Radiological classification of pulmonary asbestosis

Our plain-English summary of Radiological classification of pulmonary asbestosis, by H. Bohlig (Annals of the New York Academy of Sciences, 1965).

The study

• Author: H. Bohlig
• Journal: Annals of the New York Academy of Sciences
• Published: 1965;132(1):338-50
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002497).

Abstract

Every classification is imperfect, even more so regarding asbestosis. The classifications now in use are not quite identical, but they mainly divide the radiological appearances into three fluently changing stages, of which especially the second is illogically defined and not to be produced efficiently. Because of the national differentiation between the compensation rules only a mere radiological classification can be taken into consideration for international agreement. The fact of a conference taking place at all proves that new international agreements about a practicable classification for pulmonary asbestosis are necessary. If experts agree, that linear opacities are also disseminated shadows and that the radiological appearances of pneumoconioses can be either disseminated or squared opacities, it would seem appropriate to adopt these two kinds of appearances as a base for new classification. Doing so, considerable approximation to already existing classifications (Sydney, 1950 ; Geneva, 1958) would be gained as well. For intensifying the reproducibility of the X-ray film and, on the other hand, enlarging the distinctness of the codified X-ray findings, we suggest not to use the unalterable symbol “L” (Geneva, 1958), but to introduce another symbol “f” for linear patterns, chiefly occurring in asbestosis, and to combine it with the quantitative categories for small opacities. The large opacities might be characterized by the symbol “A” for beginning confluence and by “B” and “C” for opacities having a longer diameter than 5 cm. The additional symbols (Geneva, 1958) would be welcome for further accommodation of the findings code to individual, local or national peculiarities. Extensive reconstruction of the radiological appearances, even without the film in question, would be possible when adopting the symbol suggested. It is unimportant whether this proposition is adopted or not ; it is exceedingly important, that some international agreement should be attained, which would be really practicable.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This 1965 article was a proposal, not a study of patients or workers. The author argued for a new way to classify pulmonary asbestosis on chest X-rays and reported no new data. The author held that only a purely radiological classification could win international agreement, because compensation rules differ between countries. The author criticized the three-stage system then in use, calling its second stage illogically defined. The author also called it completely insufficient for exact comparison and noted it could not record differences between the two sides of the lung. As a replacement, the author proposed adapting the International Classification of Pneumoconioses (Geneva, 1958). The proposal replaced its symbol "L" for linear markings with a symbol "f" that could be graded 1 to 3, like the symbols for small rounded shadows. Linear shadows up to 1 cm wide would count as small opacities. Pleural changes would be recorded with the Geneva additional symbols. The author acknowledged the proposal was not wholly satisfactory and might seem complicated. The author concluded that reaching some practicable international agreement mattered more than whether this particular proposal was adopted.

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: Proposal and commentary on X-ray classification (no original data collected)
• Who was studied: No study population. Chest X-rays of an asbestos weaver and an insulation worker were shown only as illustrations.
• Main results:
  • The author argued that, because compensation rules differ between countries, only a purely radiological classification could gain international agreement.
  • The author judged the three-stage division of asbestosis inadequate, describing stage II as illogically defined and the scheme as insufficient for exact comparison.
  • The author proposed not using the Geneva 1958 symbol "L" for linear opacities.
  • In its place the author proposed the letter "f", graded in the same way as the small-opacity symbols.
  • The author proposed classifying linear shadows up to 1 cm wide as disseminated (small) opacities, the same size limit used for spotted shadows.
  • The author proposed marking large opacities with A for beginning confluence, and with B and C for opacities longer than 5 cm.
  • The author held that pleural changes, including pleural plaques and mesothelioma, must be recorded in the classification, using the Geneva additional symbols.
  • The author supported keeping a 'suspect' category ("Z") for exposed people whose films were not clearly normal.
  • The author considered grading linear markings by their width but rejected the idea for the time being.
• The authors' conclusion: The author concluded that, with a minor change, the Geneva 1958 International Classification of Pneumoconioses seemed practicable for pulmonary asbestosis. The author added that reaching a practicable international agreement mattered more than adopting this specific proposal.
• Limitations the authors state:
  • The author stated the proposal was not wholly satisfactory and had weak points.
  • The author stated the code might seem complicated to readers unfamiliar with the silicosis classification.
  • The author stated that every classification is imperfect, especially for asbestosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestosis.

Related studies

• Radiological and pathological correlations in asbestosis in the Republic of South Africa and the United Kingdom. I. A proposed radiological classification of asbestosis — G.K. Sluis-Cremer, C.P. Theron (1965)
• Radiological and pathological correlations in asbestosis in the Republic of South Africa and the United Kingdom. II. A preliminary study of observer variation in the classification of radiographs of asbestos-exposed workers and the relation of pathology and x-ray appearances — A. Caplan, J.C. Gilson, et al. (1965)
• Comparison of digital with film radiographs for the classification of pneumoconiotic pleural abnormalities — T.C. Larson, D.B. Holiday, et al. (2012)
• The relative importance of clinical, radiological and pulmonary function variables in evaluating asbestosis and chronic obstructive airway disease in asbestos workers — G.M. Regan, B. Tagg, et al. (1971)
• Clinical and radiological criteria for the differential diagnosis between asbestosis and idiopathic pulmonary fibrosis: Application in two cases — A. Stufano, A. Scardapane, et al. (2021)
• Pulmonary ventilatory function in talcosis of lung — M. Kleinfeld, J. Messite, et al. (1964)

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