ACR Appropriateness Criteria® Occupational Lung Diseases

Abstract

Occupational lung disease is a category of disease entities characterized by a reaction of the lung parenchyma to inhaled aerosolized particles found in the environment. This document summarizes the imaging appropriateness data for silicosis, coal worker pneumoconiosis, and asbestosis. The main points of the document are that computed tomography is more sensitive than radiography, computed tomography without contrast generally suffices for evaluation, and fluorodeoxyglucose-positron emission tomography may have utility in patients with mesothelioma. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Temporal Patterns of Exposure to Asbestos and Risk of Asbestosis

“…Another limitation of our study is the possible underreporting of asbestosis, particularly in the presence of a mild disease. Of note, we expect the quality of diagnosis, and the completeness of death records, to have improved over the time, also because of increasing reliability and availability of high-resolution computed tomography 23 , 24 ; thus, the diagnostic sensitivity of death certificates should have been lower for those deaths occurred during the 1970s and the 1980s among subjects who had recently quit the job. If that were the case, the decrease in the risk of asbestosis death with increasing TSLE could be even larger than we have documented.…”

Evaluation of Silicosis, Asthma, and COPD Among Sand and Gravel and Stone Surface Mine Workers

“…Finally, a chest CT scan would have been a more sensitive measure to identify silicosis or the complications of silicosis than the standard chest x-ray. 15,16 Because of cost factors, our study, and most other epidemiologic studies on the prevalence of silicosis, used a chest x-ray and not a CT scan.…”

“…One hundred seventy-six of the 344 (51.2%) eligible to have medical testing agreed to have the testing but only 67 of 344 (19.5%) followed through to schedule and show up to the hospital/clinic for the medical testing. Finally, a chest CT scan would have been a more sensitive measure to identify silicosis or the complications of silicosis than the standard chest x-ray 15,16 . Because of cost factors, our study, and most other epidemiologic studies on the prevalence of silicosis, used a chest x-ray and not a CT scan.…”

Modificação do perfil da silicose na mineração subterrânea de ouro em Minas Gerais

“…Nota-se que, a partir da subcategoria 3/2, todos tinham tempo maior que 10 anos. 163 (19,6) 282 (33,8) 44 (5,3) Ao se distribuir a prevalência da silicose (considerando-se diagnósticos por radiografia e/ou tomografia) obtido no grupo de 833 indivíduos, de acordo com faixas de tempo da exposição no subterrâneo, obtiveram-se resultados demonstrados na Figura 3.…”

“…Atualmente, a tomografia é um reconhecido método de imagem complementar à radiografia para a avaliação da exposição à sílica e da suspeita de silicose. Seus principais benefícios se dão no diagnóstico de casos iniciais da doença não manifestos na radiografia, bem como na avaliação de grandes opacidades em casos radiologicamente bem definidos 19 . Os sintomas são relativamente tardios e posteriores às manifestações radiológicas e se caracterizam por dispneia, tosse e fraqueza.…”