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NIOSH Safety and Health Topic:Chest Radiography |
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BackgroundNeed for a Reader Proficiency Program In 1949, the International Labour Office (ILO) promulgated standards for systematically describing and recording radiographic appearances of certain abnormalities provoked by the inhalation of dusts. The principle intent of the standards was to achieve uniformity in assessing pneumoconiosis across readers. However, it was found that readers, despite employing the classification scheme, still disagreed with each other and with themselves to an excessive degree (Felson 1973). As a consequence, NIOSH concluded that a proficiency program was needed to provide a pool of qualified readers. The NIOSH B Reader Program began in 1974, although it was not until 1978 that the B reader examination was given extensively (Attfield 1992). Objective of the B Reader Program The B Reader examination was originally developed to identify physicians qualified to serve in national pneumoconiosis programs directed at coal miners and others who suffer from dust-related illness. This originally included epidemiologic research on coal workers’ pneumoconiosis and the compensation of coal miners with pneumoconiosis under programs processed by government agencies (Morgan 1979). The original intent of the B Reader Program still exists, but B Readers are also now involved with epidemiologic evaluation, surveillance, and worker monitoring programs involving many types of pneumoconioses. The B Reader Program aims to ensure competency in radiographic reading by evaluating the ability of readers to classify a test set of radiographs, thereby creating and maintaining a pool of qualified readers having the skills and ability to provide accurate and precise ILO classifications. B Reader Applications B Readers, through their demonstrated proficiency in classifying radiographs of the pneumoconioses, are appropriate choices for research, surveillance, and worker monitoring programs and activities. NIOSH has employed B Readers in many epidemiologic and other research studies for nearly 30 years, as have many other organizations. Physicians who classify chest radiographs for certain federal surveillance may be required to be B Readers. For example, in the NIOSH Coal Workers’ X-ray Surveillance Program, physicians who classify radiographs for the program are required to be B Readers for the second and any later readings of each radiograph (42 CFR 37 external link). The Asbestos Medical Surveillance Program (external link), administered by the Navy Environmental Health Center, requires that the second reader of each radiograph be a B Reader. B Readers also have important roles to play in epidemiologic research, government programs, and contested proceedings. Use of B Readers alone is not sufficient for adequate data quality. Their use should be augmented by the adoption of good technical practices to provide information of the highest quality. Becoming a B ReaderExam Description and Approval Process The examination consists of the classification of 125 chest radiographs over a period of 6 hours. The test is scored on the basis of a total possible score of 100 points, with a passing score being 50 or more points. There are six sections to the examination: small opacities (3 sections), large opacities, pleural abnormalities, and other abnormalities. Scoring is weighted towards parenchymal abnormalities (60%). From 1987 to 1990, about 47% of readers passed the examination. An individual who fails the examination must wait six months before retaking it (Wagner 1993). B readers must be retested every four years to retain their status (see Maintaining B Reader Status below). Reader Training NIOSH strongly recommends pre-test preparation for examination participants to assure familiarity with the ILO Classification System and associated Roentgenographic Interpretation Form. NIOSH Home Self-Study Syllabus The Syllabus, which includes the associated film study set, is available by mail in the U.S. on a first-come, first-served basis from the Appalachian Laboratory for Occupational Safety and Health (ALOSH) prior to scheduled testing. Additionally, the Syllabus may be used on-site by anyone interested in coming to Morgantown to study prior to taking the examination. To request the Syllabus, call (888) 480-4042 or email CWXSP@cdc.gov. American College of Radiology Symposium on Pneumoconioses The American College of Radiology (ACR) Symposium on Radiology of the Pneumoconioses is usually held every 2-3 years. The ACR offers testing during their symposiums. For more information on ACR symposiums, please visit their Web site at American College of Radiology (external link). Calendar of Events Examinations are offered monthly at ALOSH. For scheduled dates, please call (888) 480-4042 or email CWXSP@cdc.gov. * See B Reader Information for Medical Professionals for more information. Maintaining B Reader statusReaders must retest every four years to maintain their B Reader status; testing can be done any time within the fourth year. The retest is very much like the original approval examination, except readers are required to classify only fifty radiographs. A reader who fails the retest must take and pass the original approval examination before the end of their four-year approval period expires in order retain their B Reader status. There is no waiting period between failing the retest and taking the original approval examination. B Readers who do not retest before expiration of their approval automatically become A Readers. New Developments Impacting the B Reader ProgramDigital Radiography Conventional film screen chest radiography has been widely applied in assessing lung health in dust-exposed workers for decades, but this technique is being replaced by digital radiography systems. NIOSH is currently assessing the equivalency of traditional radiography and digital radiography with respect to pneumoconiosis classification using conventional and digital images from patients with a spectrum of dust-related lung disorders and chest pathology. See Digital Radiography on the B Reader Information for Medical Professionals page for more information. 2000 ILO Revisions The ILO revised its Classification System in 2000 and published updated Guidelines in 2002. To assure adherence to this new system, NIOSH has modified the B Reader examinations and related training activities and materials, including the Self-Study Syllabus. See New ILO Revisions on the B Reader Information for Medical Professionals page for more information. Syllabus on Compact Disc NIOSH is working to put the entire Self-Study Syllabus on CD or DVD to increase availability of the Syllabus to each test taker. Comments or ConcernsComments or Concerns about the B Reader Program The B Reader Program welcomes any comments or concerns about the Program, the examination, or this Web site. Our goal is to serve all persons who interact with this Program and continuously improve the information that we provide. Please use any of the following contact methods: Call the Program office at (888) 480-4042 Email us at CWXSP@cdc.gov Mail the Program at: ALOSH/NIOSH Comments or Concerns about Specific B Readers The purpose of the B Reader Program is to train licensed physicians in use of the ILO Classification System and to assess their ability to apply the ILO Classification System in classifying chest radiographs for the presence and severity of changes potentially associated with exposure to dusts such as asbestos, silica, and coal mine dust. Use of a medical license in order to commit fraud is a violation of the conditions that accompany the medical license. Therefore, complaints about a specific B Reader should be referred to the appropriate State medical licensing board, as these boards are the bodies responsible for assuring the competence and integrity of licensed physicians. Contact information for each State’s medical licensing board can be found on the Federation of State Medical Boards Web site (external link). ReferencesFelson B, Morgan WKC, Bristol LJ, et al. Observations on the results of multiple readings of chest films in coal miners' pneumoconiosis. Radiology 1973;109:19-23. Attfield MD, Morring K. An investigation into the relationship between coal workers’ pneumoconiosis and dust exposure in U.S. coal miners. Am Ind Hyg Assoc J 1992; 53:486-92. Morgan RH. Proficiency examination of physicians for classifying pneumoconiosis chest films. Am J Roentgenology 1979;132:803-08. Wagner GR, Attfield MD, Parker JE. Chest Radiography in Dust-Exposed Miners: Promise and Problems, Potential and Imperfections. Occupational Medicine: State of the Art Reviews 8(1); 127-141, 1993. More InformationFederal Mine Safety and Health Act of 1977, Public Law 91-173 Specifications for Medical Examinations of Underground Coal Miners. 42 CFR 37 Asbestos Medical Surveillance Program. Navy Environmental Health Center Safety and Health Topics: Asbestos. Occupational Safety and Health Administration NIOSH Coal Workers’ Health Surveillance Program Roentgenographic Interpretation Form. NIOSH B Reader Program American College of Radiology Federation of State Medical Boards
Page last updated:
February 22, 2008
Page last reviewed: March 6, 2008 Content Source: National Institute for Occupational Safety and Health (NIOSH) |
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NIOSH B Reader Program
