Chest Radiography

The NIOSH B Reader Program

Special Notice

B Reader examinations are now open at the NIOSH facility in Morgantown. Call (888) 480-4042 or email to schedule your exam. B Reader examination information includes:

Overview of the New B Reader Examination and How It Is Graded

The new B Reader examination is very different from the older version that was in use for decades. The new examination was developed through a partnership between the National Institute for Occupational Safety and Health and the American College of Radiology. Lessons learned and feedback received during more than forty years of administering the B Reader Program informed the design and approach to the new examination, which uses modern, digitally acquired chest images. More than fifteen experts in ILO classification from around the country contributed to developing the new examination.

The new examination has five domains. Unlike the past examination, you must achieve a passing score in all the five domains to pass the examination as a whole. The five domains are:

  • Multiple choice questions covering material in the self-study syllabus (new)
  • Assigning a quality score to the radiograph (new)
  • Determining the presence or absence of small opacities; and if small opacities are present, assigning a profusion score
  • Identifying when large opacities are present
  • Identifying pleural abnormalities; specifically, the presence (and side) of pleural plaques and costophrenic angle obliteration

As noted above, there are two new domains in the new B reader examination.  First, there are twenty-four multiple choice questions testing for important concepts relevant to ILO classification which are taken from material in the B Reader study syllabus posted on the NIOSH website.  Second the new examination emphasizes the correct evaluation of image quality. While on the previous examination there were no unclassifiable, unreadable, U/R, or Quality 4 images, several images that could be classified this way are included in the new examination and your answers will be scored.  Accordingly, you should be vigilant for quality issues on each image; for example, portable studies are, by definition, unreadable/unclassifiable.

A correct classification/answer has been assigned for each domain to each of the images, based upon the responses given by majorities of the experts when independently classifying the radiographs. For an individual radiograph there may be a range of accepted “correct” small opacity profusion subcategories based upon the range of expert responses.

NIOSH recommends that when you are studying for the examination to familiarize yourself with the B Viewer software and to use the new study syllabus and accompanying images to familiarize yourself with the material.  Please remember that you must achieve a passing score in each of the examination’s domains to receive a passing score for the entire examination.