Effect of a two-hour training on physicians' skill in interpreting Pneumoconiotic chest radiographs

Our plain-English summary of Effect of a two-hour training on physicians' skill in interpreting Pneumoconiotic chest radiographs, by N.R. Ngatu, S. Suzuki, Y. Kusaka, et al (Journal of Occupational Health, 2010).

The study

• Authors: N.R. Ngatu, S. Suzuki, Y. Kusaka, H. Shida, M. Akira, N. Suganuma
• Journal: Journal of Occupational Health
• Published: 2010;52(5):294-301
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Occupational lung diseases have specific radiographic manifestations not always well known by physicians. In Japan, asbestos-related diseases became a public health concern after the "Kubota Shock", when a number of workers and residents living nearby a manufacturer of asbestos-made ducts developed mesothelioma caused by asbestos exposure. This preliminary intervention trial evaluated the effect of two-hour training on inexperienced physicians' skill in interpreting pneumoconiotic chest radiographs.

Methods: One hundred-two Japanese physicians participated in two reading-tests, using 12 radiographs, before and after the two-hour training with ILO/ICRP and Japan Pneumoconioses Study Group (JPSG) reading materials. Physicians had to check for the presence or absence of small opacity and pleural plaque consistent with pneumoconiosis. Sensitivity and specificity equal or greater than 70% were considered good, 50 to 69% acceptable and less than 50%, poor.

Results: Post-training improvements in physicians' skills were seen. For small opacity, there was an increase in the proportion of physicians with good specificity, from 42% to 60%. For pleural plaque, the proportion of physicians with good specificity and good sensitivity increased, from 60% to 67% and from 18% to 25%, respectively. Also, significant improvements were observed in overall sensitivity for pleural plaque, from 46% to 60% (p<0.0001), and specificity for small opacity, from 65% to 73% (p<0.0001).

Conclusions: This study showed that two-hour participatory training may enhance physicians' skill in interpreting pneumoconiotic chest radiographs. There are countries without any pneumoconiosis screening program despite the WHO/ILO call for worldwide cooperation in eliminating it. Although the two-hour course cannot replace the five-day ILO workshop, such a program would be useful in areas with environmental or occupational exposure to dust.

In plain English

This intervention trial in Japan tested whether a two-hour training session improved physicians' reading of chest X-rays for pneumoconiosis, the dust-caused lung diseases that include asbestosis and silicosis. The analysis covered 102 certified occupational physicians. Three more took part but were excluded because their reading sheets were incomplete. Before and after the training, the physicians marked yes or no for whether each of 12 test X-rays showed small opacities (small lung shadows) and pleural plaques. Nine of the test X-rays were abnormal and three were normal. After training, average sensitivity for pleural plaques (detecting plaques that were present) rose from 46% to 60%. Average specificity for small opacities (not reporting them when absent) rose from 65% to 73%. Both changes were statistically significant. Average sensitivity for small opacities went from 84% to 81%, and specificity for plaques from 77% to 79%; neither change was statistically significant. The authors concluded that the training enhanced inexperienced physicians' skill. They named as limitations the small number of test films, the limited number of viewboxes, and recruitment of volunteers, which could have caused bias.

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: intervention trial with reading tests before and after a two-hour training session (no control group described)
• Who was studied: 102 Japan Medical Association Certified Occupational Physicians, from two training sessions held in Kochi and Ehime prefectures, Japan (March 2008 for the Kochi session); 105 took part and 3 were excluded for incomplete reading sheets
• Exposure: Not an asbestos exposure study. The intervention was a two-hour training on the ILO International Classification of Radiographs of Pneumoconioses, using ILO standard films and 31 Japan Pneumoconioses Study Group films. Skill was tested on 12 chest radiographs from dust-exposed patients (9 abnormal, 6 of them with plaques; 3 normal), with readings compared against a B reader's, verified by CT.
• Main results:
  • All 102 readers, small opacity: mean specificity rose from 65% (pre-test) to 73% (post-test), p less than 0.0001
  • All readers, small opacity: mean sensitivity went from 84% to 81% (p=0.204 in Table 2, not significant)
  • All readers, pleural plaque: mean sensitivity rose from 46% to 60%, p less than 0.0001
  • All readers, pleural plaque: mean specificity went from 77% to 79%, p=0.3339, not significant
  • Proportion of physicians with good (70% or higher) specificity for small opacity went from 42% to 60%; the increase was not statistically significant (p greater than 0.05)
  • Pleural plaque: proportion of physicians with good specificity went from 60% to 67%, and with good sensitivity from 18% to 25% (no p-value given in the text)
  • Accuracy rate went from 69% to 75% for small opacity and from 62% to 70% for pleural plaque
  • No significant difference in reading skill improvement between internists (n=49) and physicians of other specialties (n=53)
• The authors' conclusion: The authors concluded that the two-hour participatory training enhanced inexperienced physicians' skill in interpreting pneumoconiotic chest radiographs, while stating that it cannot replace the usual five-day ILO workshop.
• Limitations the authors state:
  • Only about a dozen viewboxes for 27 or more physicians, who had to move between radiographs
  • The number of test radiographs was relatively small
  • Physicians were volunteers invited through their medical associations rather than randomly sampled, which could have been a source of bias

Topics

Medical terms in this study, explained in our Lexicon: Chest X-Ray, Occupational Lung Disease, Mesothelioma, Asbestos Exposure, Pleural Plaques, Pneumoconiosis, Occupational Exposure.

Related studies

• Assessment of physicians' proficiency in reading chest radiographs for pneumoconiosis, based on a 60-film examination set with two factors constituting eight indices — T. Tamura, Y. Kusaka, et al. (2018)
• Comparison of digital with film radiographs for the classification of pneumoconiotic pleural abnormalities — T.C. Larson, D.B. Holiday, et al. (2012)
• Exercise training to improve exercise capacity and quality of life in people with non-malignant dust-related respiratory diseases — M.T. Dale, Z.J. McKeough, et al. (2015)
• Relationship between chest X-ray findings and pulmonary function tests in dust workers — Y. Tonori, M. Niitsuya, et al. (2005)
• Identification of mineral particles in pneumoconiotic lungs — W.J. Henderson, J. Gough, et al. (1970)
• Chest physician-reported, work-related, long-latency respiratory disease in Great Britain — M. Carder, A. Darnton, et al. (2017)

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