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; :69-84
The Federal Coal Mine Safety and Health Act of 1969, as amended by the Federal Mine Safety and Health Act of 1977, PL-95-164, directs the National Institute for Occupational Safety and Health (NIOSH) to study the causes and consequences of coal-related respiratory disease, and in cooperation with the Mine Safety and Health Administration (MSHA), to carry out a program for early detection and prevention of Coal Workers' Pneumoconiosis (CWP), also called Black Lung. The 1977 Act mandates that all underground coal miners be offered a chest x-ray examination, at no cost to the miner. The x-rays must be taken at approved facilities and interpreted using a standardized classification system by certified physician readers. The presence of definite evidence of CWP on the x-ray determines a miner's eligibility for specified rights to work in a mining job with a reduced dust exposure. NIOSH administers these mandates through the Coal Workers' Health Surveillance Program (CWHSP) as outlined in 42 CFR Part 37, "Specifications for Medical Examinations of Underground Coal Miners," at the Appalachian Laboratory for Occupational Safety and Health (ALOSH) in Morgantown, West Virginia. The CWHSP carries out the following activities related to the administration of chest x-ray examinations specified in the 1977 Act: 1) Testing and certification of physicians as B Readers qualified to interpret and classify x-rays using the International Labour Office (ILO) International Classification of Radiographs for Pneumoconioses; 2) Evaluation and certification of x-ray facilities; 3) Approval of coal mine operator plans for providing chest x-rays to miners; 4) Arrangement and reimbursement for requisite B Reader interpretation of chest x-rays; 5) Notifying participating miners of the results of chest x-rays interpreted for the presence or absence of CWP; 6) Notifying miners of the results of chest x-ray interpretations where abnormal findings other than CWP are identified; and 7) Maintaining a database of information related to all aspects of the CWHSP for purposes of assessing effectiveness, identifying disease trends, and assessing the value of dust exposure limits for the mining industry. NIOSH developed and currently administers the B Reader Certification Program - a unique quality assurance program for training and certifying physicians who classify chest radiographs for the pneumoconioses. Physicians who wish to obtain B Reader certification must successfully complete an extensive initial examination. To demonstrate ongoing competence and maintain certification, a recertification examination is required every four years. Prior to sitting for the examination, candidate B Readers are strongly encouraged to adequately prepare by completing the NIOSH Self-Study Syllabus and/or attending the American College of Radiology (ACR) Symposium on Radiology of the Pneumoconioses. The Self- Study Syllabus was developed by NIOSH in 1980 under a contract with the ACR and includes 80 example chest radiographs with associated explanatory text. The ACR Symposium on Radiology of the Pneumoconioses, developed jointly with NIOSH in the 1970s, is held every 2-3 years. As part of the CWHSP, NIOSH obtains and processes B Reader interpretations regarding the presence and degree of dust-related changes on the screening chest radiographs. These radiographs are provided to underground coal miners approximately every five years. The ILO, with NIOSH involvement and support, has recently completed a revision of its radiograph classification system (ILO 2000). With the publication of these revisions, NIOSH had the opportunity and obligation to improve and update the B Reader Program. Input from physicians having practical experience interpreting x-rays for findings consistent with occupational illnesses was sought. A survey was designed and distributed in May 2003, to Proceedings 69 solicit and document input from physicians regarding program revisions. Three survey instruments were developed appropriate for soliciting input from current B Readers, former B Readers, and A Readers. A Readers are those physicians who have completed a training course or otherwise demonstrated competence in use of the ILO Classification, but who are not currently certified as B Readers.