Often based upon their misunderstanding the definitions or the science, which you can explain:
Film Quality is Not Necessarily a Disqualifier for ILO Grading:
Film Quality, Grade I, is ideal, which is rare, especially in older adults; Grade II is the average Film Quality where there are minor positional or overlapping structure issues that do not significantly affect the reading (“acceptable, with no technical defect likely to impair classification of the radiograph for pneumoconiosis”). Although Trusts tend to throw out Grade III and Unreadable cases, the actual definition of Grade III from the ILO is that it is a readable study, but with definite limitations (“acceptable, with some technical defect, but still adequate for classification purposes”). In most cases whether it is a Grade III or Unreadable, often the pleural plaques, especially if they are calcified, are easy to read and would be the equivalent of a Grade II for plaques. It is the lung parenchyma on a Grade III or Unreadable Film Quality that is usually the issue. So, if calcified pleural plaques are identified on a Grade III or Unreadable study, they are in most cases, a positive finding for asbestos markers, regardless of the Film Quality grading.
Multiple Views are Acceptable:
The ILO parenchymal profusion readings on a chest x-ray are based upon a single frontal view. Oblique and lateral views can be obtained and can add to the information, but are not required. The film quality and the parenchymal changes/profusion or quantity is based solely on the frontal view. However, oblique views can also confirm further the interstitial lung disease and can be helpful at showing the presence or absence of small irregular opacities extending into the costophrenic angles in equivocal 0/1 versus 1/0 cases – positive cases with small irregular opacities extending into the costophrenic angles. Oblique and lateral views can be helpful at identifying and confirming the presence of pleural plaques to a better extent, especially if they are equivocal in appearance on the frontal view and can also help localize a lung nodule.
Mentioning Other Studies of Different Dates, is Relevant:
Under the “Other Comments”, Section, 4D, there are times that comparison with other studies is relevant. For instance, if there is an x-ray from 2020 as well as one from 2019, the B-read and ILO form may be based upon the 2020 x-ray, but under Other Comments, Section 4D, it is important to know whether or not there has been progression or regression of interstitial changes, the presence of greater plaquing with any progression of calcifications or the presence of a new nodule, pleural thickening or a new effusion(s) since 2019. It is thus, appropriate to compare to prior or even, if necessary, occasionally future x-rays, if reading an older study, under 4D Other Comments, but with the ILO profusion score, regardless of comparison(s) is based upon the date of the study seen on the first page.
The above article is provided as a public service by Daniel Powers, M.D.: B-Reader, Board-Certified Diagnostic Radiologist, Certified by the American Board of Radiology.
If you detect any errors, have additional information to point me to, use other useful terms or have comments, please do e-mail them to me at email@example.com.