Symptoms of silicosis and progressive massive fibrosis may not appear for many years after exposure (workers may be diagnosed with these diseases and not present with any symptoms, even at the point of initial diagnosis), which is why health monitoring is critical. Health monitoring for crystalline silica may be required before the worker starts work so that a baseline can be established and any changes to the worker’s health after commencing the work can be detected.
Initial discussions about a health monitoring program should include:
- possible health effects from exposure to crystalline silica
- how to recognise and report symptoms, and
- what is involved in the health monitoring program, for example the frequency of testing and the tests that may be needed, and
- recording any previous workplace or non-occupational exposure to silica.
An initial physical examination by the registered medical practitioner should place emphasis on the respiratory system, including baseline spirometry. The spirometry should be performed as a baseline and annually in accordance with appropriate quality guidelines, so that it may be used later for comparison.
A baseline chest X-ray should also be performed before a worker starts work in a crystalline silica process. Should this be required, it should be taken in a specialist radiology practice or hospital radiology department (the Royal Australian and New Zealand College of Radiologists recommends using a specialist radiology practice or hospital radiology department accredited under Diagnostic Imaging Accreditation Scheme (DIAS) for Medicare and meeting the quality criteria of the ILO classification, so it may be used later for comparison). The X-rays should be read by an experienced radiologist who meets the reporting requirements and competencies of the Royal Australian and New Zealand College of Radiologists or is qualified as a B reader (The Royal Australian and New Zealand College of Radiologists  Imaging for Occupational Dust Lung Disease). Depending on the past exposures and medical history, the registered medical practitioner may recommend carrying out further tests with a specialist in order to detect early stage silicosis.
Depending on the past exposures and medical history, the registered medical practitioner may recommend carrying out further tests with a specialist in order to detect early stage silicosis.