Radiologists Taking Lead in Occupational Lung Disease

July 21, 2000

New York (MedscapeWire) Jul 21 — Radiologists do better than other professionals on the examination given to those vying to be certified or recertified readers of radiographs for potential occupational lung disease patients, according to a commentary published in the August issue of the American Journal of Roentgenology. The authors call for radiologists to take the lead as the most qualified experts in interpreting chest x-rays to detect such illnesses as coal miner's disease and asbestosis.

Compared with internists, specialists in occupational medicine, pulmonary specialists, and other physicians, radiologists lead the field by more than 10% with a 66% pass rate on the recertification examination for the International Union Against Cancer/Cincinnati system. Pulmonary doctors pass at a 54% rate, while the other specialists hovered at a mid 40s percentage rate.

Dr. Jerome F. Wiot of the Department of Radiology at the University of Cincinnati Hospital in Ohio teamed with medical historian Otha Linton to inform radiologists in their article. They quote Eugene Pendergrass' 1958 statement, "If we as radiologists do not do the job, others will." Wiot and Linton add to the statement, however, "And less well."

The International Union Against Cancer/Cincinnati System was introduced by a coalition of concerned groups in 1968 to answer the need for classification standards for diagnosing the diseases among coal miners, asbestos workers, and those exposed to silica dust. In 1969, Congress passed the Coal Mine Health and Safety Act, which provided for a chest x-ray for all active and retired miners to be classified using the Cincinnati system. Because so few physicians, including radiologists, knew of the classification system, the National Institute for Occupational Safety and Health of the US Public Health Service in 1970 asked the American College of Radiology to develop a method to teach physicians the classification system and to identify occupational lung disease early. Courses were developed, and in 1976, a certification examination was implemented, followed 8 years later by a recertification examination with recertification required every 4 years.

Those completing the many courses that have been offered over the years are certified as A readers. Those passing the examination are certified as B readers. Today most interpretation of radiographs for occupational lung disease is performed by certified B readers.

A study cited in the article shows that B reader-certified nonradiologists have a greater tendency to overread or interpret with false-positive findings than certified radiologists. Wiot and Linton assert that "a lack of experience in evaluating the subtleties and variabilities of chest radiographs related to technique, age, body build, and residual changes from previous nonoccupational related diseases remains a major problem."

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