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

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.

Inter-observer agreement and accuracy in classifying radiographs for pneumoconiosis among Asian physicians taking AIR Pneumo certification examination.

This study examined inter-observer agreement and diagnostic accuracy in classifying radiographs for pneumoconiosis among Asian physicians taking the AIR Pneumo examination. We compared agreement and diagnostic accuracy for parenchymal and pleural lesions across residing countries, specialty training, and work experience using data on 93 physicians. Physicians demonstrated fair to good agreement with kappa values 0.30 (95% CI: 0.20-0.40), 0.29 (95% CI: 0.23-0.36), 0.59 (95% CI: 0.52-0.67), and 0.65 (95% CI: 0.55-0.74) in classifying pleural plaques, small opacity shapes, small opacity profusion, and large opacities, respectively. Kappa values among Asian countries ranging from 0.25 to 0.55 (pleural plaques), 0.47 to 0.73 (small opacity profusion), and 0.55 to 0.69 (large opacity size). The median Youden's J index (interquartile range) for classifying pleural plaque, small opacity, and large opacity was 61.1 (25.5), 76.8 (29.3), and 88.9 (23.3), respectively. Radiologists and recent graduates showed superior performance than other groups regarding agreement and accuracy in classifying all types of lesions. In conclusion, Asian physicians taking the AIR Pneumo examination were better at classifying parenchymal lesions than pleural plaques using the ILO classification. The degree of agreement and accuracy was different among countries and was associated with background specialty training.

Assessment of physicians' proficiency in reading chest radiographs for pneumoconiosis, based on a 60-film examination set with two factors constituting eight indices.

Two hundred and thirty-three individuals read chest x-ray images (CXR) in the Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) workshop. Their proficiency in reading CXR for pneumoconiosis was calculated using eight indices (X1-X8), as follows: sensitivity (X1) and specificity (X2) for pneumoconiosis; sensitivity (X3) and specificity (X4) for large opacities; sensitivity (X5) and specificity (X6) for pleural plaques; profusion increment consistency (X7); and consistency for shape differentiation (X8). For these eight indices, one-way analysis of variance (ANOVA) and Scheffe's multiple comparison were conducted on six groups, based on the participants' specialty: radiology, respiratory medicine, industrial medicine, public health, general internal medicine, and miscellaneous physicians. Our analysis revealed that radiologists had a significant difference in the mean scores of X3, X5, and X8, compared with those of all groups, excluding radiologists. In the factor analysis, X1, X3, X5, X7, and X8 constituted Factor 1, and X2, X4, and X6 constituted Factor 2. With regard to the factor scores of the six participant groups, the mean scores of Factor 1 of the radiologists were significantly higher than those of all groups, excluding radiologists. The two factors and the eight indices may be used to appropriately assess specialists' proficiency in reading CXR.

Relationships (II) of International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases with ventilatory functions indices for parenchymal abnormalities.

The International Classification of High-Resolution Computed Tomography (HRCT) for Occupational and Environmental Respiratory Diseases (ICOERD) is used to screen and diagnose respiratory illnesses. Using univariate and multivariate analysis, we investigated the relationship between subject characteristics and parenchymal abnormalities according to ICOERD, and the results of ventilatory function tests (VFT). Thirty-five patients with and 27 controls without mineral-dust exposure underwent VFT and HRCT. We recorded all subjects' occupational history for mineral dust exposure and smoking history. Experts independently assessed HRCT using the ICOERD parenchymal abnormalities (Items) grades for well-defined rounded opacities (RO), linear and/or irregular opacities (IR), and emphysema (EM). High-resolution computed tomography showed that 11 patients had RO; 15 patients, IR; and 19 patients, EM. According to the multiple regression model, age and height had significant associations with many indices ventilatory functions such as vital capacity, forced vital capacity, and forced expiratory volume in 1 s (FEV1). The EM summed grades on the upper, middle, and lower zones of the right and left lungs also had significant associations with FEV1 and the maximum mid-expiratory flow rate. The results suggest the ICOERD notation is adequate based on the good and significant multiple regression modeling of ventilatory function with the EM summed grades.

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.

The International Classification of High-resolution Computed Tomography (HRCT) for Occupational and Environmental Respiratory Diseases (ICOERD) has been developed for the screening, diagnosis, and epidemiological reporting of respiratory diseases caused by occupational hazards. This study aimed to establish a correlation between readings of HRCT (according to the ICOERD) and those of chest radiography (CXR) pneumoconiotic parenchymal opacities (according to the International Labor Organization Classification/International Classification of Radiographs of Pneumoconioses [ILO/ICRP]). Forty-six patients with and 28 controls without mineral dust exposure underwent posterior-anterior CXR and HRCT. We recorded all subjects' exposure and smoking history. Experts independently read CXRs (using ILO/ICRP). Experts independently assessed HRCT using the ICOERD parenchymal abnormalities grades for well-defined rounded opacities (RO), linear and/or irregular opacities (IR), and emphysema (EM). The correlation between the ICOERD summed grades and ILO/ICRP profusions was evaluated using Spearman's rank-order correlation. Twenty-three patients had small opacities on CXR. HRCT showed that 21 patients had RO; 20 patients, IR opacities; and 23 patients, EM. The correlation between ILO/ICRP profusions and the ICOERD grades was 0.844 for rounded opacities (p<0.01). ICOERD readings from HRCT scans correlated well with previously validated ILO/ICRP criteria. The ICOERD adequately detects pneumoconiotic micronodules and can be used for the interpretation of pneumoconiosis.

Is it useful to combine sputum cytology and low-dose spiral computed tomography for early detection of lung cancer in formerly asbestos-exposed power industry workers?

BACKGROUND: Low-dose spiral computed tomography (LDSCT) in comparison to conventional chest X-ray proved to be a highly sensitive method of diagnosing early stage lung cancer. However, centrally located early stage lung tumours remain a diagnostic challenge. We determined the practicability and efficacy of early detection of lung cancer when combining LDSCT and sputum cytology. METHODS: Of a cohort of 4446 formerly asbestos exposed power industry workers, we examined a subgroup of 187 (4.2%) high risk participants for lung cancer at least once with both LDSCT and sputum cytology. After the examination period the participants were followed-up for more than three years. RESULTS: The examinations resulted in the diagnosis of lung cancer in 12 participants (6.4%). Six were in clinical stage I. We found 10 non-small cell lung carcinomas and one small cell lung carcinoma. Sputum specimens showed suspicious pathological findings in seven cases and in 11 cases the results of LDSCT indicated malignancies. The overall sensitivity and specificity of sputum cytology was 58.0% and 98% with positive (PPV) and negative (NPV) predictive values of 70% and 97%. For LDSCT we calculated the sensitivity and specificity of 92% and 97%. The PPV and NPV were 65% and 99% respectively. CONCLUSIONS: Our results confirmed that in surveillance programmes a combination of sputum cytology and LDSCT is well feasible and accepted by the participants. Sputum examination alone is not effective enough for the detection of lung cancer, especially at early stage. Even in well- defined risk groups highly exposed to asbestos, we cannot recommend the use of combined LDSCT and sputum cytology examinations as long as no survival benefit has been proved for the combination of both methods. For ensuring low rates of false-positive and false-negative results, programme planners must closely cooperate with experienced medical practitioners and pathologists in a well-functioning interdisciplinary network.

Evaluation of the efficacy of the guideline on reading CT images of malignant pleural mesothelioma with reference CT films for improving the proficiency of radiologists.

PURPOSE: To assess the efficacy of the developed guideline on reading CT images of malignant pleural mesothelioma for improving radiologists' reading proficiency. MATERIALS AND METHODS: Three radiologists independently read the CT films of 22 cases including definite mesothelioma and non-mesothelioma cases at two times before and after studying the malignant pleural mesothelioma CT Guideline. The sensitivity and specificity for mesothelioma were calculated and compared between the 1st and 2nd trials. The kappa statistics was examined for agreement with experts for mesothelioma probability and for mesothelioma features recorded by three radiologists. RESULTS: After studying the mesothelioma CT Guideline, the sensitivity for mesothelioma shown by the three radiologists at the 2nd trial was 100%, 100% and 80%, which were higher than 80%, 85% and 60% at the 1st trial, respectively. The average kappa for agreement between radiologists and experts on dichotomized mesothelioma probability were 0.69 (good) at the 2nd trial vs. 0.38 (fair) at the 1st trial. The average kappa for the agreement with experts for each of 7 features by three radiologists were 0.52-0.80 at the 2nd trial, which were significantly higher than 0.34-0.58 at the 1st trial (Wilcoxon Signed Rank Test: P<0.01), and as to five features "unilateral pleural effusion", "nodular pleural thickening", "tumoral encasement of lung", "mediastinal pleural thickening", and "diminished lung", they achieved good agreement with average kappa of 0.61-0.80. CONCLUSION: The developed mesothelioma CT Guideline was suggested to have substantial effect in improving the radiologists' proficiency for reading CT images of mesothelioma, and may contribute to accurate diagnosis of mesothelioma.

Development of a guideline on reading CT images of malignant pleural mesothelioma and selection of the reference CT films.

PURPOSE: International experts developed a guideline on reading CT images of malignant pleural mesothelioma for radiologists and physicians. It is intended that it act as a supplement to the current International Classification of HRCT for Occupational and Environmental Respiratory Diseases. METHODS: The research literatures on mesothelioma CT features were systematically reviewed. Ten mesothelioma CT features were adopted into the guideline prepared according to experts' opinion. The terminology of mesothelioma CT features and mesothelioma probability were agreed by consensus of experts. The CT reference films for each mesothelioma feature were selected based on agreement by experts from 22 definite mesothelioma cases confirmed pathologically and immunohistochemically. To support the validity of the mesothelioma probability, 4 experts' readings of CT films from 57 cases with or without mesothelioma were analyzed by kappa statistics between the experts; sensitivity and specificity for mesothelioma were also assessed. RESULTS: The mesothelioma CT Guideline was developed, providing the terminology of CT features and the mesothelioma probability, the judgement of severity, the distribution of mesothelioma, and the revised CT reading sheet including mesothelioma items. The CT reference films with ten mesothelioma typical features were selected. The average linearly and quadratically weighted kappa of the agreement on the 4-point scale mesothelioma probability were 0.58 and 0.71, respectively. The average sensitivity and specificity for mesothelioma were 93.2% and 65.6%, respectively. CONCLUSION: The evidence-based mesothelioma CT Guideline developed may serve as a good educational tool to facilitate physicians in recognising mesothelioma and improve their proficiency in diagnosis of mesothelioma.

The 60-film set with 8-index for examining physicians' proficiency in reading pneumoconiosis chest X-rays.

The 60-film set was developed by experts (Expert Group) for examining 8 indices: sensitivity (X(1)) and specificity (X(2)) for pneumoconiosis, sensitivity(X(3)) and specificity for (X(4)) large opacities, sensitivity (X(5)) and specificity (X(6)) for pleural plaque, profusion increment consistency for small opacities (X(7)), and shape differentiation for small opacities (X(8)) of physicians' reading skills on pneumoconiosis X-ray according to ILO 2000 Classification. The aim of this study was to assess the appropriateness of the exam film set for evaluating physicians' reading skills. 29 physicians (A1-Group) and 24 physicians (A2-Group) attended the 1st and 2nd "Asian Intensive Reader of Pneumoconioses" (AIR Pneumo) training course, respectively, and 22 physicians (B-Group) attended Brazilian training course. After training, they took examination of reading 60-film exam set. The examinees' reading results in terms of 8 indices were compared between the examinee groups and the Expert Group by parametric unpaired t-test. The Examinee Group consisting of A1-Group, A2-Group and B-Group was inferior to the Expert Group in all indices. There was no significant difference for X(7) of A1-Group, X(7) and X(8) of A2-Group (p>0.05) compared with the Expert Group. There was a significant difference in X(8) at p<0.05 between A1-Group and A2-Group, in X(3) at p<0.05 between A1-Group and B-Group, in both X(1) and in X(3) at p<0.05 between A2-Group and B-Group. Accordingly, the 60-film set providing 8 indices designed might be a good method for evaluation of the physicians' reading proficiency at different training settings.

Proficiency in reading pneumoconiosis radiographs examined by the 60-film set with 4-factor structuring 8-index.

29 physicians (A1-Group) and 24 physicians (A2-Group) attending the 1st and 2nd "Asian Intensive Reader of Pneumoconiosis" (AIR Pneumo) training course, respectively, and 22 physicians (B-Group) attending the Brazilian training course took the examination of reading the 60-film set. The objective of the study was firstly to investigate the factor structure of physicians' proficiency of reading pneumoconiosis chest X-ray, and secondly to examine differences in factor scores between groups. Reading results in terms of the 8-index of all examinees (Examinee Group) were subjected to the exploratory factor analysis. A 4-factor was analyzed to structure the 8-index: the specificity for pneumoconiosis, specificity for large opacities, specificity for pleural plaque and shape differentiation for small opacities loaded on the Factor 1; the sensitivity for pneumoconiosis and sensitivity for large opacities loaded on the Factor 2; the sensitivity for pleural plaque loaded on the Factor 3; the profusion increment consistency loaded on the Factor 4. 4-Factor scores were compared between each other of the three groups. The Factor 2 scores in A1 and A2 groups were significantly higher than in B-Group. Four factors could reflect four aspects of reading proficiency of pneumoconiosis X-ray, and it was suggested that 4-factor scores could also assess the attained skills appropriately.

Silicotuberculosis and silicosis as occupational diseases: report of two cases.

INTRODUCTION: Silicosis, the most prevalent of the pneumoconioses, is caused by inhalation of crystalline silica particles. Silica-exposed workers are at increased risk for tuberculosis and other mycobacterium-related diseases. The risk of a patient with silicosis developing tuberculosis is higher (2.8 to 39 fold higher, depending on the severity of silicosis) than that found in healthy controls. OUTLINE OF CASES: The first patient was a 52-year-old male who was admitted in 2002 for the second time with dyspnoea, wheezing and fatigue over the last 11 years. He had worked in an iron smelting factory and was exposed to silica dust for 20 years. First hospitalization chest radiography showed bilateral pleural adhesions, diffuse lung fibrosis with signs of a specific lung process. Second hospitalization chest radiography showed bilateral massive irregular, non-homogenous calcified changes in the upper and middle parts of lungs. The patient died due to respiratory failure and chronic pulmonary heart in 2007. The main causes of his death were silicotuberculosis and chronic obstructive pulmonary disease. The second patient was a 50-year-old male who was admitted in 2005 for the second time with chest tightness, dyspnoea, wheezing and fatigue over the last 10 years. He had worked in an iron smelting factory and was exposed to silica dust for 30 years. First hospitalization chest radiography showed diffuse lung fibrosis and small nodular opacities. The patient was diagnosed with silicosis, small opacities sized level p/q, and profusion level 2/3. Second hospitalization chest radiography and CT showed diffuse lung fibrosis and small nodular opacities predominantly in the upper lobes. The patient was recognized as having an occupational disease, and received early retirement due to disability. CONCLUSION: In low-income countries, new cases of silicosis and associated lung cancer, chronic obstructive pulmonary disease and tuberculosis are likely to be seen for decades because necessary reduction of silica use will take time to be achieved.

Reliability of the proposed international classification of high-resolution computed tomography for occupational and environmental respiratory diseases.

PURPOSE: We have developed a classification of high-resolution computed tomography (HRCT) images for screening, surveillance and epidemiological studies of respiratory diseases caused by occupational and environmental factors. The proposed classification consists of three parts: a guideline explaining the elements of the classification scheme, a reading sheet, and reference films to aid in assessing thin-section CT films. We assessed the reliability of the proposed classification system by blinded, independent trial reading. MATERIALS AND METHODS: Seven independent radiologists and pulmonologists performed a trial reading to measure the reliability of the classification system using HRCT films from 27 pneumoconiosis patients and 7 normal controls. RESULTS: The agreement was moderate to good for rounded opacities (weighted kappa=0.68 and 0.64), irregular opacities (0.59, 0.48), honeycombing (0.65, 0.47), emphysema (0.76, 0.62) and large opacities (0.48, 0.52). Ground glass opacities (0.16, 0.20) showed poor to fair agreement. Intra-reader agreement of each of the seven readers was moderate to good (mean: weighted kappa=0.52-0.80) for parenchymal findings, but the agreement was relatively low (mean weighted kappa=0.52) for ground glass opacities. CONCLUSION: The proposed classification is able to describe early dust-related fibrotic changes and provide a semi-quantitative description of the HRCT features of major fibrotic changes in the parenchyma and pleura. Reliability, as measured by inter-reader agreement, was satisfactory.