Radiographic diagnosis of Pneumoconioses by AIR Pneumo-trained physicians: Comparison with low-dose thin-slice computed tomography

Our plain-English summary of Radiographic diagnosis of Pneumoconioses by AIR Pneumo-trained physicians: Comparison with low-dose thin-slice computed tomography, by S. Nogami, N.A. J-P, M. Nogami, et al (Journal of Occupational Health, 2020).

The study

• Authors: S. Nogami, N.A. J-P, M. Nogami, T. Matsui, N.R. Ngatu, T. Tamura, Y. Kusaka, H. Itoh, N. Suganuma
• Journal: Journal of Occupational Health
• Published: 2020;62(1):e12141
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: The Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) is a training program designed to improve diagnostic skills for chest radiographies (CXRs) in accordance with the ILO/ICRP 2000. The purpose was to determine the prevalence of occupational environmental pulmonary disease findings in construction workers on thin-slice computed tomography (thin-slice CT), and to compare the diagnostic performance with CXR evaluated by AIR Pneumo-trained physicians.

Methods: Ninety-seven male construction workers underwent low-dose thin-slice CT and CXR on the same day. NIOSH B reader and a board-certified radiologist each interpreted the thin-slice CTs independently. The concordant findings on thin-slice CT were established as the reference standard and were statistically compared with CXRs. Four physicians interpreted CXRs independently according to the ILO/ICRP 2000.

Results: Of the 97 cases, nine showed irregular or linear opacities, and 44 had pleural plaques on thin-slice CT. Five, four, three, and two of nine cases with irregular opacity were detected by the four readers on CXRs, respectively. Sixteen, 14, 9, and 5 of the 44 cases with pleural plaques were detected by the four readers, respectively. Specificities for irregular opacities ranged from 94% to 100%, and those for pleural plaques were from 86% to 96%.

Conclusions: Thin-slice CT-detected irregular opacity was found in 9.3%, whereas pleural plaque was found in 45.4% among the construction workers. Chest radiography showed acceptable performance in classifying pneumoconiotic opacities according to ILO/ICRP 2000 by the AIR Pneumo and/or NIOSH-certified physicians.

© 2020 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.

In plain English

This study included 97 male construction workers in Japan. In 2005 to 2006 each had a low-dose thin-slice CT scan and a chest X-ray on the same day during a lung cancer screening program at the University of Fukui. Two specialists read the CT scans separately, and the findings they agreed on served as the reference. Four physicians read the X-rays using the ILO classification: one NIOSH B reader and three AIR Pneumo-trained physicians. On CT, 9 workers had irregular or linear lung opacities and 44 had pleural plaques. On X-ray, the four readers found opacities in 5, 4, 3 and 2 of those 9 workers, and plaques in 16, 14, 9 and 5 of those 44 workers. Small plaques and subtle opacities were missed. For workers without these findings on CT, the readers correctly read the X-ray as negative 94% to 100% of the time for opacities and 86% to 96% for plaques. The authors concluded that chest X-rays read by these trained physicians showed acceptable performance in classifying pneumoconiotic opacities under the ILO system. They noted few positive cases, possible selection bias and few readers.

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: Diagnostic comparison study: chest radiographs read by four physicians were compared against low-dose thin-slice CT readings used as the reference standard
• Who was studied: 97 male construction workers (current or former carpenters), aged 49 to 77 (average 61.8), examined 2005 to 2006 in a low-dose CT lung cancer screening program for a construction workers' association at the University of Fukui, Japan
• Exposure: Work as construction workers. The authors described the group as having mild exposure to asbestos and other dusts. No fiber types, products or doses were measured or reported.
• Main results:
  • On thin-slice CT, 9 of 97 workers (9.3%) had irregular or linear opacities
  • On thin-slice CT, 44 of 97 workers (45.4%) had pleural plaques
  • On CT, 18 workers had emphysema
  • Of the 9 workers (cases) with irregular opacity on CT, readers A, B, C and D detected opacities on chest X-ray in 5, 4, 3 and 2 of them
  • Specificity for irregular opacities ranged from 94% to 100% across the four readers, with no statistically significant difference between readers
  • Sensitivity for irregular opacities tended to rise with reader experience, but the difference was not statistically significant because there were few positive cases
  • Of the 44 workers (cases) with pleural plaques on CT, the four readers detected plaques in 16, 14, 9 and 5 of them
  • For pleural plaques, the sensitivity of reader A (NIOSH B reader, 36.4%) was significantly higher than that of reader C (20.5%, P = .016) and reader D (11.4%, P = .010)
  • Specificity for pleural plaques ranged from 86% to 96%, with no statistically significant difference between readers
  • Small plaques and subtle irregular opacities seen on CT were missed on chest X-ray
  • On chest X-ray, a rib fracture (1 case) and pleuritis (4 cases) were wrongly read as pleural lesions
• The authors' conclusion: The authors concluded that chest X-ray, classified according to ILO/ICRP 2000 by AIR Pneumo-trained and/or NIOSH-certified physicians, showed acceptable performance in classifying pneumoconiotic opacities
• Limitations the authors state:
  • Few workers had positive findings, which limited the statistical comparison of sensitivity between readers
  • Possible selection bias: volunteers may have had more abnormalities than construction workers in general
  • Only a small number of physicians read the chest X-rays, so the results may not reflect physicians in general clinical practice

Topics

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, NIOSH, 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)
• Screening of miners and millers at decreasing levels of asbestos exposure: comparison of chest radiography and thin-section computed tomography — M. Terra-Filho, E. Bagatin, et al. (2015)
• Relationships (I) of International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases with the ILO International Classification of Radiographs of Pneumoconioses for parenchymal abnormalities — T. Tamura, N. Suganuma, et al. (2015)
• 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)
• Comparison of digital with film radiographs for the classification of pneumoconiotic pleural abnormalities — T.C. Larson, D.B. Holiday, et al. (2012)
• 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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