Comparison of High‐resolution Computerized Tomography with Film‐screen Radiography for the Evaluation of Opacity and the Recognition of Coal Workers' Pneumoconiosis

Abstract

Jingcai XING, et al.: Comparison of HRCT and FSR in Coal Workers' Pneumoconiosis CI: 0.62−0.83) between FSR and HRCT in all coal miners. The sensitivity of HRCT for CWP diagnosis was 96.9% (93/96). We observed that 18 of the 67 (26.9%) miners negative for CWP by FSR were classified as category 1 by HRCT according to the lung parenchyma profusion category system reported by Bérgin et al. The difference in the profusion scores between CWP subjects and healthy controls for HRCT scans were statistically significantly higher than those for FSR. Conclusions: HRCT was more sensitive than FSR in recognition of the profusion of small opacities among coal miners. More research is needed to evaluate the role of HRCT in early diagnosis of CWP. (J Occup Health 2014; 56: 301-308) Key words: Coal workers' pneumoconiosis, Filmscreen radiography, High-resolution computerized tomography, Opacity coalescence, Opacity shape, Profusion of small opacities Coal workers' pneumoconiosis (CWP), caused by long-term exposure to occupational coal dust, remains one of the most serious occupational diseases in developing countries 1) . It is also the most serious occupational disease in China. Recent reports indicated that more than 2.65 million workers are exposed to coal mine dust 2) and about 5,300 to 13,000 incident CWP cases (more than 50% of all pneumoconiosis) were reported annually from 2007 to 2010 by the Chinese Ministry of Health 3). A meta-analysis of published data from 2001 to 2011 found that the pooled prevalence of CWP in China was 6.02%, much higher than that in the UK (0. 8%, during 1998-2000) or USA (3.2% in the 2000s) 4) . To detect adverse health effects, Chinese national regulations have mandated periodic medical screening for all workers exposed to hazardous dusts since 1963. These peri- Current diagnostic standards of pneumoconiosis, which is the most serious occupational disease in China, are based on film-screen radiography (FSR). However, parenchymal structure overlap limits the sensitivity of FSR in the clinic. Highresolution computerized tomography (HRCT) has the advantage of identifying nodular pulmonary parenchymal changes. In this study, we aimed to compare HRCT and FSR for recognition of the profusion of small opacities, opacity shape and opacity coalescence in coal miners with or without radiographic evidence of coal workers' pneumoconiosis (CWP) and evaluate the possible role of HRCT in CWP diagnosis. Methods: There were 96 coal miners with radiographic evidence of CWP, 67 coal miners without CWP and 37 healthy controls in this study. FSR and HRCT images for all subjects were interpreted separately by three readers. Crude agreement and Kappa values were calculated to evaluate the agreement between the two methods. Results: The overall agreement for CWP evaluation was good (crude agreement rate=87.1%, κ=0.72, 95%

Exposure‐response estimate for lung cancer and asbestosis in a predominantly chrysotile‐exposed Chinese factory cohort

“…The diagnostic criteria and the required series of films (film‐screen chest radiographs) for the Chinese radiographic classification system are similar to that of the ILO Classification of Radiographs of Pneumoconiosis [Xing et al, ]. The panel usually consists of seven to nine experts (including respiratory physicians, radiologists, and occupational physicians) who have passed an examination similar to that of the NIOSH B‐reader exam, and have been certified by the National Institute of Occupational Health and Poison Control, Chinese Centre for Disease Control.…”

Respiratory surveillance for coal mine dust and artificial stone exposed workers in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

“…Importantly, more sensitive and specific radiological techniques have been developed for the detection of lung disease at an earlier stage. The diagnostic utility of HRCT scans is superior to plain chest imaging in both detecting and evaluating small parenchymal opacities and in staging disease in CWP [40][41][42] and silicosis. Application of computerized software is increasingly allowing quantification of extent of emphysema and interstitial lung disease, as well as assessment of the airway components of COPD.…”

Medical imaging in occupational and environmental lung disease

“…Several recent studies have specifically compared HRCT with film-screen radiography in the diagnosis of pneumoconiosis [49]. Not surprisingly, CT proved more sensitive for disease [49], but also in the setting of pleural disease, proved more specific by accurately differentiating subpleural fat from true asbestos-related pleural disease [50].…”