Comparison of "B" readers' interpretations of chest radiographs for asbestos related changes

Our plain-English summary of Comparison of "B" readers' interpretations of chest radiographs for asbestos related changes, by J.N. Gitlin, L.L. Cook, O.W. Linton, et al (Academic Radiology, 2004).

The study

• Authors: J.N. Gitlin, L.L. Cook, O.W. Linton, E. Garrett-Mayer
• Journal: Academic Radiology
• Published: 2004;11(8):843-56
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Rationale And Objectives: The purpose of this study was to determine if chest radiographic interpretations by physicians retained by attorneys representing persons alleging respiratory changes from occupational exposure to asbestos would be confirmed by independent consultant readers.

Materials And Methods: For 551 chest radiographs read as positive for lung changes by initial "B" readers retained by plaintiffs' attorneys, 492 matching interpretative reports were made available to the authors. Six consultants in chest radiology, also B readers, agreed to re-interpret the radiographs independently without knowledge of their provenance. The film source, patient name, and other identifiers on each film were masked. The International Labor Office 1980 Classification of Chest Radiographs(ILO 80) was used with forms designed by the US National Institute of Occupational Safety and Health to record the consult-ants' findings. The results were compared with initial readings for film quality, complete negativity, parenchymal abnormalities,small opacities profusion, and pleural abnormalities using chi-square tests and kappa statistics.Results. Initial readers interpreted study radiographs as positive for parenchymal abnormalities (ILO small opacity profusion category of 1/0 or higher) in 95.9% of 492 cases. Six consultants classified the films as 1/0 or higher in 4.5% of 2,952 readings. Statistical tests of these and other comparable data from the study showed highly significant differences between the interpretations of the initial readers and the findings of the consultants.

Conclusion: The magnitude of the differences between the interpretations by initial readers and the six consultants is too great to be attributed to interobserver variability. There is no support in the literature on x-ray studies of workers exposed to asbestos and other mineral dusts for the high level of positive findings recorded by the initial readers in this report.

In plain English

The authors carried out this chest X-ray reading trial for a group of defense attorneys. It compared readings of 492 matched films from people with an asserted work history involving asbestos. Each film had been read once by 1 of 30 initial readers selected by plaintiffs, then independently by six consultant readers, giving 2,952 consultant readings. The initial readers recorded small opacity profusion of 1/0 or higher in 95.9% of their 492 readings. The consultants did so in 4.5% of their 2,952 readings. Pleural abnormalities were recorded in 26.4% of initial readings and 7.6% of consultant readings. Consultants answered that a film was completely negative in 37.9% of their readings; initial readers never did. The authors found essentially no agreement between the two groups on profusion, and only slight agreement among the consultants themselves. The authors concluded that the consultants' readings failed to confirm the initial readers' conclusions. They noted that they had no demographic information and no basis for judging how representative these claimants were.

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: Multiple-reader comparison (reading trial) of chest radiographs, conducted by the authors for a group of defense attorneys
• Who was studied: 492 matched chest radiographs from asbestos claimants. Each was read once by 1 of 30 initial readers selected by plaintiffs and six times by consultant readers, for 2,952 consultant readings in total.
• Exposure: Individuals with an asserted work history involving asbestos. No fiber types, products or doses were given.
• Main results:
  • Initial readers recorded small opacity profusion of 1/0 or higher in 472 (95.9%) of their 492 readings.
  • Consultant readers recorded profusion of 1/0 or higher in 133 (4.5%) of their 2,952 readings.
  • Comparing ratings of the same films, the odds of an initial reader rating profusion 1/0 or greater were 2,227.0 times the odds for a consultant reader (95% confidence interval 294.5 to 16,840.1).
  • Pleural abnormalities consistent with pneumoconiosis were recorded in 130 (26.4%) of 492 initial readings and in 224 (7.6%) of consultant readings.
  • Consultants answered "yes" to "Is film completely negative?" in 37.9% of their readings. The initial readers did so in none of theirs.
  • Initial readers graded film quality "good" for 66.5% of films; consultants did so for 33.4%.
  • The authors found essentially no agreement between consultants and initial readers on small opacity profusion ratings.
  • Agreement among the consultant readers themselves on small opacity profusion was described as "slight".
• The authors' conclusion: The authors concluded that re-reading by six independent consultants failed to confirm the conclusions of the initial B readers selected by plaintiffs' counsel.
• Limitations the authors state:
  • No demographic information was provided about the individuals examined.
  • The authors could not determine how representative this group was of asbestos claimants in general.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Chest X-Ray, Occupational Exposure, Plaintiff.

Related studies

• 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)
• Comparison of B readers' interpretations of chest radiographs for asbestos related changes — L.C. Oliver, L.S. Welch, et al. (2004)
• Comparison of B readers' interpretations of chest radiographs for asbestos related changes — A. Franzblau, B. Gillespie (2004)
• Chest radiographs in subjects with asbestos-related abnormalities: comparison between ILO categorizations and clinical reading — B. Hilt, A. Borgerson, et al. (1992)
• Inter-reader variability in chest radiography and HRCT for the early detection of asbestos-related lung and pleural abnormalities in a cohort of 636 asbestos-exposed subjects — E. Ochsmann, T. Carl, et al. (2010)

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