[Federal Register Volume 78, Number 115 (Friday, June 14, 2013)]
[Notices]
[Pages 35935-35936]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-14147]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[Docket Number CDC-2013-0008; NIOSH-234]
National Institute for Occupational Health (NIOSH)--Certified B
Readers; Training and Testing
AGENCY: National Institute for Occupational Safety and Health (NIOSH)
of the Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).
ACTION: Request for information and comment on priority knowledge and
competency items to address in training and testing of National
Institute for Occupational Health (NIOSH)--certified B Readers.
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SUMMARY: The National Institute for Occupational Safety and Health
(NIOSH) of the Centers for Disease Control and Prevention (CDC, is
requesting information from stakeholders and the general public to
identify and prioritize competencies currently needed by B Readers. The
information obtained will be used in the development of the new digital
B Reader program, including training and examinations.
DATES: Electronic or written comments must be received by August 13,
2013.
ADDRESSES: You may submit comments, identified by CDC-2013-0008 and
NIOSH-234, by any of the following methods:
Federal eRulemaking Portal: http://www.regulations.gov.
Follow the instructions for submitting comments.
Mail: NIOSH Docket Office, Robert A. Taft Laboratories,
MS-C34, 4676 Columbia Parkway, Cincinnati, OH 45226.
All information received in response to this notice must include
the agency name and docket number (CDC-2013-0008; NIOSH-234). All
relevant comments received will be posted without change to
www.regulations.gov, including any personal information provided. To
view the notice and related materials, visit http://www.regulations.gov
and enter CDC-2013-0008 in the search field and click ``Search.''
FOR FURTHER INFORMATION CONTACT: Simone Tramma, MD, MS, 1600 Clifton
Road NE. MS E20, Atlanta, GA 30329-4018, telephone 404-498-0197.
Background
Chest radiography is a widely applied and important tool for
assessing lung health in clinical care, surveillance, research and
hazard evaluations of workers exposed to respirable silica, asbestos,
coal, beryllium, and other hazardous dusts. Collectively, these dust-
induced diseases are called pneumoconioses. The International Labour
Office (ILO) International Classification of Radiographs of
Pneumoconioses provides a standardized system for classification of
chest radiographs that has been widely used by physicians and
epidemiologic researchers in the investigation of work-related
respiratory hazards. For the last four decades, NIOSH has been training
physicians and certifying competence in the use of the ILO system to
classify film-based chest radiographs. Physicians who pass a rigorous
standardized examination offered by NIOSH are designated as B Readers.
Recently, the ILO system was updated to allow the use of digital
chest images instead of analog chest radiographs. Similarly, NIOSH
updated its Coal Workers' Health Surveillance Program to allow use of
digital chest images. In follow up, NIOSH is now working to update its
B Reader training and certification program by developing digital-
format training materials and examinations.
Core knowledge and competencies to be addressed in an updated
digital-format B Reader training and certification program might
include the following:
I--Knowledge
Understand the following:
1. The different types of radiographic abnormalities that are or
may be associated with dust exposure.
2. The intention, format, and mechanics of the ILO classification
system, including:
(a) When to use the classification and what abnormalities should be
classified
(b) How the ILO defines abnormalities for parenchymal and pleural
disease
(c) The meaning of profusion and how to use major/minor profusion
categories properly
(d) The nature and use of standard films/images in classification
3. Where to find information about how to apply the ILO system.
4. Where to find information on the NIOSH B Reader system.
5. Ethical approaches to classifying radiographs, including:
(a) The responsibilities of the reader in communicating with worker,
agency, lawyer, employer
(b) Confidentiality issues impacting readers6. The effects of
technical defects on the appearances covered in the classification.
II--Skills
Ability to accurately and reliably identify and categorize the
following according to the ILO classification system:
1. Image quality
(a) Unreadable images
(b) Defects in image quality that may affect its classification
2. Normal radiographs
(a) Borderline normal
3. Small nodular opacities
(a) High profusion
(b) Low profusion
(c) Reliably classifying profusion as 1/0 or greater; or 0/1 or
less.
4. Small linear/irregular opacities
(a) High profusion
(b) Low profusion
(c) Reliably classifying profusion as 1/0 or greater; or 0/1 or
less
5. Reliable classification of Large Opacities
(a) Reliably classify presence of large opacities
(b) Reliably classify category of large opacities
6. Pleural disease
(a) Plaque and diffuse
(b) Calcifications
(c) Costophrenic angle obliteration
(d) Locations
7. Be able to identify and differentiate:
1. Large opacities and confluence of small opacities (ax) lesions
2. Cancer (ca) and pulmonary tuberculosis (tb) lesions
Information Needs
Additional data and information are needed to assist NIOSH in
determining the knowledge elements and competencies that should be
included in B Reader training and certification and how they should be
prioritized for emphasis in training and certification testing.
Information is particularly needed in response to the following
questions:
(1) What knowledge elements and competencies are essential for a B
Reader?
(2) What are the most critical knowledge elements and competencies
to identify in the B Reader certification and re-certification
examinations?
[[Page 35936]]
(3) What are the key functions of the B Reader certification and
re-certification examinations grading system, and how should the
examinations be graded to accomplish those functions? Should the
general approach currently used for grading \1\ \2\ be changed and if
yes, how and why?
(4) Should NIOSH consider alternative approaches to maintenance of
B Reader certification besides recertification examinations every 4
years? If so, what alternative approaches would be both effective and
desirable?
(5) NIOSH seeks to obtain materials, including published and
unpublished reports and research findings that will help to answer
these questions. NIOSH encourages respondents to provide these
materials.
References
1. Morgan RH [1979].Proficiency Examination of Physicians for
Classifying Pneumoconiosis Chest Films. AJR 132: 803-808.
2. Wagner GR, Attfield MD, Kennedy RD, Parker JE [1992]. The NIOSH B
Reader Certification Program-An Update Report. J Occup Med
34(9):879-84.
Dated June 7, 2013.
John Howard,
Director, National Institute for Occupational Safety and Health,
Centers for Disease Control and Prevention.
[FR Doc. 2013-14147 Filed 6-13-13; 8:45 am]
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