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Chest radiographic imaging is a widely applied and important tool for assessing lung health in workers exposed to dusts capable of producing pneumoconiosis and other diseases. Accurate and precise categorization of chest radiographic images requires close adherence to standard methods of radiograph classification and adoption of procedures for quality assurance. For over 70 years, the International Labour Office (ILO) has provided a standardized system for classification of chest radiographs for the pneumoconiosis that has been widely used by physicians and epidemiologic researchers concerned with occupational respiratory diseases. Since 1970, under the U.S. Code of Federal Regulations [42CFR37], screening chest radiographic examinations have been provided to underground coal miners. As part of this mandated Coal Workers’ Health Surveillance Program (CWHSP), the National Institute for Occupational Safety and Health (NIOSH) arranges for the interpretation of these radiographs. The presence and degree of dust-related radiological changes are determined by physicians who have demonstrated proficiency in using the ILO classification system. To determine proficiency, NIOSH developed and currently administers the B Reader Certification Program, a unique quality assurance program for training and certifying physicians who classify chest radiographs of the pneumoconioses. Under this Program, physicians who wish to obtain B Reader Certification must successfully pass a comprehensive examination, and to maintain certification, they must continue to demonstrate competence by passing a recertification examination every four years. In 2002, the ILO, with NIOSH involvement and support, completed a revision of their chest radiographic classification system. To ensure that the NIOSH B Reader Program is maintained as a relevant and effective quality assurance program for occupational lung disease research and prevention, and to maintain adherence to the revised ILO classification system, modifications are required to the B Reader examinations and related training activities and materials. Moreover, in the 30 years since the development of the B Reader Certification process, the field of radiology, as well as the discipline of professional competency testing, have experienced considerable advances in knowledge, techniques, and methodology. In short, the B Reader Certification Program could benefit from a critical evaluation in order to ensure optimal utility of the Program. Toward this end, NIOSH planned and held a scientific workshop-NIOSH B Reader Certification Program: Looking to the Future-March 5th, 2004, to discuss the important issues related to radiological surveillance for lung diseases.
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