What exactly is an ILO chest x-ray?

Chest x-rays are a common imaging test used to discover abnormalities in the lungs, airways, heart, blood vessels and bones¹. This type of imaging is quick and painless and involves the patient standing with their chest against an x-ray plate. The imaging usually takes about 15 minutes including preparation. KINNECT use chest x-rays as an effective means of discovering any abnormalities that may impact the patient’s fitness for work.

There are two types of chest x-rays that are routinely undertaken at KINNECT: standard and ILO. ILO chest x-rays follow the same process as the standard procedure however the images are subject to different reporting requirements. This standard of reporting was introduced by the International Labour Organisation (ILO) for International Classification of Radiographs of Pneumoconioses. It is used to classify images of patients who exhibit characteristics of pneumoconiosis.

Pneumoconiosis is an occupational lung disease caused by inhalation of dust particles including asbestos fibres, crystalline silica and coal dust². Coal Workers’ Pneumoconiosis (CWP) is also called “Black Lung Disease” due to the ability of dust exposure to turn the lungs black.

Who is the International Labour Organisation?

The International Labour Organisation (ILO) is an agency appointed by the United Nations to oversee labour standards and rights³. Based in the United States, the ILO has been responsible for publishing chest x-ray classification guidelines for pneumoconiosis since 1950. The purpose of these guidelines is to provide a means to describe and codify abnormalities consistent with pneumoconiosis.

In 1974, health surveillance programs for coal miners revealed unacceptable degrees of variability and quality issues in chest x-ray reporting. This variability led to the National Institute for Occupational Safety and Health (NIOSH) to develop the B reader program. The program aimed to train and certify radiographers in the ILO classification. Since then, only certified physicians are able to provide a final determination on a chest x-ray screening for pneumoconiosis. The final determination takes into account any characteristics of occupational lung disease which can otherwise be confused for similar conditions. This similarity in abnormalities requires a certified B reader to be able to distinguish and diagnose the correct disease.

In Australia, CWP was thought to have been eradicated until a retired miner from Queensland was diagnosed in 2015. Due to this incident, the Queensland Government mandated sending coal worker chest x-rays to NIOSH for a B read. In early 2017, the first Australian B readers were certified. Subsequently, as of 1 March 2019, all ILO chest x-rays remain in Australia for reporting purposes. They are sent to a company of qualified radiographers called Lungscreen.

Are my employees required to have an ILO chest x-ray?

ILO chest x-rays are included in:

• Asbestos Health Monitoring Medicals
• NSW Order 43 Coal Mine Workers Medicals
• Queensland Coal Board Medicals
• Respirable Crystalline Silica Medicals

However, B reading is only a requirement for ILO chest x-rays completed under the Queensland Coal Mine Workers’ Health Scheme.

References

1. https://www.radiologyinfo.org/en/info.cfm?pg=chestrad
2. https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/pneumoconiosis/pneumoconiosis-symptoms-causes-risks.html
3. https://www.ilo.org/safework/info/WCMS_108548/lang–en/index.htm