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 L.C. Oliver, L.S. Welch, M.R. Harbut (Academic Radiology, 2004).

The study

• Authors: L.C. Oliver, L.S. Welch, M.R. Harbut
• Journal: Academic Radiology
• Published: 2004;11(12):1397-9; author reply 1402-4
• Type of article: Letter, Comment
• Read it: PubMed · Publisher

In plain English

This was a letter to the editor, not an original study. The authors commented on a 2004 article by Gitlin and colleagues. That article compared X-ray readings of asbestos litigation plaintiffs by B readers chosen by plaintiffs' attorneys with re-readings by consultant B readers chosen by the study's authors. The letter stated that the study was done at the behest of defense attorneys. The authors asked how the consultant readers were selected and paid, how the 551 cases were chosen, and why only 492 were analyzed. They argued that the films were a selected series submitted for compensation, so the study had no denominator data for judging rates of positive findings among exposed workers. They presented kappa statistics, a measure of agreement beyond chance, for the consultant readers. Agreement was poor for film quality (0.10, 0.08–0.12), any parenchymal abnormality (0.31, 0.28–0.33) and small opacities 1/0 or greater (0.19, 0.18–0.21). It was fair for whether a film was completely negative (0.43, 0.40–0.46) and for pleural abnormalities consistent with pneumoconiosis (0.49, 0.47–0.52). The authors concluded they could not support Gitlin and colleagues' conclusions.

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: Letter to the editor commenting on another published study (Gitlin et al., Acad Radiol 2004); not original research
• Who was studied: The letter discusses the Gitlin study's sample: chest radiographs of plaintiffs in asbestos litigation, originally read by B readers selected by plaintiffs' attorneys. The initial sample was 551 cases and the final analytic sample was 492.
• Exposure: No exposure was studied directly. The subject is the classification of chest radiographs for asbestos-related changes under the International Labour Office (ILO)-1980 system.
• Main results:
  • The authors stated that the reason for reducing the initial sample of 551 cases to the final analytic sample of 492 was not clear.
  • The authors argued that because the films were a selected series of positive radiographs submitted for compensation, the study lacked denominator data to support conclusions about rates of positive findings among exposed workers.
  • The authors acknowledged a clear difference between the initial reader and the consultant readers in the overall classification of films as completely normal or not.
  • Agreement among the consultant readers on film quality: kappa 0.10 (0.08 to 0.12), described as poor.
  • Agreement among the consultant readers on whether the film was completely negative: kappa 0.43 (.40 to .46), described as fair.
  • Agreement among the consultant readers on any parenchymal abnormalities consistent with pneumoconiosis: kappa 0.31 (0.28 to 0.33), described as poor.
  • Agreement among the consultant readers on small opacities 1/0 or greater: kappa 0.19 (0.18 to 0.21), described as poor.
  • Agreement among the consultant readers on any pleural abnormalities consistent with pneumoconiosis: kappa 0.49 (0.47 to 0.52), described as fair.
  • According to the authors, adding the initial reader to the agreement measure changed it little or not at all, and the initial reader was in the same ballpark as the consultant readers for many parameters.
• The authors' conclusion: The authors concluded that they could not support Gitlin and colleagues' conclusions. Their reasons were potential bias in selecting the study sample, potential bias on the part of the consultant readers, and high variability among the consultant readers.

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.

Related studies

• 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)
• 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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