It turns out that coal, silica, and asbestos dust can all give similar shadows on the chest X-ray. For this reason, B-Readers are now called upon to read the chest X-rays of workers for lung cancer asbestosis. It is now practically a legal requirement that any lung cancer asbestosis claim (based on the chest X-ray) be sanctioned by a certified B-reader. Yet studies have shown that B-Readers, as a group, display enormous variation in chest X-ray interpretation.
Years ago, the US Department of Labor (DOL) set up a special program to train physicians to read chest X-rays of workers exposed to coal and silica dust. Coal miners were developing a disease from inhaled coal and silica dust known as "black lung."
The goal of the training program was to bring some standards to the reading of the workers' chest X-rays and to identify those with early dust disease. Because these physicians passed Part B of DOL's training course, they are collectively known as "B-Readers."
As was already pointed out, direct examination of lung tissue for evidence of lung cancer asbestosis (lung tissue from surgery or autopsy) is rarely performed. Instead, most cases are diagnosed by "shadows" seen on the ordinary chest X-ray or chest CT scan (performed much less commonly than the chest X-ray).
The problem is in the interpretation of the chest X-ray for lung cancer asbestosis. Smokers, in particular, can have "shadows" that are often misinterpreted as asbestos disease. Also, many other conditions (i.e., congestive heart failure) can mimic chest X-ray changes that are misinterpreted as due to lung cancer asbestosis.
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