Efforts to Enhance Participation in the National Institute for Occupational Safety and Health B Reader Program

Details

• Journal Article:
  Chest
• Personal Author:
  Laney, A. Scott ; Hall, Noemi B. ; Reynolds, Laura E. ; Weissman, David N.
• Description:
  For over 50 years, the National Institute for Occupational Safety and Health (NIOSH) has administered the NIOSH B Reader Program. NIOSH B Reader certification is granted after successful completion of an examination testing competency in classifying posteroanterior chest radiographs for appearances of pneumoconiosis, using the International Labour Office's (ILO) International Classification of Radiographs of Pneumoconioses. This examination is currently open only to licensed physicians, including but not limited to radiologists and pulmonologists. The ILO classification system established a standard vocabulary for describing radiographic shadows on chest films for epidemiologic studies and the ability to compare such studies across research groups and over time. The system has been adopted for medicolegal purposes and determination of eligibility for benefits in some settings. Although more advanced imaging technologies such as chest CT scans have largely displaced posteroanterior chest radiography for diagnostic purposes in the clinical setting, state and federal regulations rely on ILO classification, often called "B reading" of posteroanterior chest radiographic images for worker surveillance and disability compensation purposes. As such, demand for B readers remains relatively high; however, the number of US-based certified B readers declined from the 1990s to approximately 2019 and has been stable since then (Fig 1). The cause of this decline is likely multifactorial and discussed by Halldin et al, and includes shifts in technology, training, and perceptions of demand. At its peak in 1993, there were 772 B readers, which dropped to 189 B readers in 2025. As of 2024, 212 B readers came from the following specialties: 151 in radiology, 26 in pulmonology, 16 in internal medicine, 5 in occupational medicine, and 14 other types of physicians. Although 71.2% of currently certified B readers are radiologists, this represents only 0.2% (151/66,000) of all board-certified radiologists in the United States. In 2016, the Occupational Safety and Health Administration and in 2024, the Mine Safety and Health Administration published final rules related to exposure to respirable crystalline silica, which include provisions related to worker monitoring involving chest radiograph interpretations by B readers. During the public comment period for these rules, some commentors raised concerns as to whether there were enough B readers to take on the potential increase in the number of radiographs that would require classification. One suggestion to meet the increasing demand for B readers was to allow nurse practitioners and physician assistants to take the B reader examination and subsequently become certified B readers if they successfully passed. The American Association of Nurse Practitioners had previously posted public comments to NIOSH suggesting that nurse practitioners be allowed to become B readers.
• Subjects:
  Occupational Health Radiology Respiratory System Safety
• Keywords:
  B reader certification program; Chest X-rays; Pneumoconiosis; Radiology; Physicians
• Source:
  Chest 2025 Dec; 168(6):1443-1445
• ISSN:
  0012-3692
• Document Type:
  Text
• Genre:
  Report
• Place as Subject:
  West Virginia ; Philadelphia Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  3 pdf pages
• Volume:
  168
• Issue:
  6
• NIOSHTIC Number:
  nn:20071241
• Email:
  alaney@cdc.gov
• Federal Fiscal Year:
  2026
• Peer Reviewed:
  False
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:9793e92e724202e4a91dddec3f8e1140e608c279c078b074bccb9a32ef7ae7d9baa1060382b047b8cd3354cd5e72496619be2b296caf40dbe788420e47889054
• Download URL:
  https://stacks.cdc.gov/view/cdc/258719/cdc_258719_DS1.pdf
• File Type:
  [PDF - 264.20 KB ]