Public health implications of the variability in the interpretation of 'B' readings for pleural changes
Article Abstract:
A 'B' reader is a physician who has been trained to interpret lung and pleural X-rays according to a protocol standardized by the National Institute for Occupational Safety and Health (NIOSH) for the presence of foreign lung infiltrates such as asbestos fibers. Recently, an initially high rate of positive findings led to concern that a large-scale public environmental health problem had been uncovered in Minnesota. The great variability in interpretation of X-rays by trained physicians has been known for decades. When multiple readers judge the same images, the possibility of misdiagnosis is greatly reduced; nevertheless, it is possible for multiple readers to agree and for this judgement to be in error. When a group problem is found, the constellation of cases often triggers a public health policy that can affect a large group of individuals, many of whom have not been medically examined. In this case, approximately 30 percent of a population of 500 had X-rays that possibly indicated the presence of asbestos fibers in the pleura, the membrane enfolding the lungs. These X-rays were reviewed by two additional readers. The study examines the variability and correlation between the independent assessments made by the three readers. The degree of interreader variability was found to be great in this case and the perception of a potential public health problem arose from the interreader variability in the evaluation and interpretation of X-rays, and not from an environmental hazard. The use of B readers is called into question.
Publication Name: Journal of Occupational Medicine
Subject: Health care industry
ISSN: 0096-1736
Year: 1989
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Influence of smoking on radiographic profusion and pleural changes in asbestos-exposed subjects
Article Abstract:
It has been established that smoking cigarettes and exposure to asbestos can each cause lung disease. However, it is not known how the health of individuals who smoke and work with asbestos is affected. A study was conducted to evaluate the lungs of 440 subjects who formerly or currently worked with asbestos; most were insulation workers. Of the total group, 81 percent had a history of smoking. Chest X-rays of the subjects were examined for spots (opacities), which are thought to indicate abnormalities caused by asbestos exposure. Two parts of the lung were examined: the parenchymal tissue, which is the essential and functional part of the organ; and the pleura, the membrane surrounding the lungs, which plays a structural rather than functional role. The results showed that smoking was associated with an increased number of parenchymal opacities, especially in subjects who had a history of smoking for more pack-years. Smoking was not linked to an increase in pleural opacities. An additive effect of smoking and asbestos exposure on the lungs was observed. The findings are in agreement with most of the previous studies concerning the effect of smoking on the lungs of asbestos workers. More research is needed to determine the nature of the physical changes in the lungs that are seen as opacities on the X-rays, and also to evaluate their significance in the course of asbestos-associated lung disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Occupational Medicine
Subject: Health care industry
ISSN: 0096-1736
Year: 1990
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The reproducibility of the self-report of occupational exposure to asbestos and dust
Article Abstract:
Inhalation of asbestos and dust has been associated with lung disease and bronchitis, respectively. The severity of the condition is related to the amount and duration of exposure. Occupational exposure to asbestos and dust is not uncommon. The reproducibility of the information given in exposure reports filed by 116 male workers was determined by comparing the information obtained from a mail survey with the information obtained from a health clinic visit. The average time between the mail survey and the clinic visit was 213 days. Regarding asbestos exposure, 60 percent gave the same information in the mail survey and in the clinic visit, while 40 percent provided different information. Of the 51 men who reported that they had been exposed to asbestos at the clinic visit, 22 percent reported that they had not been exposed in the mail survey, and 26 percent said that they were not sure. Regarding dust exposure, 71 percent of the men gave the same information in the mail survey and at the clinic visit, while 29 percent gave different information. It is concluded that mail surveys may underestimate the occurrence of occupational exposure to asbestos or dust. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Occupational Medicine
Subject: Health care industry
ISSN: 0096-1736
Year: 1991
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