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Alternative approaches to B reader quality assurance.

The NIOSH B Reader Certification Program: Looking to the Future. Morgantown, WV: National Institute for Occupational Safety and Health, Publication No. 2009-140, 2009 Apr; :17-24
Reader variability is multifactorial. If reducing bias is a priority, random review of B reader interpretations with feedback and a mechanism to enforce compliance with expert reading standards must be developed. Requiring B readers to maintain a minimum volume of reading would eliminate the problem of the outlier, low volume, B reader. Circulating CD-ROM discs or creating a website with cases available for interpretation with feedback would be an inexpensive way to provide continuing education to B readers between recertification exams. Inter-reader agreement could improve as a result. Further research into chest radiograph interpretation with HRCT correlation may reduce the variability related to combining fibrotic and non-fibrotic small irregular opacities in the Classification. Differentiating pleural fat from pleural thickening may be improved through further study, or we may determine that, in the absence of diaphragmatic plaques or calcification, the chest radiograph is not effective for this purpose. The pattern of use of the Revised Edition 2000 of the ILO Classification with its acknowledgement of both epidemiological and clinical approaches needs to be clarified. Reader variability is inherent in chest radiographic interpretation. This is present where no financial incentives are involved, but accentuated when they are. Proposals for further study of methods to improve uniformity of interpretation have been presented. Effective quality assurance designed to eliminate bias will be difficult to implement. Assuring quality through innovative new methods and inquiry into improved reading practices through CT/HRCT correlation will help maintain and improve the stature of the B reader program.
Respiratory-system-disorders; Pulmonary-system-disorders; Lung-disease; Lung-disorders; Lung-function; Chest-X-rays; X-ray-diagnosis; X-ray-analysis; Diagnostic-tests; Diagnostic-techniques
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The NIOSH B Reader Certification Program: Looking to the Future
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Ralph T. Shipley