NIOSH B Reader Training and Examination


NIOSH B Reader Training and Examination

This three-day course, led by Course Directors Jeffrey Kanne, MD, FCCP and Cristopher Meyer, MD, FACR is designed to provide practicing physicians with the skills needed to sit for the National Institute for Occupational Safety and Health (NIOSH) B Reader Certification Examination. During the program, participants will receive lectures on the imaging features of pneumoconiosis and the International Labor Organization (ILO) classification system for chest radiographs interspersed with hands-on classification of chest radiographs from an enriched set of cases. Faculty will provide direct supervision and assistance. On the third day of the course, attendees will have the opportunity to sit for the NIOSH B Reader Certification Examination.

Workstation: FUJI Synapse

Course Materials
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If you have registered for an upcoming NIOSH B Reader Training and Examination course or completed a course, access the course materials. 

Target Audience

Physicians interested in becoming NIOSH certified B readers or current B readers interested in updating their practice. A valid U.S. medical license is required to sit for the examination.

Project Background/Practice Gap


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.

Program and Learning Objectives

At the conclusion of this course, participants will be able to:

  • Describe the radiographic findings of pneumoconiosis including small and large lung opacities and pleural disease
  • Use the ILO system to classify chest radiographs for pneumoconiosis
  • Recognize digital radiography artifacts and their impact on radiograph interpretation
  • State medicolegal and regulatory components of the B reading program
  • Possess knowledge to sit for the NIOSH B Reader Certification Examination


Attendees who complete a minimum of 100 cases will be awarded a Certificate of Completion.
For additional information in planning your visit to Reston, please read our hotel and travel brochure.
 7 am  Workstation Introduction
 8 am  Introduction to the NIOSH B Reader Program
 8:30 am  Imaging of Coal Worker’s Pneumoconiosis and Silicosis
 9 am  Imaging of Asbestos-Related Lung and Pleural Disease
 9:30 am  ILO classification - Parenchymal Opacities
 10 am  Break
 10:15 am  ILO classification – Pleural Abnormalities
 10:45 am  ILO classification – Obligatory Symbols
 11:15 am  NIOSH B Reading Form
 11:30 am  Supervised Case Review
 12 noon  Lunch
 12:30 pm  Supervised Case Review
 2:45 pm  Break
 3 pm  Supervised Case Review
 5:30 pm  Break
 6 pm  Optional Time for Self-Review of Cases
 8 pm  ACR Education Center Closes
 7 am  Optional Time for Self-Review of Cases
 8 am  Quality and Digital Radiography Artifacts
 8:30 am  Supervised Case Review
 10 am  Break
 10:15 am  Supervised Case Review
 11:30 am  Medicolegal and Regulatory Considerations
 12 noon  Lunch
 12:30 pm  Incorporating B Reading into your Practice
 1 pm  Supervised Case Review
 3 pm  Break
 3:15 pm  Optional Time for Self-Review of Cases
 5 pm  ACR Education Center Closes
8 am

NIOSH B Reading Certification Examination

 2 pm Exam Concludes

Course Directors

Jeffrey Kanne, MD, FCCP

University of Wisconsin

Cristopher Meyer, MD, FACR

University of Wisconsin


Jonathan Chung, MD

University of Chicago

Danielle Seaman, MD

Duke University