Update: Standardisierte CT-/HRCT-Klassifikation der Bundesrepublik Deutschland für arbeits- und umweltbedingte Thoraxerkrankungen

Abstract

The high-resolution computed tomography (HRCT) coding scheme of the international classification of occupational and environmental respiratory diseases (ICOERD) presented here is an instrument for a standardized semiquantitative description of occupation and environment-linked as well as other pulmonary and pleural diseases. Analogous to the International Labour Organization (ILO) classification, the ICOERD coding scheme should always be used when the CT/HRCT examination is employed for occupational medical investigations or expert opinions. After publication of the guidelines and recommendations on diagnostics and expert assessment of asbestos-linked diseases and silicosis, the application of a standardized investigation program and assessment with the ICOERD classification form are obligatory, at least for the initial assessment. Furthermore, its use in the field of follow-up assessments of occupational diseases should be encouraged in order to guarantee comparability between individual reports (interreader variability) and at least a semiquantitative assessment of disease progression in isolated cases. Because the anatomical structures in projection radiography and CT are not presented identically, a 1:1 transfer of the results of the ILO classification to the CT/HRCT coding scheme is not possible. An overview image of the thorax does not allow overlap-free reproduction of structures, in contrast to CT. These methodological differences can in cases of isolated assessment result in different opinions of projection and CT images mostly by different investigators. In cases of discrepant opinions an integrated report of findings by combination of all information from both procedures is necessary.

Relations between vital capacity, CO diffusion capacity and computed tomographic findings of former asbestos-exposed patients: a cross-sectional study

“…To ensure a standardised evaluation, the International Classification of Occupational and Environmental Respiratory Disease (ICOERD) was used to assess the TCTs [29,30]. The semi-quantitative description and coding were performed by radiologists following the guidelines for assessment and image data documentation by Hering et al [8]. In 32 (78%) of the subjects, TCT was performed with a maximum interval of 30 days after/before administering the lung function test; in five subjects within 31 to 180 days and in four subjects within 181 to 365 days (mean 42 days, SD 82).…”

“…In the "Pleura" section, two forms of pleural changes can be differentiated: the parietal type with tableland-shaped or flat, partly spindle-shaped thickenings of the pleura without subpleural fibrosis and the visceral type with thickenings of the pleura with adjacent parenchymal ligaments. The parietal type can be regarded as highly asbestos-related pleural plaques, while the visceral type can be caused differently [8]. According to the Helsinki criteria, the minimum requirement for a clear diagnosis of asbestosis in the TCT is fibrosis, which is represented by at least two bilateral irregular densifications of the lower lung sections and/or bilateral honeycombing with a total of more than 2 points [10,31].…”

“…Honeycombing is the term for maximum fibrosis, i.e. the destruction of the lung parenchyma [5][6][7][8][9]. Asbestosis is difficult to detect in early stages [9,10].…”

The Validity of Static Lung Compliance in Asbestos-induced Diseases

“…The radiologist was aware that the participants had been exposed to asbestos but was blinded to the medical data. The findings were classified according to an international system [1,2].…”

“…The high-resolution computer tomography (HRCT) features of asbestosinduced fibrosis have been extensively described [1][2][3]. Asbestos-induced pulmonary disorders include curvilinear subpleural lines, parenchymal bands, interlobular septal thickening and centrilobular nodules, architectural distortion of the lobule, and honeycombing.…”