Study Syllabus for Classification of Radiographs of Pneumoconioses
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Subset 4 – Small and Large Opacities
Radiograph #39 – Type p
Small rounded opacity of type p
Radiograph #39A represents a normal lung. The normal vascular pattern is well illustrated. There are several small blood vessels seen on end, which should not be confused with small rounded opacities.
There are p a few t small opacities present in Radiograph #39B, but they are few in number, appearing as tiny opacities like fine grains of sand. This image represents profusion level 1/0. The identification low profusion radiographs is strongly influenced by the quality of the radiograph. Beware of over-reading profusion in the presence of grid lines, slight underexposure, extensive overlying soft tissue, or excessive radiographic contrast.
Radiograph #39C. Here p rounded opacities are unequivocally present. Some readers determined profusion to be 1/0 while others preferred 1/1. This emphasizes the difficulty in determining profusion with limited parenchymal involvement. There are many small blood vessels seen on end. Do not confuse end-on vessels with q opacities.
Radiograph #39D. Close observation will reveal multiple p and a few s opacities. This image represents profusion level 1/1. There is blunting of the right costophrenic angle but no diffuse pleural thickening is identified
Radiograph #40 – Type q
Small rounded opacities, type q
Radiograph #40A. This image again presents the absence of small parenchymal opacities, profusion 0/0.
Radiograph #40B. In this image the quality is 2 due to significant scapula overlay. Small rounded opacities of the q size are subtly but clearly present in the upper zones, but somewhat less profuse than the category 1/1 standard. In other words, 1/0 profusion.
Radiograph #40C. This radiograph illustrates q opacities in the upper zones that are more numerous than in Radiograph #40B above, however there are still fewer opacities than in the 1/1 q/q standard. This image presents another example of profusion level 1/0.
Radiograph #40D This image is quality 3 due to gridlines, mottle, underinflation and overexposure. However one can still see clear q opacities predominately in the upper zones at profusion level 1/1 as well as small blood vessels on end. Note that a few of the small opacities in image D are slightly larger than those in images B and C. The small opacities in all three images are within the defined limits of size for q opacities, that is, exceeding 1.5 mm and up to about 3 mm. Hilar adenopathy is likely in 40D and hi is checked in Section 4B. Note partially visible fusion hardware in the lower cervical spine.