Study objectives: Due to the lack of consensus in the
literature in the use of posteroanterior (PA) vs PA with right and left
oblique views as the optimum radiograph surveillance methodology to
investigate pleural changes, a study was undertaken to evaluate the
reliability, sensitivity, and specificity of these two approaches.
Design: Three experienced radiologist B readers used the
1980 International Labor Office classification system for
pneumoconiosis to independently read chest radiographs of workers with
individual identifiers masked. All radiographs were read first as a PA
view only. Unknown to the B readers, each subject’s PA was then
matched to his or her corresponding right and left oblique views (film
triad) and re-read several weeks later.
participants: The respiratory health of 652 workers exposed to
refractory ceramic fiber was assessed as part of cross-sectional and
longitudinal surveillance programs.
results: κ Statistics for interreader and intrareader
reliability between the PA view and film triad methods were calculated.
Sensitivity, specificity, and positive predictive value were assessed
by comparing the initial cross-sectional study to the longitudinal
study. The film triad method had considerably higher interreader
reliability (κ = 0.59) compared to the PA-only method
(κ = 0.44). Results from the initial cross-sectional study were
then compared to findings evaluated longitudinally. The film triad
again was superior, demonstrating a positive predictive value of 73.7%
compared to only 47.8% for the PA method.
Conclusions: It is our recommendation that the film triad
method be used in surveillance studies where both parenchymal and
pleural changes are anticipated.