Hisao Shida

Reliability of the proposed international classification of high-resolution computed tomography for occupational and environmental respiratory diseases.

Reliability of the Proposed International Classification of High‐Resolution Computed Tomography for Occupational and Environmental Respiratory Diseases: Narufumi Suganuma, et al. Department of Environmental Medicine, Kochi Medical School

The Japanese Classification of Computed Tomography for Pneumoconioses with Standard Films. Comparison with the ILO International Classification of Radiographs for Pneumoconioses.

The Japanese Classification of Computed Tomography for Pneumoconioses with Standard Films: Comparison with the ILO International Classification of Radiographs for Pneumoconioses: Narufumi Suganuma, et al. Department of Environmental Health, School of Medicine, Fukui Medical University—Objective; Computed tomography (CT) has recently come to be used for personal diagnosis of pneumoconioses and preliminarily for epidemiological purposes. This study aimed to compare the diagnosis of pneumoconioses by the Japanese Classification of CT for Pneumoconioses (Hosoda‐Shida Classification) with that by the ILO International Classification of Radiographs of Pneumoconioses (ILO 1980 standard). The Hosoda‐Shida Classification is also described in this article. Subjects and Methods: CT and chest posterior‐anterior X‐ray (CXR) were performed in 21 subjects with an occupational history of mining, and 6 subject without exposure to any risk of pneumoconiosis. Three radiologists independently described the findings of CT and CXR according to both the Hosoda‐Shida Classification and the ILO 1980 standard, respectively. Results: At least two of the three readers agreed in determining both the profusion and the type of small rounded opacities in 96% (26/27) of the CT films. The inter‐reader agreement of profusion was satisfactory with the Cohens weighted kappa value of 0.57 to 0.71. The weighted kappa for CXR and CT in describing the profusion and the type of small rounded opacities were 0.70 and 0.77, respectively. Conclusion: The Hosoda‐Shida Classification for pneumoconioses is shown to be reliable and compatible with the ILO 1980 standard in describing the profusion and the type of small opacities.

Progression from Near-Normal to End-Stage Lungs in Chronic Interstitial Pneumonia Related to Silica Exposure: Long-Term CT Observations

OBJECTIVE The objective of our study was to evaluate serial CT changes from normal or near-normal lungs to honeycomb lungs in dust-exposed patients who developed chronic interstitial pneumonia. MATERIALS AND METHODS From the records of the national hospital for pneumoconiosis, we retrospectively identified patients with chronic interstitial pneumonia who were under surveillance between 1986 and 2006. All patients occasionally underwent chest CT for evaluation of silicosis or exclusion of possible complications. Patients were included in this study only if the initial CT examination did not show obvious chronic interstitial pneumonia. Fourteen patients (all men; median age at initial CT, 58 years) were identified as meeting the inclusion criterion. Two independent reviewers randomly reviewed the CT scans of the study patients to score the extent of ground-glass opacity, reticulation, and honeycombing; to provide a summation of all interstitial opacities (fibrosis score); and to assess coarseness. RESULTS Autopsy findings were available for eight of the 14 patients and confirmed the usual interstitial pneumonia (UIP) pattern seen on CT. The median follow-up period was 15.4 years, and none of the patients experienced acute exacerbation. One hundred two CT scans were reviewed. The earliest CT abnormalities included faint ground-glass opacity limited to the lung bases (n = 13) or only coarse reticular opacity (n = 1). In 13 patients, fibrosis and coarseness progressed linearly, whereas the other opacities did not. The annual increase of the fibrosis score and coarseness ranged from 0.306% to 4.633% and 0.179 to 0.479, respectively. Honeycombing developed in all patients over a median period of 12.1 years (range, 3.7-19.1 years). CONCLUSION The coarseness best represented the progression of chronic interstitial pneumonia in dust-exposed patients. The earliest CT finding of a UIP pattern in dust-exposed patients was indistinguishable from other types of chronic interstitial pneumonia.

A Flat-Panel Detector Digital Radiography and a Storage Phosphor Computed Radiography: Screening for Pneumoconioses

A Flat‐Panel Detector Digital Radiography and a Storage Phosphor Computed Radiography: Screening for Pneumoconioses: Yoshihiro Takashima, et al. Division of Environmental Health, Department of International Social and Health Sciences, University of Fukui School of Medicine—Storage phosphor computed radiography (SR) and flat‐panel detector (FPD) radiography are two types of digital X‐ray utilizing different techniques. We compared these two techniques with conventional analogue chest radiograph (AR) among pneumoconiotic patients and healthy controls. Thirty individuals consisting of 20 silica‐exposed ex‐workers and 10 healthy controls without occupational exposure to any mineral dust were examined with chest X‐ray by AR, SR and FPD. Three occupational physicians, including one NIOSH B reader, assessed the digital and conventional radiographs by the side‐by‐side method according to the ILO 2000 International Classification of Radiograph of Pneumoconioses (ILO/ ICRP). No significant difference was shown between the subjective film qualities by AR and FPD. Inter‐reader agreement of the profusion of small opacities on radiographs was high in the order of SR (κ=0.64), FPD (κ=0.62), and AR (κ=0.55). The profusions of small opacity for AR and FPD by the 12‐point scaled profusion of ILO/ICRP did not show a statistically significant difference, but those for AR and SR showed a significant difference. The areas under the receiver operator curves (ROC) using clinical diagnosis by a pulmonologist as the reference showed no statistically significant difference among the three radiographic techniques. FPD gives image quality as good as that of AR, and it has acceptable agreement with AR in small profusion categories, which consequently assures its application to pneumoconiosis screening. SR showed less profusion than FPD and AR, which can be fixed with image modification.

Computed tomography findings of Caplan syndrome

We report a case of Caplan syndrome complicated with tuberculosis, which was clinically followed up for 18 years and underwent autopsy. Initial chest radiograph showed 2 large nodules against the background of smaller pneumoconiotic nodules. One of the large nodules showed cavitation during follow-up. Computed tomography (CT) was helpful in identifying calcification in another large nodule. Autopsy confirmed the 2 large nodules as burned-out rheumatoid nodules and revealed additional rheumatoid nodules that were indistinguishable from silicotic nodules by CT.

Mixed dust fibrosis and tuberculosis in comparison with silicosis and macular pneumoconiosis.

BACKGROUND To assess the relationship between mixed dust fibrosis (MDF) and tuberculosis. METHODS We performed a comparative analysis with MDF, silicosis, and macular pneumoconiosis (Mac), using autopsy records from 1975 to 1994. RESULTS Prevalences of having tuberculosis among MDF, silicosis, and Mac were not significantly different, albeit a tendency of higher prevalence in silicosis. Cure rates of tuberculosis were, in order, silicosis < MDF < Mac (P=0. 085). Death rates associated with tuberculosis were, in order, silicosis > MDF=Mac (P=0.911). With respect to the two types of association with tuberculosis, i.e., combined type (tuberculopneumoconiosis) and complicated one (pneumoconiosis with tuberculosis); the former was significantly dominant in silicosis, the latter was significantly dominant in Mac, and intermediate in MDF. As a whole, the complicated type had a tendency of a higher cure rate than the combined type (P=0.071). Although the differences of profiles between the combined and complicated types were not statistically significant, the combined type had a tendency to have longer duration of exposure to dusts, earlier registration for treatment, higher profusion score, and earlier death compared with the complicated type. CONCLUSIONS From our findings, MDF takes an intermediate position between silicosis and Mac regarding the relationship with tuberculosis. The type of association with tuberculosis rather than the kind of background pneumoconiosis seemed to be more important in light of responsiveness to the treatment.

Asbestos—Related Pleural Abnormalities Detected by Chest X—Ray: Fair Agreement with Detection by Computed Tomography

Asbestos‐Related Pleural Abnormalities Detected by Chest X‐Ray: Fair Agreement with Detection by Computed Tomography: Narufumi Suganuma, et al. Department of Environmental Health, Fukui Medical University School of Medicine, Fukui—The International Labour Office (ILO) 1980 International Classification of Radiograph for Pneumoconioses (ILO 1980) is used widely round the world for the evaluation of dust‐exposed workers, whereas computed tomography (CT) has been introduced for more accurate diagnosis of pneumoconioses. This study is aimed to assess whether the chest X‐ray can detect pleural abnormalities as accurately as CT in patients with asbestos‐related lung diseases in the early stages. Eighty subjects with positive finding in 10 cm x 10 cm CXR were selected from 1178 ex‐workers with asbestos exposure for the study. They underwent CXR and CT to be assessed by two ILO 1980 experts for CXR and a chest physician and a radiologist for CT films according to ILO 1980 and the CT criteria, respectively, which we developed. The CT and CXR readings were obtained independently. Scores of the extent of pleural abnormalities agreed on by two readers were compared in CT and CXR. Sensitivity and specificity of CXR for detecting pleural abnormalities by CT result as a gold standard were also calculated. Among the 80 subjects, there were 66 patients (83%) who had pleural abnormalities detected by CXR. Of these 66 persons, CT confirmed 61 subjects to have pleural plaque. The reading results of CXR and CT showed fair agreement with Cohens weighted kappa of 0.53. Sensitivity and specificity of CXR and CT were 0.94 and 0.73, respectively. Fair agreement was seen between CXR and CT in detecting pleural plaque in terms of extent in dust‐exposed workers. Such a standardised system as ILO 1980, CXR is still useful for the screening for pleural abnormalities in dust‐exposed individuals.

Delayed development of silicoproteinosis with diffuse interstitial fibrosis: 16-year follow-up with autopsy correlation.

Sir, Silicoproteinosis usually occurs within a few months to years after massive exposure to silica [1], and progresses rapidly to a fatal outcome within a few years [2]. We recently experienced a case of silicoproteinosis with a peculiar pattern of diffuse interstitial fibrosis, in which the disease showed an indolent progression.

Assessment of physicians’ proficiency in reading chest radiographs for pneumoconiosis, based on a 60-film examination set with two factors constituting eight indices

Two hundred and thirty-three individuals read chest x-ray images (CXR) in the Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) workshop. Their proficiency in reading CXR for pneumoconiosis was calculated using eight indices (X1–X8), as follows: sensitivity (X1) and specificity (X2) for pneumoconiosis; sensitivity (X3) and specificity (X4) for large opacities; sensitivity (X5) and specificity (X6) for pleural plaques; profusion increment consistency (X7); and consistency for shape differentiation (X8). For these eight indices, one-way analysis of variance (ANOVA) and Scheffe’s multiple comparison were conducted on six groups, based on the participants’ specialty: radiology, respiratory medicine, industrial medicine, public health, general internal medicine, and miscellaneous physicians. Our analysis revealed that radiologists had a significant difference in the mean scores of X3, X5, and X8, compared with those of all groups, excluding radiologists. In the factor analysis, X1, X3, X5, X7, and X8 constituted Factor 1, and X2, X4, and X6 constituted Factor 2. With regard to the factor scores of the six participant groups, the mean scores of Factor 1 of the radiologists were significantly higher than those of all groups, excluding radiologists. The two factors and the eight indices may be used to appropriately assess specialists’ proficiency in reading CXR.

Radiological and Pathological Correlation of Autopsied Cases of Pneumoconioses

In this chapter, we provide case presentations of various pneumoconioses with radiological and pathologic correlation. Included here are classical silicosis, asbestosis, talcosis, arc-welders pneumoconiosis and mixed dust pneumoconiosis. In recent years, the incidence of classical silicosis is on the decline, whereas mixed dust pneumoconiosis has become increasingly frequent and, thereafter, has got the importance in clinical setting. A few years ago, based on this recognition, the authors held an international meeting about mixed dust pneumoconiosis and made clear its clinical and pathologic findings and proposed its definition (1). We briefly describe the concept and definition of mixed dust pneumoconiosis.