Effect of a Two‐hour Training on Physicians' Skill in Interpreting Pneumoconiotic Chest Radiographs

Abstract

Effect of a Two-hour Training on Physicians' Skill in Interpreting PneumoconioticChest Radiographs: Nlandu Roger NGATU, et al. Department of Environmental Medicine, KochiMedical School, Kochi University-Objective: Occupational lung diseases have specific radiographic manifestations not always well known by physicians. In Japan, asbestos-related diseases became a public health concern after the "Kubota Shock", when a number of workers and residents living nearby a manufacturer of asbestos-made ducts developed mesothelioma caused by asbestos exposure. This preliminary intervention trial evaluated the effect of twohour training on inexperienced physicians' skill in interpreting pneumoconiotic chest radiographs. Methods: One hundred-two Japanese physicians participated in two reading-tests, using 12 radiographs, before and after the two-hour training with ILO/ICRP and Japan Pneumoconioses Study Group (JPSG) reading materials. Physicians had to check for the presence or absence of small opacity and pleural plaque consistent with pneumoconiosis. Sensitivity and specificity equal or greater than 70% were considered good, 50 to 69% acceptable and less than 50%, poor. Results: Post-training improvements in physicians' skills were seen. For small opacity, there was an increase in the proportion of physicians with good specificity, from 42% to 60%. For pleural plaque, the proportion of physicians with good specificity and good sensitivity increased, from 60% to 67% and from 18% to 25%, respectively. Also, significant improvements were observed in overall sensitivity for pleural plaque, from 46% to 60% (p<0.0001), and specificity for small Field Studyopacity, from 65% to 73% (p<0.0001). Conclusions: This study showed that two-hour participatory training may enhance physicians' skill in interpreting pneumoconiotic chest radiographs. There are countries without any pneumoconiosis screening program despite the WHO/ILO call for worldwide cooperation in eliminating it. Although the two-hour course cannot replace the five-day ILO workshop, such a program would be useful in areas with environmental or occupational exposure to dust. (J Occup Health 2010; 52: 294-301)

Lung Diseases - Selected State of the Art Reviews

“…When compared according their medical specialties, a relatively similar reading skill improvement was observed between internists and physicians from working in other departments. Higher scores of sensitivity for the detection of small opacities and specificity for plaques were found in internists, and a similar trend was also noted in the group of physicians from other specialties in which a significant improvement of specificity score for pleural plaques was found (p<0.05) in the post-test (Table 3) (Ngatu et al, 2010). The lack of training for medical doctors in the diagnosis of occupational diseases is the main factor leading to the misdiagnosis of pneumoconiosis as either chronic bronchitis or pulmonary tuberculosis (Murlidhar et al, 2005).…”

“…Pneumoconioses have relatively specific radiologic features that are not well-known to most physicians. Radiological imaging plays an important role in the diagnosis of those occupational lung diseases, including asbestos-related diseases, Silicosis and coal worker's pneumoconiosis (Ngatu et al, 2010;Blum et al, 2008). This review is aimed at providing health care workers, especially clinicians, with basic and accurate knowledge on principal radiologic features often found on a pneumoconiotic chest radiograph that characterize each of the above mentioned lung diseases related to occupational or environmental exposure to dust.…”

“…The presence of lymph nodes, muscles (serratus anterior, oblique externus abdominis...), pleural fat's shadow and normal cross-section or tangential views of blood vessels can be interpreted as opacities or pleural plaques related to pneumoconiosis, for example. This poses a challenge during chest radiograph reading process and may lead to misclassification of conditions consistent with pneumoconioses (Ngatu et al, 2010;Jinkai et al, 2008).…”

Development of CAD based on ANN analysis of power spectra for pneumoconiosis in chest radiographs: effect of three new enhancement methods

“…Pneumoconiosis includes asbestosis, silicosis, and other occupational diseases caused by exposure to dust [1]. Pneumoconiosis may be classified as either fibrotic or nonfibrotic, according to the presence or absence of fibrosis [2].…”

“…Pleural plaque on plain chest radiographs, mimicking shadows, such as rib-companion shadows, may lead to misclassification of conditions consistent with pneumoconiosis [1]. Therefore, computer-aided diagnosis (CAD) systems for chest radiographs are potentially useful tools that can lead to a more accurate diagnosis of various lung diseases [6–17].…”