Comparison of independent randomised reading of radiographs with direct progression scoring for assessing change in asbestos-related pulmonary and pleural lesions

Our plain-English summary of Comparison of independent randomised reading of radiographs with direct progression scoring for assessing change in asbestos-related pulmonary and pleural lesions, by G.H. McMillan, C.E. Rossiter, R. Deacon (British Journal of Industrial Medicine, 1982).

The study

• Authors: G.H. McMillan, C.E. Rossiter, R. Deacon
• Journal: British Journal of Industrial Medicine
• Published: 1982;39(1):60-1
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001769).

Abstract

Direct scoring of progression of pleural and parenchymal lesions was compared with change assessed by independent readings to the ILO classification among 155 men from HM Dockyard, Devonport, followed-up for 10 years. For pleural calcification the two methods agreed closely, whereas direct scoring yielded relatively too little progression of small opacities and too much progression of pleural thickening. The choice of method for assessing progression should depend on objectives.

In plain English

The authors compared two ways of judging change between chest X-rays taken in 1966 and 1976 from 155 men at HM Dockyard, Devonport, who already had pleural lesions. Three readers read each film independently, in random order, to the ILO U/C 1971 classification. The readers also directly scored each pair of films for change. For small opacities, 36 film pairs showed possible or definite progression on direct scoring, against 61 pairs on the independent ILO readings, though the two were quite strongly correlated. For pleural calcification the methods agreed well. For uncalcified pleural lesions (pleural thickening), the independent readings showed more cases regressing and fewer progressing than direct scoring did. The authors suggested this could partly reflect the coarseness of the ILO classification. They concluded that the choice of method depends on a survey's aims. In their view, independent randomised ILO reading is necessary for prevalence estimates, while direct reading of progression would be the method of choice if only change is of interest.

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: Methodological comparison of two ways of reading serial chest radiographs: independent random-order reading of each film to the ILO U/C 1971 classification by three readers, compared with the same readers directly scoring each pair of films for progression. It was carried out within a 10-year follow-up study.
• Who was studied: 155 men from HM Dockyard, Devonport (UK), who already had pleural lesions, each with chest radiographs from 1966 and 1976.
• Exposure: Not described in this article. The men are described only as dockyard workers with existing pleural lesions, studied for asbestos-related changes. No fiber types, jobs or doses are given.
• Main results:
  • Small opacities: 36 film pairs showed possible or definite progression on direct progression readings, compared with 61 pairs on the independent ILO readings. The correlation between the methods was quite strong.
  • Pleural calcification: the two methods agreed well.
  • Pleural calcification, table 2: of 25 film pairs read as two steps of progression on independent ILO reading, direct scoring rated 22 (88%) definite progression, 2 (8%) possible progression and 1 (4%) no change.
  • Uncalcified pleural lesions: independent ILO readings showed more cases to have regressed, and fewer to have progressed, than direct progression reading.
  • Overall, compared with the independent ILO readings, direct reading underestimated progression of small opacities, overestimated progression of uncalcified pleural thickening, and agreed well about pleural calcification.
• The authors' conclusion: The authors concluded that the choice of method depends on the survey's objectives. Independent randomised reading to the ILO classification is necessary when an estimate of prevalence is required. Direct reading of progression would be the method of choice if only change in radiographic appearance is of interest.
• Limitations the authors state:
  • The authors noted that part of the difference for pleural lesions could come from the coarseness of the ILO classification. Progression can occur while the classified extent stays unchanged.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: ILO Classification, Pleural Calcification, Pleural Thickening.

Related studies

• Effect of smoking on attack rates of pulmonary and pleural lesions related to exposure to asbestos dust — G.H. McMillan, R.J. Pethybridge, et al. (1980)
• Comparison of chest radiograph reading methods for assessing progress of pneumoconiosis over 10 years in Wittenoom crocidolite workers — N.H. de Klerk, A.W. Musk, et al. (1990)
• Chest radiographs in subjects with asbestos-related abnormalities: comparison between ILO categorizations and clinical reading — B. Hilt, A. Borgerson, et al. (1992)
• Risk and significance of chest radiograph and pulmonary function abnormalities in an elderly cohort of former nuclear weapons workers — M.A. Mikulski, P.G. Hartley, et al. (2011)
• Development of radiological and clinical evidence of parenchymal fibrosis in men with non-malignant asbestos-related pleural lesions — G.H. McMillan, C.E. Rossiter (1982)
• The prevalence of pleural plaques and/or pulmonary changes among construction workers in Okayama, Japan — T. Kishimoto, K. Morinaga, et al. (2000)

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