ACR Appropriateness Criteria Review ACR Appropriateness Criteria® Occupational Lung Diseases

Our plain-English summary of ACR Appropriateness Criteria Review ACR Appropriateness Criteria® Occupational Lung Diseases, by Expert Panel on Thoracic Imaging, L. Bacchus, R.D. Shah, et al (Journal of Thoracic Imaging, 2016).

The study

• Authors: Expert Panel on Thoracic Imaging, L. Bacchus, R.D. Shah, J.H. Chung, T.P. Crabtree, D.E. Heitkamp, M.D. Iannettoni, G.B. Johnson, C. Jokerst, B.L. McComb, A.G. Saleh, R.M. Steiner, T.L. Mohammed, J.G. Ravenel
• Journal: Journal of Thoracic Imaging
• Published: 2016;31(1):W1-3
• Type of article: Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Occupational lung disease is a category of disease entities characterized by a reaction of the lung parenchyma to inhaled aerosolized particles found in the environment. This document summarizes the imaging appropriateness data for silicosis, coal worker pneumoconiosis, and asbestosis. The main points of the document are that computed tomography is more sensitive than radiography, computed tomography without contrast generally suffices for evaluation, and fluorodeoxyglucose-positron emission tomography may have utility in patients with mesothelioma. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

In plain English

This article is a practice guideline, not a new study. An expert panel of the American College of Radiology reviewed published medical literature and used a consensus rating method (modified Delphi) to rate imaging tests for people exposed to silica, coal dust or asbestos. For asbestos exposure it covered two situations: suspected interstitial lung disease and suspected mesothelioma. Tests were rated 1 to 9, with 7 to 9 meaning usually appropriate. For suspected asbestos-related interstitial lung disease, chest CT without contrast was rated 9 and chest X-ray 8. The panel said the two are complementary and both should be done. For suspected mesothelioma, chest CT with contrast was rated 9, chest X-ray 8, CT without contrast 7 and FDG-PET/CT 6. The panel concluded that CT detects lung and pleural abnormalities more sensitively than X-ray and that CT without contrast suffices in most cases. It also concluded that FDG-PET may help in suspected mesothelioma and that MRI is generally not regarded as appropriate. Where evidence was lacking or not definitive, expert opinion could be used.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Clinical practice guideline (ACR Appropriateness Criteria) based on a literature review and expert panel consensus rating (modified Delphi); this article is a summary of the full guideline
• Who was studied: No patients were studied directly. The guideline addresses patients with silica exposure and suspected silicosis, coal dust exposure and suspected pneumoconiosis, and asbestos exposure with suspected interstitial lung disease or suspected mesothelioma.
• Exposure: Occupational exposure to inhaled particles: silica, coal dust and asbestos (fiber types not specified by the panel)
• Main results:
  • Rating scale used by the panel: 1 to 3 usually not appropriate; 4 to 6 may be appropriate; 7 to 9 usually appropriate.
  • For asbestos exposure with suspected interstitial lung disease: chest CT without contrast was rated 9 and chest X-ray 8; chest CT with contrast and FDG-PET/CT were rated 3; CT without and with contrast and both MRI options were rated 2. X-ray and CT without contrast were described as complementary, and both should be performed.
  • For asbestos exposure with suspected mesothelioma: chest CT with contrast was rated 9, chest X-ray 8, chest CT without contrast 7, FDG-PET/CT 6, MRI without and with contrast 5 (with panel disagreement), and CT without and with contrast and MRI without contrast 3.
  • The panel stated that chest CT allows more sensitive and accurate detection and characterization of lung and pleural abnormalities than chest radiography.
  • The panel stated that FDG-PET may have utility in suspected mesothelioma for defining mediastinal and distant metastatic disease and perhaps for localizing a biopsy site, and that MRI is generally not regarded as appropriate.
  • Evidence cited by the panel (another study, not this guideline's own data): Spyratos et al studied 266 employees of an asbestos cement plant. Chest radiography detected abnormal findings in about 21% of them and HRCT in 67%.
• The authors' conclusion: The authors concluded that CT is more sensitive than radiography, that CT without contrast generally suffices for evaluation, and that FDG-PET may have utility in patients with mesothelioma.
• Limitations the authors state:
  • Where evidence is lacking or not definitive, the recommendations may rest on expert opinion.
  • The authors note there is still no standardized scoring system for high-resolution CT.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Lung Disease, Parenchyma, Silicosis, Pneumoconiosis, Mesothelioma.

Related studies

• ACR Appropriateness Criteria® Occupational Lung Diseases — Expert Panel on Thoracic Imaging, C.W. Cox, et al. (2020)
• Occupational lung diseases and global occupational health on the Net — K. Takahashi, A. Sekikawa, et al. (1998)
• Notes from the 2012 Annual Meeting of the Korean Society of Thoracic Radiology: asbestos-related thoracic diseases — J.S. Kim, J.G. Yi, et al. (2013)
• Comparison of "B" readers' interpretations of chest radiographs for asbestos related changes — J.N. Gitlin, L.L. Cook, et al. (2004)
• Comparison of B readers' interpretations of chest radiographs for asbestos related changes — K.D. Rosenman (2004)
• Comparison of B readers' interpretations of chest radiographs for asbestos related changes — J.P. Kassirer (2004)

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