Radiological Assessment of Dysbaric Osteonecrosis as a Part of Fitness-to-dive Examinations

Abstract

Introduction:It is important for professional divers and candidates to be medically and physically fit to undertake their underwater work safely. This study aimed to review the screening of dysbaric osteonecrosis (DON) using conventional radiography, which has been stated in the legislation as part of fitness-to-dive examinations, in terms of international standards and scientific facts.Methods:Data on clinical, demographic, laboratory, and radiological evaluations were retrospectively collected for 46 professional divers or candidates who were referred for fitnessto- dive examinations between 2018 and 2020. The approach of the Professional Divers Regulation to DON was compared with that of the Military Health Regulation for the Turkish Armed Forces and the Turkish Underwater Sports Federation Equipped Diving Instruction, as well as that of the legislation of United Kingdom and European Diving Technology Committee standards.Results:Forty-six divers (males: n=45; female: n=1) were enrolled in the study. Their median age was 34 (range: 18-63) years, and the mean body mass index was 25.42 kg/m2. The prevalence of DON was 2.17% in the study group. Compared with the national and international legislations, Professional Diver Regulation was the only regulation that mandated radiological evaluation for DON in both the initial and periodic fitness-to-dive examinations.Conclusion:One of the aims of regulations is that medical fitness-to-dive standards should be evidence-based and compatible with contemporaneous clinical practice. By the 2000s, attitudes toward DON, fitness to continue diving, and compressed air work have changed in Europe. In light of the findings of the present study, we believe that it is time for a critical reappraisal of the Professional Divers Regulation.

Keywords

• dysbaric osteonecrosis
• fitness-to-dive examinations
• radiology