[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]
BILLING CODE 4163-19-P