A comparison of pneumoconiosis interpretation between Chinese and American readers and classifications

As a preliminary step in joint Sino-American pneumoconiosis research efforts, a formal chest X-ray pneumoconiosis reading trial was conducted among Chinese and American radiologists. Twelve Chinese readers from different institutions located in south central China used the 1986 Chinese Roentgenodiagnostic Criteria of Pneumoconioses. Three American radiologists, centified as NIOSH "B" readers, used the International Labour Office Classification of Pneumoconioses. The chest X-ray study set consisted of 150 posterior-anterior films. One-half were Chinese X-rays of silica-exposed workers, and the other half were American films of variously exposed workers but primarily coal miners. All readings were done independently. The results showed that the inter-reader variability among the Chinese was similar to that of the American readers, both being in an acceptable range. In addition, there was general agreement between the Chinese and American interpretations. For small opacity profusion, the Chinese readers tended to read slightly more diseases than their American counterparts, although there was exact agreement as to the major category in two-thirds of the films. Agreement for film quality, and pleural disease was less, but was not different from reported variation among American "B" readers. Overall, the results suggest that despite the use of two different classification systems, a valid correspondence exists between the Chinese and American Interpretations, which is suitable for use in epidemiologic research.