SECTION 1 – BACKGROUND
Pneumoconiosis is a progressive and irreversible interstitial lung disease caused by inhaling respirable mineral dusts, most typically in occupational settings. Pneumoconiosis can be identified by evaluating changes on chest radiographs. The National Institute for Occupational Safety and Health (NIOSH) is required by the Federal Mine Safety and Health Act of 1977 [Pub. L. 91–173; Approved Dec. 30, 1969; 83 Stat. 742] to carry out a national program of health surveillance for coal miners, including periodic chest radiography to identify pneumoconiosis (specifically coal workers’ pneumoconiosis, also known as Black Lung). As part of this surveillance, chest radiographs must be classified for the presence and severity of appearances of pneumoconiosis according to the Guidelines for the Use of the International Labour Office (ILO) International Classification of Radiographs of Pneumoconioses. The ability to use the ILO classification system is a highly specialized skill and most physicians are unfamiliar with the system. Thus, in order to carry out its surveillance responsibilities, NIOSH has developed regulations to maintain a pool of physicians “who have demonstrated ongoing proficiency . . . in classifying the pneumoconioses" using the ILO system (42 CFR 37).
To establish this pool and evaluate the proficiency of readers’ use of the ILO system in an ongoing manner, NIOSH developed the B Reader Program in 1974. The B Reader Program maintains a self-study syllabus which helps physicians learn about classification of radiographs of pneumoconiosis according to the ILO system. The B Reader program also administers a certification examination evaluating the ability to classify chest radiographs using the ILO classification system. In order to become a B Reader, a licensed physician must successfully pass the B Reader Certification Examination. In order to maintain certification, B Readers must be recertified by passing periodic re-examinations every 4 years. Physician test candidates can prepare for examinations by reviewing the self-study syllabus material or by attending a B Reader Course. In the past, there has been a history of NIOSH working with the American College of Radiology (ACR) to put on such courses. Also, NIOSH occasionally teaches a course at the NIOSH facility in Morgantown or at external sites at the request of stakeholders. However, due to personnel and resource constraints, NIOSH is very limited in its ability to provide such courses on its own.
Demand for B Readers has increased over the years. Since the B Reader Program was developed in the 1970s, several other federal and state medical monitoring and disability compensation programs have instituted the requirement for using physicians familiar with the ILO system or are certified B Readers to classify radiographs for the presence and severity of findings of pneumoconiosis (Standards for Determining Coal Miners’ Total Disability or Death Due To Pneumoconiosis [20 CFR 718]; Occupational Safety and Health Standards General Industry[Respirable Crystalline Silica] [29 CFR 1910.1053] and Construction [29 CFR 1926.1153]; Occupational Safety and Health Standards for Asbestos in General Industry [Subpart Z of 29 CFR 1910.1001], Shipyard Employment [Subpart Z of 29 CFR 1915.1001], and Construction [Subpart Z of 29 CFR 1926.1101]). B Readers may classify chest radiographs in other workplace settings where monitoring of workers for interstitial lung disease is needed, or in support of public health research studies. Additionally, the opinions of B Readers regarding the presence and severity of chest radiographic findings are often considered in compensation cases and other administrative and legal proceedings.
Over the past 10 years, NIOSH, with the help of partners, has worked to modernize B Reader training and testing material to include modern, digitally-acquired chest radiographs instead of older film-based chest radiographs. Additionally, implementation of the silica standard noted above has increased the demand for B Readers. Over the same time period, the population of B Readers has decreased from nearly 400 in the mid-2000s, to 165 today. Also, the average age of the remaining B Readers has progressively increased to an average of more than 60 years old. To address increased demand, remedy attrition, and bring on a new generation of B Readers, NIOSH requires the assistance of stakeholders to conduct outreach to the appropriate physician populations, make training more widely available, and offer increased accessibility to examination opportunities.