1990, has become a recognized cause of occupational asthma for
statutory compensation in the UK. [57]
While several countries are reducing permissible airborne levels of this
chemical, [58] other
processing chemicals and routes of exposure need further exploration in
determining causes of DD.
Darkroom disease is a preventable illness, however, as Hewitt reported, an unfortunate
common feature is the lack of understanding and the slow and often
inappropriate responses of management to deal with reported problems. [59] Clearly, educating radiology
workers about potential hazards and prevention techniques should form an
essential component of their training. Only then can they learn to
recognize problems, make informed decisions, and take an active role in
assuring a healthy work environment.
_________
Acknowledgments
The author acknowledges the support of the
Radiology and MRI Department at the UBC Site of Vancouver Hospital. Thank
you also to Dr. Bruce Forster for his pre-emptive suggestions and to Dr. David
Li, Diane Durand, and Christopher Glen for their support. Thanks also to
Phillipa Martin, the daughter of Marjorie Gordon, and her Support Network for
the Aldehyde Affected (SNFTAA) for providing research and case histories.