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 icon). The Asbestos Medical Surveillance Program (AMSP)external icon, 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 five years to maintain their B Reader status; testing can be done any time within the fifth 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 five-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.
For more information on when and where B Reader Examinations are offered please call 1-888-480-4042 or email CWHSP@cdc.gov.