Chest x ray

 1-    Outline

Chest x-rays are noninvasive diagnostic studies to aid in the diagnosis of lung disease, cardiac conditions,

bony abnormalities and chest wall conditions.

Chest x-ray has no good reputation for screening of healthy people for lung cancer or other diseases, with low sensitivity and uptake, however it is still has a place in occupational health screening.

 The benefit of screening for lung cancer has not been established in any group, including asymptomatic high-risk populations such as older smokers.

 The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer with either low dose computerized tomography (LDCT), chest x-ray (CXR), sputum cytology, or a combination of these tests (USPSTF 2014).

 Annual screening for lung cancer using a standard chest x-ray does not reduce the risk of dying from lung cancer when compared with no annual screening,

(Oken 2011).

 The Chest X-ray is required for GCC residence permit (RP) according to the Rules and Regulations of the Medical Examination of Expats requited for work in the Executive Board of the Health Ministers’ Council for GCC States (GCC 2010).


2- International standards:

  1. Offshore: If the doctor finds it necessary, the person will be referred for X-ray 
  2. (Norwegian Directorate of Health 2012)

b-    Offshore: Chest x-ray is not required.

 (UK Offshore Oil and Gas 2008)


c-    Offshore: Chest x-ray is normally included if clinically indicated.

(GoM BP 2012) 

  1. Fire fighter; Chest radiography. Chest X-ray posterior-anterior and lateral views.
  2. (NFPA 2012)
  3. Fire fighter; Chest radiography; Chest x-ray if indicated for asbestos exposure.
  4. (AFAC 2006) 
  6. Divers; Chest X-ray should only be performed if justified on individual clinical grounds.  
  8. (HSE UK, MA1, 2011)
  9. Hazardous Occupations, Full-sized chest x-ray examination for employment in Mines, Quarries and exposure to asbestos and for compressed air work.

(Hong Kong 2004)


i-     OSHA Standard;

Hazardous Waste Operations and Emergency Responses (HAZWOPER): Chest x-ray is required for HAZMAT team members and emergency response team. In addition, CXR is required for works exposure to Asbestos, Arsenic and coke oven emissions not required for benzene and blood borne exposure.

(OSHA 2009)

For Silica exposure works: The National Industrial Sand Association has developed its own guidelines on medical testing. They recommend medical testing every 2 years with x-rays performed every 2-4 years based on the age of the worker and duration of exposure. (Rosenman 2011)

j-     Drivers; Chest x-ray is not a routine test; may be requested performed at the discretion of the examining doctor.

(UK DVLA 2014)

2-    Suggested indications: it is recommend for fire fighter fitness assessment.



  1. Oken MM, Hocking WG, Kvale PA, Andriole GL, Buys SS, Church TR,
  2. Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial. JAMA. 2011 Nov 2; 306(17):1865-73. doi: 10.1001/jama.2011.1591.
  3. GCC, Rules & Regulations for Medical Examination of Expatriates Recruited for work in the GCC States, 2010.
  4. Kronick, R. (2014). The Guide to Clinical Preventive Services. USPSTF. Retrieved from
  5. Guidelines - health requirements for persons working on installations offshore. Norwegian Directorate of Health 2012.
  6. Medical Aspects of Fitness for Work Offshore ( 2008 The United Kingdom Offshore Oil and Gas)
  7. GoM Medical Aspects of Fitness for Offshore Work Safety Work Practice (BP 2012)
  8. NFPA 1582, Chapter 6 Medical Evaluations of Candidates - 2012
  9. HSE UK, The medical examination and assessment of divers (MA1) 2011,
  10. Doctors’ Guide to Medical Examinations for Workers engaged in Hazardous Occupations in Industrial Undertakings - Occupational Safety and Health – 2004, Hong Kong.
  11. OSHA, Hazardous Waste Operations and Emergency Response, OSHA 3114-07R, 2008, 
  13. Screening and Surveillance: A Guide to OSHA Standards, 2009
  14. Rosenman D, Recommended Medical Screening Protocol, for Silica Exposed Workers, Michigan State University, 2011
  15. At a glance Guide to the current Medical Standards of Fitness to Drive'. Drivers Medical Group, DVLA, UK, May 2014 



Parent Category: Fitness for Work