Laney-AS; Petsonk-EL; Attfield-MD
Chest 2011 Dec; 140(6):1574-1580
BACKGROUND: Digital radiography systems are replacing traditional film for chest radiographic monitoring in the recognition of pneumoconiosis. METHODS: To further investigate previous findings regarding the equivalence of film screen radiographs (FSR) and storage phosphor computed radiographs (CR), FSR and CR from 172 underground coal miners were classified independently by seven NIOSH-approved B Readers, using the International Labour Office (ILO) classification of radiographs of pneumoconiosis. RESULTS: More CR were classified as "good" quality compared to FSR (prevalence ratio (PR) =1.5; 95% CI, 1.4-1.6; P<0.001). B Readers showed good overall agreement on scoring small opacity profusion using CR versus FSR, (weighted kappa =0.58, 95% CI 0.54-0.62). Significantly more irregular opacities (compared to rounded) were classified using CR images compared to FSR (PR=1.3; 95% CI=1.1-1.6; P=0.01). Similarly, the smallest size opacities (width <1.5 mm, p and s-type) were reported more frequently using CR vs. FSR images (PR=1.3; 95% CI= 1.1-1.5; P<0.001). Inter- and intra-reader agreement was lower with respect to the classification of shape/size than for small opacity profusion. Overall, inter- and intra-reader variability did not significantly differ using CR versus FSR. CONCLUSIONS: Under optimal conditions using standardized methods and equipment, reader visualization of small pneumoconiotic opacities does not appear to meaningfully differ whether using CR or FSR. Variability in ILO classifications between imaging modalities appears considerably less than variability between readers. The well-documented challenge of reader variability does not appear to be resolved through the use of digital imaging alone, and additional approaches must be evaluated.
Respiratory-system-disorders; Diagnostic-techniques; Diagnostic-tests; Chest-X-rays; Radiographic-analysis; Radiography; Pneumoconiosis; Coal-workers-pneumoconiosis; X-ray-analysis; X-ray-diagnosis; X-ray-equipment; Medical-monitoring; Surveillance-programs; Underground-miners; Coal-miners; Lung; Lung-disease; Quality-control; Quality-standards
National Institute for Occupational Safety and Health, Division of Respiratory Disease Studies, Surveillance Branch, Mail Stop HG900.2, 1095 Willowdale Road, Morgantown, WV 26505-2888