ABSTRACT
U.S. Navy Asbestos Medical Surveillance Program B-reading reports were analyzed for variability in identifying pneumoconiosis in 278,944 chest radiographs done from 1990 to 2004 using commercial database and statistical software. Reported presence of pneumoconiosis by 33 B-readers ranged from 1.85 to 32.28%. The reported presence of parenchymal abnormalities ranged from 0.11 to 15.07%; increased profusion (to 1/0 or greater) of small parenchymal opacities ranged from 0.10 to 17.70%; presence of large opacities ranged from 0.00 to 0.67%; and presence of pleural abnormalities ranged from 1.08 to 23.93%. Ranges appear to be decreasing slightly as rates of abnormal findings are diminishing. Differences between U.S. East Coast, West Coast, and midcontinent were not statistically significant.
Subject(s)
Asbestos/toxicity , Military Personnel , Naval Medicine , Occupational Health , Pneumoconiosis/diagnostic imaging , Population Surveillance , Databases as Topic , Humans , Pneumoconiosis/epidemiology , Pneumoconiosis/etiology , Radiography , Risk Factors , Time Factors , United States/epidemiologyABSTRACT
OBJECTIVE: To study the impact of variability among B-readers on clinical occupational medicine. METHODS: A total of 419,770 B-reading reports from February 1980 to May 2004 in the US Navy Asbestos Medical Surveillance Program were analyzed for changes in category from the previous B-reading on each individual worker. RESULTS: Over 7% of films were categorized as worse (ie, read as going from negative to positive), and over 6% were categorized as better. When profusion categories were reported as different from the previous reading (over 6% of the time), they were more frequently read as 2 or more minor categories worse or better. CONCLUSIONS: Changes from previous B-readings are common, and may have clinical and other implications, which are discussed. B-readings should not be used as the sole basis for determining the presence or absence of pneumoconiosis.
Subject(s)
Asbestosis/diagnostic imaging , Mass Chest X-Ray/standards , Occupational Health , Population Surveillance/methods , Asbestos/adverse effects , Asbestos/standards , Asbestosis/epidemiology , Asbestosis/prevention & control , Humans , Medical Records Systems, Computerized/statistics & numerical data , Military Hygiene/standards , Naval Medicine , Observer Variation , Occupational Health Services , Reproducibility of Results , United StatesABSTRACT
A case of clinically definite multiple sclerosis presenting as neurological decompression sickness is presented. A 23-yr-old U.S. Navy diver experienced onset of hypesthesia of the left upper trunk approximately 19 h after making two SCUBA dives. She did not seek medical attention until 3 wk later, at which time she was diagnosed with possible neurological decompression sickness. She was treated with hyperbaric oxygen, but demonstrated no improvement. Further evaluation led to the diagnosis of multiple sclerosis. This case underscores the potential similarity in neurological presentation between multiple sclerosis and decompression sickness. The differential diagnosis of neurological decompression sickness, particularly in atypical cases, should include multiple sclerosis. The appropriateness of medically clearing multiple sclerosis patients for diving is discussed.
