A "B" reader is a physician certified by the National Institute for Occupational Safety and Health (NIOSH) as demonstrating proficiency in classifying radiographs of the pneumoconioses.

History

In 1974, after studies of surveillance programs for coal miners revealed unacceptable degrees of reader variability, NIOSH began the "B" reader program (so named because of the Black lung or Coal Workers' X-ray Surveillance Program), with the intent to train and certify physicians in the ILO Classification system (for classifying radiographs for the presence of pneumoconiosis), so as to insure that physicians using this system were as accurate and precise as possible. The "B" reader certification examination system went into full operation in 1978. The current examination involves a timed classification of 125 radiographs. A physician must pass the certification examination to be a "B" reader and certification lasts 4 years. Examinations are offered monthly at the Appalachian Laboratory for Occupational Safety and Health (ALOSH) located in Morgantown, West Virginia.

Objectives of the "B" reader program

The original objective of the "B" reader examination was to identify physicians who were qualified to serve in national pneumoconiosis programs, particularly regarding epidemiological research and compensation of coal miners. Currently, "B" readers are involved with epidemiological evaluation, surveillance, and worker monitoring programs involving many types of pneumoconioses, not just the Coal Workers' programs. The "B" reader program aims to ensure competency in radiographic reading by evaluating the ability of readers to classify a test set of radiographs, thereby creating and maintaining a pool of qualified readers having the skills and ability to provide accurate and precise ILO classifications.

Certified "B" readers

As of 2/16/10 there were 272 NIOSH-certified "B" readers in the US and 50 international "B" readers. As of 10/20/17, there were 181 NIOSH-certified "B" readers in the US and 58 international "B" readers according to the Centers for Disease Control and Prevention website.

Reader variability

Inter-reader variability occurs when readers disagree amongst themselves on a classification. Intra-reader variability occurs when a reader classifies a radiograph differently on different occasions. Reader variability was one of the factors prompting the ILO to develop the ILO Classification system and was a catalyst for NIOSH's development of the "B" reader program. NIOSH notes that excessive, reader variability can reduce the quality and utility of the data. Inter-reader variability can be random or systematic. Systematic variation between readers, in which one reader consistently reports more or less abnormality than another, is related to bias, according to NIOSH. Bias can occur when a reader has information concerning the radiograph being classified (including information regarding the worker, such as exposure), by consciously or unconsciously influencing their classification. In a study comparing interpretations by "B" readers retained by lawyers in asbestos litigation compared to those from an independent blinded panel of "B" readers, there was an exceptionally high rate of disagreement (95.9% positive versus 4.5% positive, respectively).

NIOSH Code of Ethics for "B" readers

NIOSH has established the following Code of Ethics for "B" readers:

Recommended practices

NIOSH has four categories of recommended practices: