CHEST RADIOGRAPHY

B Reader looking at an xray

The NIOSH B Reader Program

Background

In 1949, the International Labour Office (ILO) promulgated standards for systematically describing and recording radiographic appearances of certain abnormalities caused by the inhalation of dusts. The principle intent of the standards was to achieve uniformity in assessing pneumoconiosis across readers. However, it was found that readers, despite employing the classification scheme, still disagreed with each other and with themselves to an excessive degree (Felson 1973). As a consequence, NIOSH concluded that a proficiency program was needed to provide a pool of qualified readers. The NIOSH B Reader Program began in 1974, although it was not until 1978 that the B reader examination was given extensively (Attfield 1992).

The B Reader examination was originally developed to identify physicians qualified to serve in national pneumoconiosis programs directed at coal miners and others who suffer from dust-related illness. This originally included epidemiologic research on coal workers’ pneumoconiosis and the compensation of coal miners with pneumoconiosis under programs processed by government agencies (Morgan 1979). The original intent of the B Reader Program still exists, but B Readers are also now involved with epidemiologic evaluation, surveillance, and worker monitoring programs involving many types of pneumoconioses. The B Reader Program aims to ensure competency in radiographic reading by evaluating the ability of readers to classify a test set of radiographs, thereby creating and maintaining a pool of qualified readers having the skills and ability to provide accurate and precise ILO classifications.

B Reader Applications

B Readers, through their demonstrated proficiency in classifying radiographs of the pneumoconioses, are appropriate choices for research, surveillance, and worker monitoring programs and activities. NIOSH has employed B Readers in many epidemiologic and other research studies for nearly 30 years, as have many other organizations.

Physicians who classify chest radiographs for certain federal surveillance programs may be required to be B Readers. For example, in the NIOSH Coal Workers’ X-ray Surveillance Program, physicians who classify radiographs for the program are required to be B Readers for the second and any later readings of each radiograph (42 CFR 37External). The Asbestos Medical Surveillance Program (AMSP)External, administered by the Navy and Marine Corps Public Health Center (NMCPHC), requires that the second reader of each radiograph be a B Reader. B Readers also have important roles to play in epidemiologic research, government programs, and contested proceedings.

Use of B Readers alone is not sufficient for adequate data quality. Their use should be augmented by the adoption of good technical practices to provide information of the highest quality.

Need for a Reader Proficiency Program

In 1949, the International Labour Office (ILO) promulgated standards for systematically describing and recording radiographic appearances of certain abnormalities caused by the inhalation of dusts. The principle intent of the standards was to achieve uniformity in assessing pneumoconiosis across readers. However, it was found that readers, despite employing the classification scheme, still disagreed with each other and with themselves to an excessive degree (Felson 1973). As a consequence, NIOSH concluded that a proficiency program was needed to provide a pool of qualified readers. The NIOSH B Reader Program began in 1974, although it was not until 1978 that the B reader examination was given extensively (Attfield 1992).

Objective of the B Reader Program

The B Reader examination was originally developed to identify physicians qualified to serve in national pneumoconiosis programs directed at coal miners and others who suffer from dust-related illness. This originally included epidemiologic research on coal workers’ pneumoconiosis and the compensation of coal miners with pneumoconiosis under programs processed by government agencies (Morgan 1979). The original intent of the B Reader Program still exists, but B Readers are also now involved with epidemiologic evaluation, surveillance, and worker monitoring programs involving many types of pneumoconioses. The B Reader Program aims to ensure competency in radiographic reading by evaluating the ability of readers to classify a test set of radiographs, thereby creating and maintaining a pool of qualified readers having the skills and ability to provide accurate and precise ILO classifications.

Maintaining B Reader status

Readers must retest every four years to maintain their B Reader status; testing can be done any time within the fourth year. The retest is very much like the original approval examination, except readers are required to classify only fifty radiographs. A reader who fails the retest must take and pass the original approval examination before the end of their four-year approval period expires in order retain their B Reader status. There is no waiting period between failing the retest and taking the original approval examination. B Readers who do not retest before expiration of their approval automatically become A Readers.

ILO classifications of chest radiographs performed by B Readers are used for a variety of purposes such as public health surveillance of workers potentially exposed to respirable dust, administrative purposes in systems of benefits for work-related lung disease, and for epidemiologic studies. These activities may involve providing medical care; for example, if a chest radiograph submitted to a B Reader has not previously been evaluated by a physician and the B Reader is simultaneously performing a classification and a clinical interpretation, then the activity involves providing clinical care. Alternatively, if a clinical interpretation was previously performed by a physician, then the B Reader’s ILO classification can potentially be viewed as being performed for a purpose other than providing clinical care. In such cases, B Readers should confirm that the clinical interpretations and necessary notifications of results have been communicated to both the ordering physician and patient, as required by the B Reader Code of Ethics. In order to ensure that any and all medical licensure requirements have been met irrespective of the B Reader’s role in evaluating chest radiographs, NIOSH recommends that non-federal employee B Readers consult with relevant State Boards of Medicine and with those engaging them to perform classifications to ensure compliance with potentially applicable State and Territorial laws, rules, regulations and policies. This includes confirming whether a medical license from the particular state in which the radiograph requiring classification was obtained is required. Certification through NIOSH’s B Reader program solely indicates proficiency in classifying radiographs with the ILO system; therefore, B Readers and those engaging them to perform ILO classifications are responsible for ensuring that physicians have valid medical licenses and are performing duties in accordance with applicable state medical licensure laws depending on the nature of the work.

This list will be updated continuously. Listing does not imply medical licensure.

Use this search form to select the criteria for your search. Leaving the Last Name and State fields blank will produce a complete list of B Readers.

Listed by State of Residence


Successful International Examinees

Use this search form to obtain a listing of physicians from outside the United States who have demonstrated competence in applying the ILO classification by successfully completing the NIOSH B Reader examination. Leaving the Last Name field blank will produce a complete list of examinees.


You can contact one of these organizations to use the NIOSH self study syllabus on pneumoconiosis at their location. Visit the NIOSH B Reader Study Syllabus page for more information and other available syllabus formats.

United States Sites

United States Sites
Organization Contact Phone # Email
NIOSH
Coal Workers’ Health Surveillance Program
1095 Willowdale Road
Morgantown, WV 26505
Jennifer L. Orrahood (304)285-6080 JOrrahood@cdc.gov
WVU Health Sciences Center
Pulmonary and Critical Care Medicine
P.O. Box 9166
Morgantown, WV 26506
John E. Parker, M.D. (304)293-4661
Cincinnati General Hospital
Department of Radiology
234 Goodman Street
Cincinnati, OH 45267
(513)558-4396
Cook County Hospital
Division of Pulmonary Medicine/Critical Care
Division of Occupational Medicine
1900 West Polk Street, Room 500
Chicago, IL 60612
Sandra Anaya (312)864-5523 osandee2@aol.com
Dept. of Epidemiology & Preventive Medicine
1 Shields Avenue – TB 168
Davis, CA 95616-8638
Marc B Schenker, M.D. (530)752-5676
Uniformed Services University
4301 Jones Bridge Road
Bethesda, MD 20814
Col. David Feigin (301)295-3145 ext. 3520
University of Michigan
School of Public Health
Occupational Medicine Program
Dept. of Environmental & Industrial Health
109 observatory Street
Ann Arbor, MI 48109-2029
(313)764-2594
OSHA-Office of Occupational Medicine
200 Constitution Avenue NW
Room N-3457
Washington, DC 20210
Glenda Price-Livingston (203)693-2323 Price-livingston.glenda@dol.gov

International Sites

International Sites
Organization Contact Phone # Email
Fundacentro
Division of Medicine/Fundacentro
Rua Capote Valente 710
Sao Paulo, 05409-002
BRAZIL
Eduardo Algranti +55 11 30666190 eduardo@fundacentro.gov.br
Institut de recherché Robert-Sauve en
santé et en securite du travail (IRSST)
505, boul. De Maisonneuve Ouest, 15e etage
Montreal (Quebec) H3A3C2
CANADA
Madame Chantal Dion, Ph.D. (514)288-1551 (322) dion.chantal@irsst.qu.ca
Unite De Pathologic Professionnelle
Hopital Raymont Poincare
104, Boulevard Raymond Poincare
Garches, 92380
FRANCE
Jacques Ameille, M.D. 7-011-331-4-3-48-17-36 Jacques.ameille@rpc.aphp.fr
State of Israel
Ministry of Industry, Trade and Labour
Labour Inspectorate
5 Bank Israel Street
P.O. Box 3166
Jerusalem, 91036
ISRAEL
Dr. Luba Pushnoy Phone: 9722 666 2844
Fax: 9722 666 2973
Luba.Pushnoy@moital.gov.il
Azienda Unita Sanitaria Locale Viterbo
Via Enrico Fermi,
Viterbo, 15-01100
ITALY
Augusto Quercia 0761 236740 augusto.quercia@osl.vt.it
Seoul National University
School of Public Health
599 Gwanak-ro, Gwanak-gu
Seoul, 151-742
KOREA
Domyung Paek, M.D. 82-2-880-2733 paekdm@snu.ac.kr
Ekaterinburg Medical Research Centre for
Prophylaxis & Health Protection in Industrial Workers
Medical Research for Prophylaxis and
Health Protection in Industrial Workers
30 Popov Street
Ekaterinburg, 620014
RUSSIA
Vladimir B. Gurvich, M.D. +7 343 371 87 54/+7 343 371 87 40 info@ymrc.ru
mrc@otel.ru
Department of Occupational & Environmental Health
University of Kwazulu-Natal
George Campbell Building, Room 321
Durban, 4041
SOUTH AFRICA
Prof. Rajen Naidoo +2731 2604385 naidoon@ukzn.ac.za
International Labour Office
4, Route Des Morillons
CH-1211 Geneva 22
SWITZERLAND
Igor Fedotov, M.D. +41 22 7997495 fedotov@ilo.org
Bureau of Occupational and Environmental Diseases
Department of Disease Control
Ministry of Public Health Tiwanon Road
Taradkean, Muang, Nonthaburi 11000
THAILAND
Dr. Somkiat Siriruttanapruk (662)590-4382 sirirut.somkiat@gmail.com
Institute for Occupational Health
75, Ste. Saksaganskogo
Kiev, 01033
UKRAINE
Prof. Angela Basanets : +38050386212 basanets@ioh-ams.kiev.ua

Digital Radiography

Conventional film screen chest radiography has been widely applied in assessing lung health in dust-exposed workers for decades, but this technique is being replaced by digital radiography systems. NIOSH is currently assessing the equivalency of traditional radiography and digital radiography with respect to pneumoconiosis classification using conventional and digital images from patients with a spectrum of dust-related lung disorders and chest pathology. See Digital Radiography for more information.

2011 ILO Revisions

The ILO revised its Classification System in 2011. To assure adherence to this new system, NIOSH has modified the B Reader examinations and related training activities and materials, including the Self-Study Syllabus. See New ILO Revisions for more information.

Syllabus Online and Compact Disc

The NIOSH Self-Study Syllabus is now available electronically to increase availability of the Syllabus to each test taker.

Quality Assurance Review of Classification Submitted for the DOL Black Lung Benefits Program

NIOSH and the DOL Office of Workers’ Compensation Programs (OWCP) are working together to carry out a quality assurance (QA) activity focused on classifications of chest radiographs according to the International Labour Organization (ILO) classification system that are submitted to the Black Lung Benefits Program operated by OWCP.  The QA activity focuses on how the presence or absence of large opacities are classified by B Readers submitting the classifications.  Information is available at this web link: https://www.cdc.gov/niosh/topics/chestradiography/breader-blacklung-benefits-qa-program.html

Comments or Concerns about the B Reader Program

The B Reader Program welcomes any comments or concerns about the Program, the examination, or this Web site. Our goal is to serve all persons who interact with this Program and continuously improve the information that we provide. Please use any of the following contact methods:

Call the Program office at (888) 480-4042

Email us at CWHSP@cdc.gov

Mail the Program at:

National Institute for Occupational Safety and Health
Coal Workers’ Health Surveillance Program
1095 Willowdale Road – M/S LB205
Morgantown, WV 26505

Comments or Concerns about Specific B Readers

The purpose of the B Reader Program is to train licensed physicians in use of the ILO Classification System and to assess their ability to apply the ILO Classification System in classifying chest radiographs for the presence and severity of changes potentially associated with exposure to dusts such as asbestos, silica, and coal mine dust. Use of a medical license in order to commit fraud is a violation of the conditions that accompany the medical license. Therefore, complaints about a specific B Reader should be referred to the appropriate State medical licensing board, as these boards are the bodies responsible for assuring the competence and integrity of licensed physicians. Contact information for each State’s medical licensing board can be found on the Federation of State Medical Boards (FSMB) Web siteExternal.

Felson B, Morgan WKC, Bristol LJ, et al. Observations on the results of multiple readings of chest films in coal miners’ pneumoconiosis. Radiology 1973;109:19-23.

Attfield MD, Morring K. An investigation into the relationship between coal workers’ pneumoconiosis and dust exposure in U.S. coal miners. Am Ind Hyg Assoc J 1992; 53:486-92.

Morgan RH. Proficiency examination of physicians for classifying pneumoconiosis chest films. Am J Roentgenology 1979;132:803-08.

Wagner GR, Attfield MD, Parker JE. Chest Radiography in Dust-Exposed Miners: Promise and Problems, Potential and Imperfections. Occupational Medicine: State of the Art Reviews 8(1); 127-141, 1993.

More Information

Federal Mine Safety and Health Act of 1977, Public Law 91-173External

Specifications for Medical Examinations of Underground Coal Miners. 42 CFR 37External

Asbestos Medical Surveillance Program, Navy and Marine Corps Public Health Center (NMCPHC)External

Safety and Health Topics: Asbestos. Occupational Safety and Health AdministrationExternal

NIOSH Coal Workers’ Health Surveillance Program (CWHSP)

Roentgenographic Interpretation Form
En EspañolCdc-pdf
(OMB 0920-0020) (CDC/NIOSH 2.8) (December 2009)
This form must be completed by the A or B Reader that interprets a chest radiograph for NIOSH as part of the Coal Workers’ X-ray Surveillance Program. Mail the completed form to the address on the form. Do NOT send this form electronically to NIOSH. Print/Copy as a double-sided form.

American College of Radiology (ACR)External

Federation of State Medical Boards (FSMB)External

Page last reviewed: May 24, 2011