Journal of Thoracic Imaging

Our medical research library holds 24 studies published in Journal of Thoracic Imaging (1987–2024). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 20 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Lippincott Williams & Wilkins
• Published: 1985 to the present, United States
• Language: English
• ISSN: 0883-5993 (print), 1536-0237 (electronic)
• Its record in the NLM Catalog

2020s

• Artificial Intelligence-based Quantification of Pleural Plaque Volume and Association With Lung Function in Asbestos-exposed Patients. K.B.W. Groot Lipman, T.N. Boellaard, C.J. de Gooijer, et al. 2024;39(3):165-172. PubMed · Publisher · Free full text

  Abstract

  Purpose: Pleural plaques (PPs) are morphologic manifestations of long-term asbestos exposure. The relationship between PP and lung function is not well understood, whereas the time-consuming nature of PP delineation to obtain volume impedes research. To automate the laborious task of delineation, we aimed to develop automatic artificial intelligence (AI)-driven segmentation of PP. Moreover, we aimed to explore the relationship between pleural plaque volume (PPV) and pulmonary function tests.

  Materials And Methods: Radiologists manually delineated PPs retrospectively in computed tomography (CT) images of patients with occupational exposure to asbestos (May 2014 to November 2019). We trained an AI model with a no-new-UNet architecture. The Dice Similarity Coefficient quantified the overlap between AI and radiologists. The Spearman correlation coefficient ( r ) was used for the correlation between PPV and pulmonary function test metrics. When recorded, these were vital capacity (VC), forced vital capacity (FVC), and diffusing capacity for carbon monoxide (DLCO).

  Results: We trained the AI system on 422 CT scans in 5 folds, each time with a different fold (n = 84 to 85) as a test set. On these independent test sets combined, the correlation between the predicted volumes and the ground truth was r = 0.90, and the median overlap was 0.71 Dice Similarity Coefficient. We found weak to moderate correlations with PPV for VC (n = 80, r = -0.40) and FVC (n = 82, r = -0.38), but no correlation for DLCO (n = 84, r = -0.09). When the cohort was split on the median PPV, we observed statistically significantly lower VC ( P = 0.001) and FVC ( P = 0.04) values for the higher PPV patients, but not for DLCO ( P = 0.19).

  Conclusion: We successfully developed an AI algorithm to automatically segment PP in CT images to enable fast volume extraction. Moreover, we have observed that PPV is associated with loss in VC and FVC.

  Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

2010s

• 3-Dimensional Quantification of Composite Pleural Plaque Volume in Patients Exposed to Asbestos Using High-resolution Computed Tomography: A Validation Study. G. Dournes, A. Dubois, I. Benlala, et al. 2019;34(5):320-325. PubMed · Publisher

  Abstract

  Rationale: As pleural plaque has been reported as a risk factor in the occurrence of lung cancer and mesothelioma, a reproducible and precise method of measurement of pleural plaque volume (PPV) is needed to further describe these relationships. The aim of the study was to assess the reproducibility of a 3-dimensional computed tomography (3D-CT) volumetric analysis of PPV in patients with occupational exposure to asbestos.

  Material And Methods: A total of 28 patients were retrospectively randomly selected from the multicenter APEXS (Asbestos Post Exposure Survey) study, which was held between 2003 and 2005. All patients underwent a 3D-CT scan. Two readers specialized in chest radiology completed the 3D semiautomated quantification of lung volume using dedicated software. They also had to categorize the visual extent of pleural plaque in terms of thickness and circumference. Reproducibility of the continuous PPV variable was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Reproducibility of categorical variables was assessed using the κ test.

  Results: Intraobserver reproducibility of PPV was almost perfect (ICC=0.98 [95% interval: 0.97-0.99]), and interobserver reproducibility was very good (ICC=0.93 [0.88-0.97]). At Bland-Altman analysis, the mean differences were 0.1 (limit of agreement: -11.0 to 11.2) and 3.7 cc (-17.8 to 25.2), respectively. Visual analysis of both plaque in terms of thickness and circumference were fair to moderate, with κ values ranging from 0.30 to 0.60.

  Conclusions: 3D semiautomatic quantification of PPV is feasible and reproducible using CT in patients with occupational exposure to asbestos. PPV measurement may be useful to correlate with other asbestos-related disease outcomes and prognosis.

• A Case of Diffuse Intrapulmonary Malignant Mesothelioma. M. Kumazawa, H. Arakawa, T. Shiobara, et al. 2019;34(6):W147-W149. Case report PubMed · Publisher

• ACR Appropriateness Criteria Review ACR Appropriateness Criteria® Occupational Lung Diseases. Expert Panel on Thoracic Imaging, L. Bacchus, R.D. Shah, et al. 2016;31(1):W1-3. Review 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.

• Notes from the 2012 Annual Meeting of the Korean Society of Thoracic Radiology: asbestos-related thoracic diseases. J.S. Kim, J.G. Yi, Y.K. Kim, et al. 2013;28(3):W49-55. Case report PubMed · Publisher

• Oncological applications of positron emission tomography for evaluation of the thorax. T.C. Kwee, D.A. Torigian, A. Alavi. 2013;28(1):11-24. Review PubMed · Publisher

  Abstract

  Positron emission tomography is a powerful quantitative molecular imaging technique that is complementary to structural imaging techniques for purposes of disease detection and characterization. This review article will provide an overview of the applications of positron emission tomography for evaluation of patients with oncological diseases that may be encountered in the thorax.

• High serum immunoglobulin G4-related retrosternal fibrosclerosis. K. Kamiya, A. Yoshizu, T. Nakazato, et al. 2012;27(6):W190-2. Case report PubMed · Publisher

  Abstract

  A 65-year-old man with a history of exposure to asbestos complained of left leg edema. Computed tomography showed a flat, symmetrical, and longitudinal retrosternal thickening in addition to a presacral tumor. Retroperitoneal fibrosis was suspected. Serum immunoglobulin G4 (IgG4) levels were elevated (213 mg/dL). Thoracoscopic biopsy was performed. Histopathologic findings showed fibrotic tissue accompanied by proliferation of IgG4-positive plasma cells (proportion of IgG4/IgG-positive plasma cells ≥70%) indicative of multifocal fibrosclerosis.

• A case of malignant pleural mesothelioma with osseous and cartilaginous differentiation. N. Shiba, M. Kusumoto, K. Tsuta, et al. 2011;26(1):W30-2. Case report PubMed · Publisher

  Abstract

  A 69-year-old man with a history of exposure to asbestos was admitted because of a chest radiographic abnormality. Subsequent findings from computed tomography and a thoracoscopic biopsy suggested malignant mesothelioma. Punctate calcification was observed in the pleural tumor on computed tomography scanning. The patient underwent pleuropneumonectomy, and the tumor was pathologically diagnosed as malignant mesothelioma, sarcomatoid type with osseous and cartilaginous differentiation. Malignant mesothelioma with osseous and cartilaginous differentiation is a rare condition. Punctate calcification in the pleural mass as a lesion distinct from the pleural plaque may indicate osseous or osteosarcomatous differentiation in malignant mesothelioma.

2000s

• Asbestos-related disease: progression of parenchymal abnormalities on high-resolution CT. C.I. Silva, N.L. Müller, J.A. Neder, et al. 2008;23(4):251-7. PubMed · Publisher

  Abstract

  Purpose: To evaluate the changes over time in the pattern and extent of parenchymal abnormalities in asbestos-exposed workers after cessation of exposure and to compare 3 proposed semiquantitative methods with a careful side-by-side comparison of the initial and the follow-up computed tomography (CT) images.

  Materials And Methods: The study included 52 male asbestos workers (mean age+/-SD, 62.2 y+/-8.2) who had baseline high-resolution CT after cessation of exposure and follow-up CT 3 to 5 years later. Two independent thoracic radiologists quantified the findings according to the scoring systems proposed by Huuskonen, Gamsu, and Sette and then did a side-by-side comparison of the 2 sets of scans without awareness of the dates of the CT scans.

  Results: There was no difference in the prevalence of the 2 most common parenchymal abnormalities (centrilobular small dotlike or branching opacities and interstitial lines) between the initial and follow-up CT scans. Honeycombing (20%) and traction bronchiectasis and bronchiolectasis (50%) were seen more commonly on the follow-up CT than on the initial examination (10% and 33%, respectively) (P=0.01). Increased extent of parenchymal abnormalities was evident on side-by-side comparison in 42 (81%) patients but resulted in an increase in score in at least 1 semiquantitative system in only 16 (31%) patients (all P>0.01, signed test).

  Conclusions: The majority of patients with previous asbestos exposure show evidence of progression of disease on CT at 3 to 5 years follow-up but this progression is usually not detected by the 3 proposed semiquantitative scoring schemes.

• Pleural plaques in asbestos-exposed workers: reproducibility of a new high-resolution CT visual semiquantitative measurement method. G.S. Meirelles, J.I. Kavakama, D. Jasinowodolinski, et al. 2006;21(1):8-13. PubMed · Publisher

  Abstract

  Objective: To assess the reproducibility of a new high-resolution computed tomography (CT) visual semiquantitative method for pleural plaques in asbestos-exposed workers.

  Material And Methods: We performed thin-section CT in 752 chrysotile asbestos mining workers and ex-workers. Institutional review board approval and signed written informed consent from subjects were obtained. Two readers independently evaluated the 752 CT scans and identified 57 workers (mean age +/- SD, 61.8 years +/- 8.1; range, 37 to 81 years) who had pleural plaques and no other pleural or parenchymal abnormality. Three independent radiologists then quantified the plaque burden in these 57 workers using a scoring system based on the evaluation of the maximum thickness of parietal pleural plaques and percentage of parietal pleural surface involvement. We also calculated the proportion between the number of CT slices with diaphragmatic plaques and the total number of slices in which the diaphragm was seen (pdiaph). The intraobserver and interobserver agreements were analyzed using weighted Kappa coefficient.

  Results: Interobserver agreements were good for the pleural plaque score (k = 0.61, 0.75, and 0.79) and ranged from good (k = 0.61) to excellent (k = 0.86) for the pdiaph. Intraobserver agreements ranged from good to excellent for the pleural plaque score (k = 0.79 and 1.00) and for the pdiaph (k = 0.79 and 0.93).

  Conclusion: The method proposed for high-resolution CT pleural plaque quantification in asbestos-exposed workers has a high reproducibility.

• Imaging of thoracic occupational and environmental malignancies. K. Garg, D.A. Lynch. 2002;17(3):198-210. PubMed · Publisher

  Abstract

  The imaging features of occupational lung cancer are similar to those of nonoccupational cancer. Occupational lung cancer in patients with asbestos exposure must be differentiated from mimics such as round atelectasis and fissural pleural plaques. Mesothelioma remains a largely incurable tumor, though treatment options are expanding. CT, MRI, and PET scanning may all have complementary roles in staging mesothelioma.

• Occupational and environmental thoracic malignancies. E.B. Gottschall. 2002;17(3):189-97. Review PubMed · Publisher

  Abstract

  Lung cancer is the most common thoracic malignancy caused by exposures at work and in the environment. The most unique thoracic malignancy is mesothelioma, because it is relatively rare and one of only a few neoplasms for which one specific inciting agent-asbestos-has been identified. Based on epidemiologic studies, approximately 15% of lung cancers in men and 5% of lung cancers in women are caused by occupational exposures. The International Agency for Research on Cancer has devised a rating system by which, based on animal and human data, they assign an agent, mixture, or exposure circumstance to one of five categories, ranging from group 1 (agent is carcinogenic to humans) to group 4 (agent is probably not carcinogenic to humans). Group 1 pulmonary carcinogens reviewed in this article include arsenic, asbestos, beryllium, bis (chloromethyl) ether, cadmium, chromium (IV), mustard gas, nickel, radon, and silica. The clinical presentation and pathology of lung cancers and mesothelioma caused by such exposures do not differ from those of cancers caused by other factors. The key to the recognition of a thoracic malignancy caused by workplace or environmental exposures is clinical suspicion and consideration of all causes for the disease present. Recognition of an exposure-related case of lung cancer or mesothelioma can aid in the identification of excess risk for a whole workforce or community and can lead to actions to reduce exposure, thus preventing future cases. In addition, such recognition allows the individuals struck by devastating illness to exercise their legal rights to compensation if so desired.

1990s

• Rounded atelectasis. P. Batra, K. Brown, K. Hayashi, et al. 1996;11(3):187-97. Review PubMed

  Abstract

  Rounded atelectasis (RA) is a special type of peripheral lung collapse that develops as a result of pleural disease. Most cases have been attributed to asbestos inhalation, but many other causes have also been implicated. It is usually detected incidentally in an asymptomatic older man. RA can be diagnosed by a constellation of radiologic findings. It appears as a rounded masslike opacity in the peripheral lung adjacent to thickened pleura and with curvilinear opacities of bronchi and vessels (comet tail) extending from the site of RA toward the hilum. Volume loss of the affected lobe is uniformly present. In addition to the classic lesion, a spectrum of atypical lesions has also been described. Computed tomography (CT) and high-resolution CT demonstrate the full extent of disease better than chest radiography. Familiarity with this benign condition is important to differentiate it from other pulmonary and pleural diseases and to prevent unnecessary invasive procedures and surgical resection.

1980s

• Computed tomography in the diagnosis of asbestos-related thoracic disease. G. Gamsu, D.R. Aberle, D. Lynch. 1989;4(1):61-7. Review PubMed · Publisher

  Abstract

  High-resolution computed tomography (HRCT) has improved the radiologist's ability to detect and potentially quantify the abnormalities of asbestos exposure. It has proved to be more sensitive than chest radiography for detecting pleural plaques and for discriminating between pleural fibrosis and extrapleural fat. HRCT is also more sensitive than chest radiography or conventional CT for detecting parenchymal abnormalities in asbestos-exposed persons. The HRCT findings that correlate with other parameters of asbestosis include (1) septal and centrilobular thickening, (2) parenchymal fibrous bands, (3) honeycomb patterns, (4) subpleural density persisting in the prone position, and (5) subpleural curvilinear lines that persist in the prone position. CT has an important role in evaluating benign and malignant lung and pleural masses in asbestosis.

• Misconceptions regarding the pathogenicity of silicas and silicates. D.S. Feigin. 1989;4(1):68-80. Review PubMed · Publisher

  Abstract

  Several inhaled substances, from occupational or other environmental exposure, produce significant pulmonary disease and abnormalities demonstrated by pulmonary imaging. Areas of controversy and misconception relate principally to the extent and nature of both the clinical disease and the imaging abnormalities specific to each substance. The size and shape of the inhaled particles is an important determinant of the nature and severity of the disease produced, with fibrous shapes usually being the most pathogenetic. Fibrogenicity is another important pathogenetic characteristic of talc and kaolin, as well as asbestos. Talc produces four distinct forms of pulmonary disease, depending not only on the other substances with which it is inhaled, but also whether it is inhaled or injected intravenously. When inhaled alone, talc does not appear to produce significant pulmonary fibrosis or malignancy. Kaolin, mica, fuller's earth, zeolite, and fiberglass all vary in disease production according to their shape and fibrogenicity. Silica, diatomaceous earth, and other forms of silica are all highly fibrogenic and thus produce clinically obvious disease with sufficient inhalation. The largest particles usually produce nodular patterns in the upper pulmonary fields, as is typical of silicosis. The fibrous particles are more likely to manifest themselves as interstitial patterns in the lower pulmonary fields.

• A clinical diagnostic model for the assessment of asbestosis: a new algorithmic approach. A. Schwartz, S.D. Rockoff, D. Christiani, et al. 1988;3(4):29-35. PubMed · Publisher

  Abstract

  Asbestosis, one of the pneumoconioses that is defined by a set of clinical, radiographic, and pathologic findings, occurs as a result of exposure to asbestos fibers. Several approaches have attempted to describe the presence, progression, or extent of asbestosis. However, these approaches have attempted to describe the presence, progression, or extent of asbestosis. However, these approaches have limitations or lack correlations with other diagnostic modalities. We propose a comprehensive clinical diagnostic model that uses the sensitivities and specificities of the various clinical, radiographic, and pathologic findings to generate a set of "likelihood numbers." These likelihood numbers, contribute to the calculation of a value that can indicate the probability of asbestosis. The clinical diagnostic model is heuristic in that a specific feature supportive of the diagnosis of asbestosis may be tested as to its sensitivity and specificity, and new features may be added to the model. The model also indicates how probabilistic a given set of findings is in the diagnosis of asbestosis and suggests what additional data may make the diagnosis more or less statistically probable. Regarding the radiologic considerations of asbestosis, the strength of the clinical diagnostic model is that it is capable of supporting a diagnosis of asbestosis in the presence of a normal chest radiograph and, conversely, may reject the diagnosis of asbestosis despite the radiographic finding of pulmonary fibrosis.

• Current issues regarding the pathobiology of asbestosis: a chronologic perspective. E. Kagan. 1988;3(4):1-9. Review PubMed · Publisher

  Abstract

  Asbestosis is a pneumoconiosis that results from the inhalation of asbestos fibers. There is a body of evidence that implicates the alveolar macrophage in the pathogenesis of asbestosis because of its prominence in asbestos-related histologic lesions. Injury to the alveolar epithelium also may contribute to the pathogenesis of asbestosis. Evidence is presented to suggest that pulmonary fibrosis may result from the persistent release of inflammatory mediators (chemoattractants, lysosomal enzymes, toxic oxygen radicals, arachidonic acid metabolites, interleukins, and fibroblast growth factors) at sites of asbestos deposition. Histologic features of asbestosis can be detected within months after the initial contact with asbestos. In contrast, the stigmata of asbestos-related disease usually are not radiologically detectable, even by the most sensitive imaging techniques, until after a latency period of at least a decade, and often considerably longer. There is, therefore, a long diagnostic delay between the time when asbestosis is histologically detectable and when it is radiographically detectable.

• Induction of thoracic malignancy in inorganic dust pneumoconiosis. J.C. Scatarige, F.P. Stitik. 1988;3(4):67-79. Review PubMed · Publisher

  Abstract

  Pulmonary carcinoma is now the leading cause of death due to cancer in men and women. Aside from cigarette smoking, occupational exposure to carcinogens is the most important cause of lung cancer, accounting for up to one third of all cases. The following article is a review of occupationally induced thoracic neoplasms with an emphasis on those related to the inhalation of inorganic dust. After introducing some basic terms, describing the research methods, and reviewing the process of carcinogenesis, current information on the relationship between exposure to asbestos, synthetic mineral fibers, silica, and other nonfibrous mineral dusts and the development of lung cancer and malignant mesothelioma of the pleura will be presented. The goal of this article is to provide the practicing radiologist with knowledge and insight into this difficult area.

• Inorganic dust diseases: issues and controversies. 1988;3(4):1-85. PubMed

• Inorganic dust pneumoconioses. S.D. Rockoff, E. Kagan. 1988;3(4):vii. Editorial PubMed

• Issues and controversies in the plain-film diagnosis of asbestos-related disorders in the chest. W.B. Gefter, E.F. Conant. 1988;3(4):11-28. Review PubMed

  Abstract

  This article reviews the chest radiographic manifestations of asbestos exposure. While the chest radiograph (CXR) is a highly valuable tool in the evaluation of asbestos-related disease, there are ongoing controversies regarding the sensitivity and specificity of the plain film in diagnosing asbestos-related disorders. Autopsy series indicate that at least 60% of pleural plaques may be overlooked. Conversely, such series indicate that up to 20% of plaques are falsely diagnosed. The significance of visceral pleural thickening and the definition and positive predictive value of diffuse pleural thickening as they relate to asbestos exposure are unresolved issues. Data suggest that the CXR may fail to reflect significant asbestosis in 10% to 20% of cases. On the other hand, the presence of overlying pleural abnormalities as well as technical factors may contribute to overreading of interstitial disease. Data on the rate of false positive readings for asbestosis are limited. Considered alone, the CXR can support but not specifically establish nor exclude the diagnosis of asbestosis. In practice, an ILO grade of less than 1/0 implies that the diagnosis is unlikely. A constellation of positive CXR findings may increase specificity, although the diagnosis rests on a combination of multiple clinical criteria.

• The effect of cigarette smoking on the detection of small radiographic opacities in inorganic dust diseases. P.D. Blanc, G. Gamsu. 1988;3(4):51-6. Review PubMed · Publisher

  Abstract

  Whether cigarette smoking can cause radiographic opacities indistinguishable from those due to pneumoconiosis remains controversial. The situation becomes clearer when one limits the abnormalities to those that can be standardized under the International Labour Office (ILO) classification system. The bulk of the evidence indicates that, using the ILO system, cigarette smoking alone is not associated with radiographic opacities that would be mistaken for pneumoconiosis with sufficient frequency to be of any practical importance. The effects of cigarette smoking, as a cofactor, in conjunction with occupational dust exposure depend on the type of dust. No relationship has been convincingly demonstrated for coal dust or silica. Only with asbestos exposure does there appear to be a significant cigarette smoking-associated increase in the frequency of irregular radiographic opacities. This increase does not appear to translate into a restrictive impairment in pulmonary function. The limited information available indicates that the features of asbestosis on high-resolution computed tomography are not similarly related to cigarette smoking. Additional research is needed to substantiate the relationship between smoking and occupational exposure to dust of many types, and also the possible imaging and pathophysiologic significance of their interactions.

• The radiographic pleural abnormalities in asbestos exposure: relationship to physiologic abnormalities. R.N. Jones, T. McLoud, S.D. Rockoff. 1988;3(4):57-66. Review PubMed · Publisher

  Abstract

  The effects of asbestos-induced benign pleural conditions on pulmonary function have been controversial since this subject was first studied in the mid-1960s. Firm conclusions have been difficult to reach because of (1) the difficulty of taking into account asbestos exposure, which may have effects on pulmonary function other than those mediated through pleural lesions, (2) the disagreement over the type and extent of radiographic pleural abnormalities, (3) the imprecision in measuring pulmonary function, and (4) the numerous potential confounding factors of reduced pulmonary function, such as cigarette smoking, age, concurrent occupational exposures, and prior chest diseases or trauma. This article critically evaluates the published reports on the functional significance of asbestos-induced pleural conditions. The results of this analysis lead to the conclusion that (1) pleural plaques are not associated with clinically significant reductions in pulmonary function, (2) diffuse pleural thickening, when extensive, can severely impair ventilation, and (3) restriction with a preserved diffusing capacity is the expected pattern when pleural lesions are responsible for reduced pulmonary function.

• Visceral pleural thickening in asbestos exposure: the occurrence and implications of thickened interlobar fissures. S.D. Rockoff, E. Kagan, A. Schwartz, et al. 1987;2(4):58-66. PubMed · Publisher

  Abstract

  We evaluated fissural (ie, visceral pleural) thickening on radiographs in two asbestos-exposed study populations and a control group. Asbestos workers had an incidence of fissural thickening of 54.5% compared with 16.0% in the unexposed control group, with a strong positive statistical effect due to asbestos exposure beyond that attributable to age. Fissural thickening occurred in 85% of workers with parietal plaques and in 36% without pleural plaques. Fissural thickening occurred in 45% without radiographic evidence of pulmonary fibrosis, but it was very common (85%) in those with pulmonary fibrosis. Data analysis showed that fissural thickening responds more strongly to asbestos exposure than does plaque formation, with 21 years of asbestos exposure needed for a 50% chance of developing fissural thickening, while 31 years of exposure were needed for a 50% chance of forming pleural plaques. From a second group of 57 asbestos workers evaluated clinically, 8 were diagnosed as having asbestosis with radiographically clear lungs and fissural thickening. We conclude that visceral pleural thickening is common in asbestos exposure, that it is related to the years since first asbestos exposure, and that its presence may indicate the presence of pulmonary asbestosis, even with radiographically normal lungs.

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