Asian Intensive Reader of Pneumoconiosis program: examination for certification during 2008-2020

Our plain-English summary of Asian Intensive Reader of Pneumoconiosis program: examination for certification during 2008-2020, by N.A. J-P, A.D. Susanto, E. Samoedro, et al (Industrial Health, 2024).

The study

• Authors: N.A. J-P, A.D. Susanto, E. Samoedro, M. Mansyur, S. Tungsagunwattana, S. Lertrojanapunya, P. Subhannachart, S. Siriruttanapruk, N. Dumavibhat, E. Algranti, J.E. Parker, K.G. Hering, H. Kanayama, T. Tamura, Y. Kusaka, N. Suganuma
• Journal: Industrial Health
• Published: 2024;62(2):143-152
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This study examined physicians' participation and performance in the examinations administered by the Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) program from 2008 to 2020 and compared radiograph readings of physicians who passed with those who failed the examinations. Demography of the participants, participation trends, pass/fail rates, and proficiency scores were summarized; differences in reading the radiographs for pneumoconiosis of physicians who passed the examinations and those who failed were evaluated. By December 2020, 555 physicians from 20 countries had taken certification examinations; the number of participants increased in recent years. Reported background specialty training and work experience varied widely. Passing rate and mean proficiency score for participants who passed were 83.4% and 77.6 ± 9.4 in certification, and 76.8% and 88.1 ± 4.5 in recertification examinations. Compared with physicians who passed the examinations, physicians who failed tended to classify test radiographs as positive for pneumoconiosis and read a higher profusion; they likely missed large opacities and pleural plaques and had a lower accuracy in recognizing the shape of small opacities. Findings suggest that physicians who failed the examination tend to over-diagnose radiographs as positive for pneumoconiosis with higher profusion and have difficulty in correctly identifying small opacity shape.

In plain English

This field report reviewed records from the Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) program, which trains and tests physicians in reading chest X-rays for dust-related lung disease using the International Labour Office (ILO) classification system. Between 2008 and 2020, 555 physicians from 20 countries took the examinations, in which they classified 60 test radiographs, 9 of which showed pleural plaques. The certification analysis included 543 physicians and the recertification analysis included 69. The pass rate was 83.4% (453 out of 543) for certification and 76.8% (53 out of 69) for recertification. Physicians who failed labelled more normal radiographs as showing pneumoconiosis than those who passed: 33% versus 10.6% in certification, and 19.1% versus 2.6% in recertification. Those who failed also tended to read a higher profusion (concentration) of small opacities. They more often overlooked large opacities and pleural plaques, and less often recognized irregular-shaped small opacities. The authors concluded that physicians who failed tended to over-diagnose pneumoconiosis and had difficulty identifying small opacity shape. They said further studies are needed to evaluate the program's effectiveness.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Field report: retrospective analysis of examination records (participant questionnaires, reading records and test scores) from a physician training and certification program
• Who was studied: Physicians who took AIR Pneumo certification or recertification examinations from December 2008 to December 2020: 555 physicians from 20 countries, mostly in Asia (Indonesia 31.1%, Thailand 22.5%). After excluding 12 physicians who left 6 or more test radiographs unclassified on their first attempt, 543 were included in the certification analysis. Records of 69 physicians taking recertification for the first time were used. 114 (21.0%) reported never having reviewed a pneumoconiosis chest radiograph.
• Exposure: Not a study of dust or fiber exposure. Physicians classified a set of 60 test chest radiographs under the ILO classification, compared against the readings of an expert panel of 12 B Readers. The set comprised 20 without nodular or reticular lesions, 9 boundary cases and 31 with small opacities (20 pure rounded, 4 pure irregular, 9 also with large opacities). Nine radiographs showed pleural plaques.
• Main results:
  • Pass rate in the certification examination was 83.4% (453 out of 543 physicians); 90 (16.6%) failed.
  • Pass rate in the recertification examination was 76.8% (53 out of 69). Mean total score for those who passed was 77.6 ± 9.4 in certification and 88.1 ± 4.5 in recertification (out of 100).
  • Physicians who failed incorrectly classified 33% (certification) and 19.1% (recertification) of normal radiographs as positive for pneumoconiosis; the corresponding figures for physicians who passed were 10.6% and 2.6%.
  • Compared with physicians who passed, physicians who failed had significantly higher false-positive and false-negative rates in identifying small opacities, large opacities and pleural plaques. The exception was the false-positive rate for large opacities in the recertification examination.
  • Physicians who failed the certification examination had a mean pleural plaque accuracy score of 5.7 out of 15 points (versus 10.4 for those who passed).
  • Physicians tended to read a higher small opacity profusion than the expert panel, particularly those who failed. All physician groups differed significantly from the expert panel's profusion classification (p less than 0.001).
  • On the 4 radiographs with pure irregular opacities, 70.9% (95% CI 68.8 to 73.0) of physicians who passed certification classified the shape as irregular, versus 44.6% (39.4 to 49.9) of those who failed. In recertification the figures were 82.4% for those who passed and 81.3% for those who failed.
• The authors' conclusion: The authors concluded that the number of physicians taking initial certification has increased in recent years. Physicians who failed were more likely to classify radiographs as positive for pneumoconiosis and to read higher small opacity profusion, and tended to overlook or not recognize pleural plaques and to misclassify irregular-shaped small opacities. They called for efforts to increase the number of competent ILO classification readers in developing countries.
• Limitations the authors state:
  • The authors state that further studies are required to evaluate the effectiveness of the AIR Pneumo program.

Topics

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, Pleural Plaques.

Related studies

• Inter-observer agreement and accuracy in classifying radiographs for pneumoconiosis among Asian physicians taking AIR Pneumo certification examination — N.A. J-P, A.D. Susanto, et al. (2022)
• Assessment of physicians' proficiency in reading chest radiographs for pneumoconiosis, based on a 60-film examination set with two factors constituting eight indices — T. Tamura, Y. Kusaka, et al. (2018)
• Radiographic diagnosis of Pneumoconioses by AIR Pneumo-trained physicians: Comparison with low-dose thin-slice computed tomography — S. Nogami, N.A. J-P, et al. (2020)
• Variability in interpretation among B-readers in the U.S. Navy Asbestos Medical Surveillance Program — J.G. Muller, J.M. Lieske, et al. (2008)
• Talc pneumoconiosis: a report of six patients with postmortem findings — M. Kleinfeld, C.P. Giel, et al. (1963)
• Effect of a two-hour training on physicians' skill in interpreting Pneumoconiotic chest radiographs — N.R. Ngatu, S. Suzuki, et al. (2010)

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