Use of oblique chest roentgenograms in detecting pleural disease in asbestos-exposed workers

Our plain-English summary of Use of oblique chest roentgenograms in detecting pleural disease in asbestos-exposed workers, by C.B. Sherman, S. Barnhart, L. Rosenstock (Journal of Occupational Medicine., 1988).

The study

• Authors: C.B. Sherman, S. Barnhart, L. Rosenstock
• Journal: Journal of Occupational Medicine.
• Published: 1988;30(9):681-3
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000936).

Abstract

Oblique chest roentgenograms have been recommended by some for use in screening programs of asbestos-exposed workers to increase detection of pleural fibrosis not evident on posteroanterior (PA) films. As a screening test, identification of pleural abnormalities with oblique films is especially important in subjects without evidence of other asbestos-induced abnormalities on PA films, namely, parenchymal fibrosis. To evaluate the incremental value of oblique films in the identification of pleural fibrosis, a comparison was made between PA films read alone and PA films read with both oblique views in a systematic evaluation of 489 male pipefitters examined in a screening program. Analysis of the subsets of pipefitters with and without parenchymal fibrosis showed that 2.5% of workers with normal PA films (n = 326) and 13.0% of subjects with isolated parenchymal fibrosis on PA films (n = 46) had pleural fibrosis detectable only on oblique films. In only eight (1.6%) did the oblique view represent the sole evidence of an asbestos-related roentgenographic abnormality. We conclude that oblique films should not be routinely used in screening workers for evidence of asbestos-induced disease.

In plain English

This study tested whether two extra angled (oblique) chest X-rays, added to the standard front-view (posteroanterior, or PA) X-ray, helped find pleural fibrosis (scarring of the lung lining) in asbestos-exposed workers. The authors studied 489 consecutive plumbers and pipefitters in a voluntary asbestos surveillance program from 1982 to 1984. Two trained readers read each PA film alone, then read it again together with the oblique films. Adding the oblique films found pleural abnormalities in 14 of the 372 workers whose PA films showed no pleural disease, which the authors reported as a 3.8% increase in pleural detection. Among the 326 workers whose PA films showed neither pleural nor parenchymal (lung tissue) fibrosis, eight (2.5%) had pleural abnormalities on oblique films. Among the 46 workers with only parenchymal fibrosis on PA films, six (13%) had pleural fibrosis seen only on oblique films. In only eight workers (1.6%) were the oblique views the sole evidence of an asbestos-related X-ray abnormality. The authors concluded that oblique films should not be routinely used in screening workers for asbestos-induced disease.

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: Comparison of chest X-ray readings within a screening program: PA films read alone versus PA films read together with both oblique views
• Who was studied: 489 consecutive plumbers and pipefitters (described as male) enrolled in a voluntary asbestos surveillance program from 1982 to 1984; mean age 42.3 years (range 21 to 80)
• Exposure: Asbestos exposure in the plumbing and pipefitting trades, with a mean of 17.4 years in those trades. Fiber types were not specified.
• Main results:
  • On PA films alone, 326 (66.7%) of 489 workers had no pleural or parenchymal abnormalities, 68 (13.9%) had pleural abnormalities only, 46 (9.4%) had parenchymal abnormalities only, and 49 (10.0%) had both
  • Adding oblique films to PA films found pleural abnormalities in 14 of the 372 workers without pleural disease on PA films (Table 1). The authors reported this as a 3.8% increase in pleural detection.
  • Among the 326 workers with neither parenchymal nor pleural fibrosis on PA films, eight (2.5%) had pleural abnormalities on one or both oblique films
  • Among the 46 workers with parenchymal fibrosis only on PA films, six (13%) had pleural fibrosis seen only on oblique films
  • In only eight workers (1.6%) was the oblique view the sole evidence of an asbestos-related X-ray abnormality
• The authors' conclusion: The authors concluded that oblique films should not be routinely used in screening workers for evidence of asbestos-induced disease. They judged the films of marginal benefit relative to their economic and radiation costs.

Topics

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

Medical terms in this study, explained in our Lexicon: Fibrosis, Interstitial Fibrosis, Pipefitter.

Related studies

• The detection of thoracic abnormalities using posterior-anterior (PA) vs PA and oblique roentgenograms — R.B. Reger, R.G. Ames, et al. (1982)
• Incremental value of oblique chest radiographs in the diagnosis of asbestos-induced pleural disease — E.L. Baker, R. Greene (1982)
• Asbestos-related pleural disease and asbestosis: a comparison of CT and chest radiography — A.C. Friedman, S.B. Fiel, et al. (1988)
• The usefulness of computed tomography in detecting asbestos-related pleural abnormalities in people who had indeterminate chest radiographs: the Libby, MT, experience — O.I. Muravov, W.E. Kaye, et al. (2005)
• Diagnostic Performance of Ultra-Low-Dose Computed Tomography for Detecting Asbestos-Related Pleuropulmonary Diseases: Prospective Study in a Screening Setting — M. Schaal, F. Severac, et al. (2016)
• Effect of tobacco smoking on the presence of asbestosis at postmortem and on the reading of irregular opacities on roentgenograms in asbestos-exposed workers — E. Hnizdo, G.K. Sluis-Cremer (1988)

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