Application of the ILO International Classification of Radiographs of Pneumoconioses to Digital Chest Radiographic Images

A NIOSH Scientific Workshop

The following content has been adapted from a presentation given at the NIOSH Scientific Workshop: Application of the ILO International Classification of Radiographs of Pneumoconioses to Digital Chest Radiographic Images.

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American College of Radiology Perspective

Daniel A. Henry, M.D., F.A.C.R
Chair
ACR Pneumoconiosis Committee

Objectives, organizational perspective

• To implement digital acquisition and display for local x-ray facilities
• To implement digital classification for readers who classify images

Stakeholder actions / challenges

• Facilitate the development of technical guidelines for the acquisition and display of digital chest images suitable for ILO classification
• Based on the above, transition established teaching methods of classification from an analog to digital format and environment

The Beginning

• Collaboration with National Institute of Occupational Safety and Health & ILO
• An Integrated Mission
  • Education
  • Technical development and support

ACR The Beginning

• 1969 – Federal Coal Mine Health & Safety Act
  • Active miners: CXR within 18 mos, 3yr, 5yr
  • Retired miners
  • Disability / compensation benefits
  • Length of exposure / radiographic findings
  • International Union Against Cancer/Cincinnati system (based on 1958 ILO system)
• NIOSH / US Public Health Service requests assistance
• 1970 - ACR Pneumoconiosis Task Force

ACR Education

• Meeting the Instructional Challenge
• A crash program was developed
• Weekend Symposia for attendee convenience
• 6 courses in the first year
• > 30 meetings since 1970
• 4,000-5,000 physician attendees

• Viewbox teaching method
• Test-Teach-Test sequence of instruction*
• Compels active participation in the learning process
• Incorporated into other ACR subspecialty teaching seminars
• Remains the backbone of the current ACR Symposia on the Pneumoconioses

*Felson B, Jacobson G, Pendergrass E, Bristol L, Linton O, Harrington R. Viewbox seminar: A new method for teaching roentgenology. Radiology 1975; 116:75-78.

• Symposia restricted to physicians
• 6 Technical Symposia for radiographers on chest radiographic technique
• Special seminars for administrative judges & lawyers interpreting the law for state and federal programs

• Development of Home Study Syllabi
  • Classification for Physicians / B-reader candidates
  • Chest technique for radiographers
• Exhibits detailing proper radiographic technique and the ILO classification system
• Cinematic production explaining the law and the obligation of physicians

• Support for and validation of the “B reader” examination
• Implementation of the step wedge for improving radiographic technique*
• Development of a teaching module on asbestos related diseases

*E. DALE TROUT and JOHN P. KELLEY A PHANTOM FOR THE EVALUATION OF TECHNIQUES AND EQUIPMENT USED FOR ROENTGENOGRAPHY OF THE CHEST Am. J. Roentgenol., Apr 1973; 117: 771 - 776.

• ACR Pneumoconiosis Task Force consulted with various federal agencies conducting related programs:
  • Food and Drug Administration
  • Department of Labor
  • Social Security Administration
  • National Cancer Institute

• Development of Technical Guidelines prepared for NIOSH
• Home Study Syllabus on Technique for Chest Radiography
• Technique for Chest Radiography for Pneumoconiosis

ACR

• Members of the Task Force have been or are members of ILO committees
• Participated in the development/revisions of ILO Guidelines 1971, 1980, & 2000
• ACR sponsored conferences in Washington, D.C. which subsequently led to the 1980 & 2000 Guidelines
• ACR instrumental in the production of the 1980 ILO Standard Radiographs & the subsequent quadrant standards
• Participated as consultants to NIOSH for the review of teaching materials including the transition to digital

• 1982-84: ACR-NEMA collaboration
• ACR members requested non-proprietary format for image production from digital sources (CT, NM, US)
• National Electrical Manufacturers Association
• ACR-NEMA Digital Communication Standard
• Digital Imaging and COmmunication in Medicine standard - DICOM

Technique for Chest Radiography for Pneumoconiosis

• Overview
• Equipment
• Technique guides
• Scatter control
• Quantum mottle
• Screen/film combinations
• Sensitometric monitoring
• Radiation protection

• ACR practice guidelines
  • Performance of Adult Chest Radiography (10/06)
  • Digital Radiography* (10/07)
• ACR Technical Standard for Electronic Practice of Medical Imaging (10/07)

*Developed collaboratively by American College of Radiology
American Association of Physicists in Medicine
Society for Imaging Informatics in Medicine

DICOM

• To promote communication of digital image information, regardless of manufacturer
• To facilitate the development and expansion of PACS that can interface with other systems of hospital information
• To allow the creation of information databases that can be accessed by a wide variety of devices distributed geographically

• Used by other specialties utilizing digital imaging such as cardiology, GI endoscopy, pathology, dentistry, & dermatology
• Consists of 13 layers or sections
• Ongoing evolution
• Critical to digital imaging and this transition

American College of Radiology “Dust to Digital”

• Collaboration with National Institute of Occupational Safety and Health
• An Integrated Mission
  • Education
  • Technical development and support

ACR: Dust to Digital

• Transition to digital “viewbox” seminars
• Maintain the individual or registrant oriented approach for instruction
• Test – Teach – Test, interactive model
• What type of digital display devices will be necessary?
• Emulate the test and practice environment

• The challenge for teaching
• Transition away from the viewbox
• Classroom of the future
• New logistical paradigm using digital media but maintaining the benefits of the viewbox seminar
• Converting analogue material

• New facility
• Site of future teaching seminars?
• Site of future b-reader testing?

• Image processing driving display market
• Industry has moved to color LCD monitors
• More versatile for cross sectional imaging and CR/DR
• Color monitors generally load images faster
• Cheaper
• Can we use color monitors for B-reading?
• Will we require a B/W monitor?

• Established models for image acquisition
• Reestablish the primacy of high quality standard procedures in acquiring images regardless of modality
• Integrate digital acquisition and display guidelines with basic elements of chest radiography
• Reinvent the 1984 monograph as “Technique for Digital Chest Radiography for Pneumoconiosis”

• Use past experience as template
• Transition the current ACR Pneumoconiosis Committee to a Task Force, once again
• Draw from ACR Digital Guidelines authors & collaborators and members of this workshop
• Expand the Task Force’s role and composition from primarily education to a more integrated and supportive posture with NIOSH & ILO to assist in the “dust to digital” technical and educational transition
• Explore accreditation/ QA function