Public Health Implications of the Variability in the Interpretation of "B" Readings.
Parker-DL; Bender-AP; Barklind-A
NIOSH 1990 Sep:196-200
The public health implications of the variability in interpretation of chest X-rays by B-readers were discussed. The discussion focussed on an incident in which chest X-ray films were incorrectly interpreted by B-readers. A radiologist who was a B-reader in an area of northern Minnesota historically associated with problems related to asbestos (1332214) in mine tailings reported finding diffuse or circumscribed pleural thickening in approximately 30% of 500 sequential chest X-rays during the previous 2 years in his clinical practice. His interpretation was apparently confirmed by a second B-reader, who was a NIOSH consultant, who analyzed 259 films and 310 additional films from other regional clinics. Because of this apparent confirmed increase in asbestos associated pleural changes, 563 films were read by a third B-reader in New York City and then by a panel of three NIOSH B-readers in Morgantown, West Virginia. A kappa statistical analysis revealed moderate overall agreement between the initial reader and the NIOSH consultant and the NIOSH consultant and the third reader. Agreement was poor for pleural plaquing and diffuse pleural thickening when the films were read side by side. The proportion of films from males read as being positive for pleural abnormalities by the NIOSH consultant and the third reader were 54 and 25%, respectively. The proportion of films from female subjects read as being positive for pleural abnormalities by the same two readers were 15 and 5%, respectively. The differences were statistically significant. NIOSH found that only 24 (4.2%) of the original films were positive for pleural abnormalities. By sex, 8% of the films from males and 1% of the films from females were read as positive. The NIOSH panel read 55% of the positive control films as positive and 98% of the negative control films as negative. The authors conclude that interreader variability was the source of the abnormal findings.
Chest-X-rays; Asbestos-dust; Environmental-exposure; Lung-lesions; Radiodiagnosis; Pleural-cavity; Humans; Sex-factors;
Special Populations; Work Environment and Workforce;
Proceedings of the VIIth International Pneumoconioses Conference