Asian Intensive Reader of Pneumoconiosis program: examination for certification during 2008-2020

Abstract

This study examined physicians' participation and performance in the examinations administered by the Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) program from 2008 to 2020 and compared radiograph readings of physicians who passed with those who failed the examinations. Demography of the participants, participation trends, pass/fail rates, and proficiency scores were summarized; differences in reading the radiographs for pneumoconiosis of physicians who passed the examinations and those who failed were evaluated. By December 2020, 555 physicians from 20 countries had taken certification examinations; the number of participants increased in recent years. Reported background specialty training and work experience varied widely. Passing rate and mean proficiency score for participants who passed were 83.4% and 77.6 ± 9.4 in certification, and 76.8% and 88.1 ± 4.5 in recertification examinations. Compared with physicians who passed the examinations, physicians who failed tended to classify test radiographs as positive for pneumoconiosis and read a higher profusion; they likely missed large opacities and pleural plaques and had a lower accuracy in recognizing the shape of small opacities. Findings suggest that physicians who failed the examination tend to over-diagnose radiographs as positive for pneumoconiosis with higher profusion and have difficulty in correctly identifying small opacity shape.

Keywords: Asian Intensive Reader of Pneumoconiosis (AIR Pneumo); Chest radiograph; International Labour Office (ILO); Occupational health; Pneumoconiosis; Surveillance.

Fig. 1.

Number of physicians taking certification examination and recertification examination, 2008–2020.

Fig. 2.

False-positive (FP) and false-negative (FN) rates in classifying pneumoconiosis, stratified according to pass (black bar) or fail (gray bar) status in (A) certification examination and (B) recertification examination. Group comparisons were performed using Student’s t-test; *p<0.01; **p<0.001. Error bars represent standard deviations. The ILO International Classification of Radiographs of Pneumoconioses defines parenchymal abnormalities as small opacities (opacities with diameters up to 1 cm) or large opacities (opacities larger than 1 cm) and pleural abnormalities as localized plaques or diffuse pleural thickening (abnormalities extending up the lateral chest wall with involvement of obliterated costophrenic angle).

Fig. 3.

Distribution of classifications for small opacity profusion of 54 test radiographs, stratified according to pass or fail status in (A) certification examination and (B) recertification examination. True distribution=classified by expert panel of 12 B Readers. To determine the profusion category for a group of physicians, we analyzed the most frequently reported profusion category by the physicians in that group. The profusion classified by physicians’ groups was significantly different from the true profusion; p<0.001 for all χ² tests. The ILO International Classification of Radiographs of Pneumoconioses utilizes four major profusion categories, ranging from 0 to 3, indicating the increasing concentration of small opacities (opacities with diameters up to 1 cm).