The relationships between chest radiographic appearances, corresponding pathologic abnormalities, and lung dust burden were investigated in an autopsied population of coal miners and non-miner controls from southern West Virginia to determine the detection limits of chest radiographic evaluations. The cases studied consisted of 430 coal miners and 33 non-miner controls with ante-mortem chest x-rays and post-mortem whole lung evaluations. Whole lung sections were reviewed and graded by two pathologists on a four point scale for macules, micronodules, macronodules and progressive massive fibrosis (PMF). The chest x-rays were classified by three B readers using the 1971 ILO classification. In a random subgroup of 100 coal miners and 9 non-coal miner controls, dust analysis was made for the total dust, coal, silica and other particulate minerals. The mean age for the study group was 68 +/- 0.45 years with an average of 31 +/- 0.7 years of underground coal mining exposure. By pathologic evaluations, 97% of coal miners were found to have macules, 70% micronodules, 45% macronodules, 15% silicosis, and 28% PMF. In contrast to this, only 67% of the chest x-rays showed category one or greater combined opacities, 59% with small rounded opacities, and 23% with irregular opacities. Moderate and severe categories of micro and macronodules showed good correlations with chest x-rays (r=0.53 and 0.48, respectively). X-ray pathologic correlation was the least for macules (r=0.1), indicating the likelihood of negative x-ray readings. Furthermore, moderate (30%) and severe (20%) grades of macules and 29% mild grades of micronodules were reported with category 0 x-rays. In the dust analysis a relationship was found between macronodules and total dust and silica content. Retained coal and silica also showed a correlation with combined opacities. The results of these studies show that mild to moderate grades of simple CWP are often not detected by chest radiographic means.
Chest-X-rays; Radiographic-analysis; Pathology; Autopsies; Postmortem-examination; Coal-miners; Coal-workers-pneumoconiosis; Respiratory-system-disorders; Pulmonary-system-disorders; Lung-disorders; Lung-burden; Lung-fibrosis; Coal-dust; Silica-dusts; Analytical-instruments; Diagnostic-techniques; X-ray-analysis; X-ray-diagnosis; X-ray-equipment; Radiological-equipment; Equipment-reliability; Performance-capability; Detectors; Medical-equipment