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Basic dataStandard ID: GBZ 106-2020 (GBZ106-2020)Description (Translated English): Diagnostic criteria for radiation skin diseases Sector / Industry: National Standard Classification of Chinese Standard: C60 Classification of International Standard: 13.100 Word Count Estimation: 16,153 Date of Issue: 2020 Date of Implementation: 2020-10-01 Issuing agency(ies): State Administration for Market Regulation, China National Standardization Administration GBZ106-2020: Diagnostic criteria for radiation skin diseases---This is a DRAFT version for illustration, not a final translation. Full copy of true-PDF in English version (including equations, symbols, images, flow-chart, tables, and figures etc.) will be manually/carefully translated upon your order.Diagnostic criteria for radiation skin diseases ICS 13.100 C 60 GBZ National Occupational Health Standards of the People's Republic of China Replace GBZ 106-2016, GBZ 219-2009, WS/T 475-2015 Diagnosis of occupational radiation skin diseases 2020-04-03 released 2020-10-01 implementation Issued by the National Health Commission of the People's Republic of China Table of contentsForeword...II 1 Scope...1 2 Normative references...1 3 Terms and definitions...1 4 Principles of Diagnosis...2 5 Diagnosis and treatment of acute radiation skin injury...2 6 Diagnosis and treatment of chronic radiation skin injury...3 7 Diagnosis and treatment of radiation skin cancer...4 Appendix A (informative appendix) Instructions for the correct use of this standard...5 Appendix B (informative appendix) Infrared thermal imaging technology...6 Appendix C (Informative Appendix) Treatment of Acute Radiation Skin Injury...7 Appendix D (informative appendix) Care of radiation-induced skin injury...8 Appendix E (Informative Appendix) Treatment of chronic radiation skin injury...10 Appendix F (informative appendix) TNM staging and clinical staging of skin cancer (American Joint Committee on Cancer (AJCC) Eighth Edition).11 Appendix G (informative appendix) Radiation skin cancer treatment...12Foreword5.1, 6.1, and 7.1 of this standard are mandatory, and the rest are recommended. This standard is formulated in accordance with the "Law of the People's Republic of China on Occupational Disease Prevention and Control" This standard was drafted in accordance with the rules given in GB/T 1.1-2009. This standard replaces GBZ 106-2016 "Diagnosis of Occupational Radiation Skin Injury", GBZ 219-2009 "Diagnosis of Radiation Skin Cancer" Standard" and WS/T 475-2015 "Radioactive Skin Disease Care Regulations". Compared with the above standards, the main technical changes except for editorial changes Change as follows. --- Added a normative reference document of GBZ /T 244, and revised the name of GBZ 104 (see Chapter 2, Section GBZ 106-2016) Chapter 2). -Added the definition of "body surface radionuclide contamination", revised 2 definitions, and deleted the definition of "long-term effects" (see Chapter 3, GBZ 106-2016 3.1 and 3.2, WS/T 475-2015 3.6). - In the diagnosis principle, the "exposed dose" was changed to "absorbed dose", and the "pathological examination" was changed to "histopathology" (see section Chapter 4, Chapter 4 of GBZ 106-2016, GBZ 219-2009). - In the clinical manifestations, "β-rays, low-energy X-rays" are modified to "weak penetrating radiation". (See 5.1.3, GBZ 106-2016 5.1.3). - Increased the dose threshold of weak penetrating radiation to skin damage (see 5.1.3). --The "cumulative exposure" in the diagnostic criteria for chronic radiation skin damage was revised to "chronic accumulation" (see Table 2 in 6.1.3, GBZ 106-2016 6.1.3 Table 2). - Increase the time range of the incubation period of radiation skin cancer (see 7.1.2). --Added the histopathological diagnosis of radiation skin cancer (see 7.1.3). - Modified the treatment of acute and chronic radiation skin injury, and made it an informative appendix (see Appendix C, Appendix E, GBZ 106 -2016 Appendix C, Appendix D). -Modified the staging of radiation skin cancer (see Appendix F, Appendix A of GBZ 219-2009). --Added the treatment of radiation skin cancer (see Appendix G). Drafting organizations of this standard. 307 Hospital of the Chinese People’s Liberation Army, Institute of Radiation Medicine, Chinese Academy of Medical Sciences, Public Health of Jilin University School of Health, Peking University Third Hospital, Henan Institute of Occupational Disease Prevention and Control. The main drafters of this standard. Yang Wenfeng, Liu Wenjun, Jin Zengqiang, Fu Baohua, Jiang Enhai, Liu Libo, Zhang Zhaohui, Jiang Bo, Lu Xiuling, Li Xiaona, Zhen Binbin, Yan Yi, Guo Linsen. The previous releases of GBZ 106-2016 are as follows. --GB 8282-1987, GB 8282-2000; --GBZ 106-2002. Diagnosis of occupational radiation skin diseases1 ScopeThis standard specifies the diagnosis of acute and chronic skin damage and radiation skin cancer caused by external exposure to ionizing radiation and surface radionuclide contamination. Discontinuity and processing principles. This standard is applicable to the diagnosis and treatment of skin diseases of radiation workers caused by ionizing radiation exposure.2 Normative referencesThe following documents are indispensable for the application of this document. For dated reference documents, only the dated version applies to this document. For undated references, the latest version (including all amendments) applies to this document. GBZ 96 Diagnostic criteria for internal exposure radiation sickness GBZ 104 Diagnosis of acute radiation sickness caused by occupational external exposure GBZ 105 Diagnosis of chronic radiation sickness caused by occupational external exposure GBZ /T 244 Estimation method of skin dose caused by ionizing radiation3 Terms and definitionsThe following terms and definitions apply to this document. 3.1 Acute radiation injury of skin Acute radiation dermatitis and radiation skin ulcers caused by exposure to one part of the body or multiple large doses of external radiation within a short period of time (several days) ulcer. 3.2 Chronic radiation injury of skin Local skin has been exposed to excessive dose limit for a long time, and the cumulative dose is generally greater than 15Gy. Chronic radiation dermatitis and skin caused by a few years later Ulcers can also be prolonged from acute radiation skin damage to chronic radiation dermatitis or ulcers. 3.3 Radiation skin cancer Skin cancer that occurs on the basis of skin radiation damage caused by ionizing radiation. 3.4 Protective isolation In order to prevent highly susceptible patients from being exposed to pathogenic microorganisms from other patients, medical staff, visitors and various conditions in the ward environment Infection, and the isolation measures taken. 3.5 Total environment protection Take necessary measures to achieve a high degree of purification of the internal and external environments, thereby preventing and reducing the occurrence of infections, including the space environment and the human body Two aspects of environmental purification. 3.6 Radionuclide contamination of body surface The radionuclide adheres to the surface of the human body (skin or mucous membrane), and the attached radionuclide constitutes an external source of exposure to the contaminated area. It can be absorbed into the human body through the body surface to form internal pollution and internal radiation.4 Principles of diagnosisAccording to clear occupation history, exposure history, radiation type, absorbed dose and clinical manifestations, refer to auxiliary examination, histopathology, and exclude Make a diagnosis for skin diseases caused by other factors.5 Diagnosis and treatment of acute radiation skin injury5.1 Diagnosis basis 5.1.1 Licensing history Have clear experience in relevant radiological work. Accidental exposure to radionuclides on the body surface and/or external exposure during work Accident exposure, and the experience of emergency exposure after participating in accident rescue. 5.1.2 Absorbed dose Based on the personal dosimeter worn, site dose monitoring and dose reconstruction data, the local skin absorbed dose is estimated. According to clinical Appears to estimate the local absorbed dose. Refer to GBZ /T 244 for details. 5.1.3 Clinical manifestations The classification of skin damage has its typical clinical manifestations, which are due to the type of radiation, radiation energy, absorbed dose, dose rate, exposure location, The irradiated area and the whole body condition vary. According to Table 1, especially the skin manifestations in the period of obvious clinical symptoms, and refer to the local absorbed dose value Make a graded diagnosis of damage depth. The reference dose threshold for skin damage caused by weak penetrating radiation is 2 Gy. The graded diagnosis of radiation-induced skin damage is mainly based on exposure history, absorbed dose, and gradually revealed skin manifestations, see Appendix A. 5.1.4 Auxiliary inspection After partial exposure, the application of infrared thermal imaging technology can be used as a reference basis for diagnosing the extent and scope of local damage. Infrared heat See Appendix B for imaging techniques. 5.2 Processing principles 5.2.1 Leave the radiation source immediately, and decontaminate the skin contaminated by radionuclides. 5.2.2 Measure and evaluate systemic and local absorbed doses. 5.2.3 Protect the wound to prevent trauma and local physical and chemical stimulation. For combined life-threatening damage (such as shock, trauma, suffocation and hemorrhage), It should be rescued first to maintain life. 5.2.4 When the skin damage area is large and deep, systemic treatment and corresponding nursing measures should be given. 5.2.5 Acute radiation skin injury wounds should be treated according to different levels of injury and different stages. According to the depth of damage, Area and the patient's overall condition, surgical treatment and corresponding nursing measures should be taken in due course. See Appendix C and Appendix D.6 Diagnosis and treatment of chronic radiation skin injury6.1 Diagnosis basis 6.1.1 History of exposure Have clear experience in relevant radiological work. The local skin has been exposed to radiation exceeding the annual dose limit for a long time. Acute radiation Sexual skin damage persists. 6.1.2 Absorbed dose The cumulative absorbed dose (or split dose) is greater than 15 Gy, and the dose prolonged from acute injury is greater than 5 Gy. Absorption dosimeter Refer to GBZ /T 244 for the calculation method. 6.1.3 Clinical manifestations Chronic lesions of the skin and its appendages appear after several years of exposure, and acute radiation skin injuries can be chronically changed after 6 months. skin Each degree of injury depth has its typical clinical manifestations. Diagnosis can be made according to Table 2. 6.1.4 Auxiliary inspection If necessary, perform histopathological examination. 6.2 Processing principles 6.2.1 For patients with first-degree chronic radiation skin injury, local skin should be properly protected from trauma and excessive exposure, and long-term observation should be made. 6.2.2 For patients with second-degree injury, the size and severity of the skin injury area should be considered to reduce radiation exposure or break away from radiation work, and give Active treatment. 6.2.3 Those with third degree injury should be separated from radioactive work and timely local and systemic treatment should be given. For persistent ulcers or severe skin For skin tissue hyperplasia or atrophic lesions, surgical treatment and correct nursing measures should be taken as soon as possible. See Appendix D and Appendix E.7 Diagnosis and treatment of radiation skin cancer7.1 Basis for diagnosis 7.1.1 Licensing history Have clear experience in relevant radiological work. Chronic radiation damage occurs in the local skin and cancerous transformation occurs on this basis. 7.1.2 Clinical manifestations The clinical manifestations of radiation skin cancer are as follows. a) The tumor occurs in the skin damaged by ionizing radiation and the possibility of skin metastasis is excluded. b) There is an incubation period, varying in length, generally 10 to 20 a, and the longest can be up to 30 a. c) Precancerous manifestations are chronic dermatitis, keratosis or long-term non-healing ulcers caused by radiation. d) See Appendix F for the staging and clinical manifestations of radiation skin cancer. 7.1.3 Histopathology Histopathology of the diseased skin confirmed the presence of malignant tumor cells (except for malignant melanoma), and immunohistochemistry was performed if necessary. 7.2 Processing principles The treatment of radiation skin cancer should follow the principles of early prevention, early detection and early treatment, as follows. a) Patients who have been determined to have skin tissue damage caused by ionizing radiation should work without radiation. b) Apply protective ointment to the skin damage area caused by ionizing radiation to avoid skin chapped and ulcerated. c) Surgical removal as soon as possible when there is a non-healing ulcer or obvious tumor proliferation on the skin damaged by ionizing radiation. d) Patients with chronic radiation skin damage should be followed up regularly. e) Pathological examination should be done for long-term non-healing ulcers or keratosis that occur on the skin damaged by ionizing radiation. Once pathologically diagnosed Carcinogenesis should be clearly staged and surgical treatment should be adopted as soon as possible. f) When lymph node metastasis or distant metastasis has been confirmed, a combination of surgery and medication is required, and combined immunization can be used when conditions permit Conditioner treatment. At the same time take correct care measures. See Appendix D and Appendix G.Appendix A(Informative appendix) Instructions for the correct use of this standard The diagnosis of radiation skin injury is mainly based on the exposure history of the local overdose limit, the absorbed dose, and the gradually displayed skin surface. Now, diseases such as fungal infection, flat warts, chronic eczema and other non-radioactive contact dermatitis should be excluded. The threshold of absorbed dose that causes some skin damage given in this standard is only a reference value, and its clinical scale is still based on clinical manifestations.Appendix B(Informative appendix) Infrared thermal imaging technology The principle and method of infrared thermal imaging technology is based on the amount of infrared radiation of each part of the human body, that is, the change in surface skin temperature, and The infrared camera accurately captures these infrared rays, and then converts them into images and displays them through the computer temperature measurement analysis system. Infer The degree of local damage can be determined so that a correct diagnosis can be made. The significance of infrared thermal imaging temperature change in diagnosis. a) Temperature rise during erythema and edema; b) The temperature of the necrotic area of the blister is reduced; c) The higher the temperature rise, the heavier the damage; d) The temperature change area is basically the same as the damage range. Therefore, the temperature change is related to the damage degree of the radiation dose, which can be used as one of the indicators and basis for diagnosing the damage degree and scope.Appendix C(Informative appendix) Treatment of acute radiation skin injury C.1 Systemic therapy C.1.1 Strengthen nutrition and give a diet high in protein and rich in vitamins and trace elements. C.1.2 Strengthen anti-infective measures and apply effective antibiotics. C.1.3 Give vitamin drugs. C.1.4 Give analgesic drugs. C.1.5 Pay attention to water, electrolyte and acid-base balance, and fresh blood can be transfused if necessary. C.1.6 According to the needs of the disease, various proteolytic enzyme inhibitors, free radical scavengers and drugs that increase the body's immune function can be used. C.1.7 When necessary, drugs that promote blood circulation and remove blood stasis can be used to improve microcirculation. C.1.8 If acute radiation sickness is combined with external radiation, it should be treated in accordance with GBZ 104. C.1.9 If internal pollution is combined, it should be treated in accordance with GBZ 96. C.2 Local conservative treatment C.2.1 First-degree radiation skin injury, second-degree radiation skin injury or third-degree radiation skin injury, fourth-degree radiation skin injury in the skin Before blisters appear on the skin, take care to protect the local skin. Antihistamines or corticosteroids can be used when necessary. C.2.2 When blisters occur in third-degree radiation skin damage and fourth-degree radiation skin damage, the blister fluid can be removed under strict disinfection, and it can be used Effective antibacterial topical drugs, combined with vitamin B12-containing solutions and antibacterial dressings to cover wounds, pressurized bandaging to prevent infection. C.2.3 When the blister skin is contaminated with radionuclides, it should be decontaminated first, and then the blister skin should be cut off. C.2.4 Ⅳ degree radiation skin injury, blisters rupture to form superficial ulcers, vitamin B12-containing solution can be used for external application to prevent wound infection. If secondary infection occurs on the wound, a wet compress with sensitive antibiotics can be used according to the results of bacterial culture on the wound. Surgery at the right time after entering the recovery period. C.3 Surgical treatment C.3.1 Surgical treatment should be avoided as much as possible in the acute phase, so the disease is still progressing, and it is difficult to determine the scope of the surgery. Can be done if necessary Simple necrotic tissue resection and biological dressing and free skin covering surgery. Pay attention to protecting local functions. Complete surgical treatment will be performed after the recovery period. C.3.2 Early-stage surgical treatment should be carried out for skin damage of degree IV radiation or ulcer with damage area greater than 25 cm2 located in the functional part.Appendix D(Informative appendix) Care of radiation-induced skin injury D.1 Acute radiation skin injury D.1.1 I degree injury requires close observation of the appearance and changes of hair loss and hair follicle papules on the exposed part. D.1.2 Second-degree injury requires close observation of the time of appearance of erythema and changes in color and range, and observation of skin itching, burning, and burning pain Changes, and whether the skin has symptoms such as dryness, scaling, and hair loss. Avoid mechanical irritation such as friction and scratching of the skin; avoid skin during infusion Skin injury site. D.1.3 Third-degree injury requires close observation of the changes in erythema color, itching, burning, swelling and pain in the irradiated area. Small water appears When blisters, pay attention to protect the blisters to prevent ulceration, and allow them to be absorbed naturally and shriveled; when the small blisters merge into large blisters and the blister tension gradually increases At that time, the blister fluid can be withdrawn under aseptic conditions and pressure-wrapped. When the blister fluid is turbid and there are obvious inflammatory reactions around or the blister has been ruptured, you must Cut off the blister skin to prevent aggravation of the infection. D.1.4 IV degree injury requires close observation of the extent and degree of erythema, blisters, ulcers, and tissue necrosis. For ulcers less than 3cm, follow The doctor ordered the use of anti-infective and promote epithelial cell growth drugs for local wet dressing, and gave sedative and analgesic drugs to control pain; necrosis, ulcers Those over 3 cm should be washed locally with 0.9% saline and debride if necessary. D.1.5 Persons with degree ......Tips & Frequently Asked Questions:Question 1: How long will the true-PDF of GBZ106-2020_English be delivered?Answer: Upon your order, we will start to translate GBZ106-2020_English as soon as possible, and keep you informed of the progress. The lead time is typically 1 ~ 3 working days. 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