[Judgement of fitness to work and forensic-medical aspects]

The occupational physician, specifically trained in radiation protection, has to consider different criteria, such as psycho-physical ability, biological fitness and worker's validity to formulate judgement of fitness to work in exposure to ionizing radiation (IR). According to National Legislations (D.Lgs. 230/95; DM 488/2001), there are different possible outcomes about fitness to work criteria: absolutely fit to work, partially fit to work, not fit to work and medical examination before workers exposed to IR's retirement; besides, the occupational physician has to pay particular attention to evaluate individual hypersusceptibility conditions. Stochastic somatic diseases require a "not fit to work" judgement, an occupational disease complaint to the Insurance Institute and a report obligation. Forensic-medical ascertainment of diseases caused by radiation exposure needs different criteria, particularly for stochastic effects. The most suitable criterion, applied to attribute etiologic role in stochastic effects, is "Probability of Causation" theory, deriving from scientific literature evidence. This theory is an epidemiology-based method conceived to evaluate the probability of a linkage between a specified cancer and an exposure. Judgement of fitness to work in case of neoplasia partial or complete remission should be based on objective considerations, giving particular importance to the human and social aspects.