Radiologists better at identifying lung disease
Radiologists better at identifying lung disease
Journal article urges continued involvement
When it comes to identifying potential cases of occupational lung disease on radiographic examinations, radiologists appear to do a better job than occupational health professionals. That’s the news in a report to be published soon in the American Journal of Roentgenology.
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 the report.
The authors called 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 to occupational medicine professionals, internists, pulmonary specialists, and other physicians, radiologists lead the field by more than 10% with a 66% pass rate on the recertification exam for the International Union Against Cancer/Cincinnati system. Pulmonologists pass at a 54% rate, while the other specialists hovered at a mid-40s percentage rate.
Jerome Wiot, MD, of the department of radiology at the University of Cincinnati Hospital, teamed with medical historian Otha Linton to inform radiologists in their article, "The radiologist and occupational lung disease: An appeal for continued involvement." They quote University of Pennsylvania researcher Eugene Pendergrass’ 1958 statement, "If we as radiologists do not do the job, others will." Wiot and Linton, however, added to the statement: "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, in 1970, the National Institute for Occupational Safety and Health of the U.S. Public Health Service 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 in 1984 by a recertification exam with recertification required every four years.
Those completing the many courses offered over the years are certified as "A" readers. Those passing the exam are certified as "B" readers. Today most interpretation of radiographs for occupational lung disease is 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 asserted 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."
(The American Journal of Roentgenology is a monthly publication of Leesburg, VA-based American Roentgen Ray Society, the first and oldest radiological society in America.)
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