Chest X-ray (CXR) screening can identify workers affected by job exposures, and can help guide preventative interventions. We investigated film quality, a key element in effective screening, for CXRs received from October1, 2000, to September 30, 2001, under the U.S. National Coal workers' X-ray Surveillance Program (CWXSP). The study included 7,018 CXRs from 88 NIOSH-approved facilities, and 14,731 independent readings of these CXRs, based on the 1980 ILO Classification System, by 92 NIOSH-certified readers (25 'A' and 67 'B'). During each reading, film quality was graded 1 - Good(n=11,102, 75.4%), 2 -Acceptable (n=2601,17.7%), 3 - Poor (n=922, 6.3%) and 4 - Unacceptable (106, 0.7%). Frequently recorded film defects included underexposure (27%), improper positioning (19%) and overexposure (17%). For the same CXRs, 'B' readers tended to grade film quality more severely than 'A' readers. Only 13 films (0.2%) were considered unreadable (i.e. Grade 4 by 2 readers), but 950 films (13.5%) were considered of Lower Quality (i.e. Grade 3 or 4 noted by >1 reader). Among 11 facilities submitting at least 100 CXRs, Lower Quality films were significantly (P<0.0001) more frequent for two facilities and less frequent for three. Overall, quality for mobile X-ray vans was similar to fixed facilities, but particular fixed and mobile facilities were much more likely to submit films with specific defects. Certain quality defects appeared to influence the final pneumoconiosis classifications. These results suggest that occupational CXR screening programs that do not already do so may benefit from efforts to monitor and improve film quality.
American Journal of Respiratory and Critical Care Medicine, 2002 International Conference, The American Thoracic Society, Atlanta Georgia, May 17-22, 2002