DR Khanyakude S MASHAO
MBCHB,MMED RAD(D),DOH
RADIOLOGIST MBOD
 Good
quality radiographs are essential for
accurate diagnosis and classification of
occupational lung diseases
 A reader is expected to grade film quality.
 Grade1 :Good
 Grade 2 :Acceptable with to technical
defects to impair classification.
 Grade 3: Acceptable with technical defects
but still adequate
 Grade 4 Unacceptable with quality defects
Quality defects include
 Under-inflation
 Improper
position
 Artifacts
 Over-exposure
 Film
processing/post processing in case of
digital
 Under-exposure
Small opacities: small opacities are classified
according to shape and size
Small rounded opacities
 P up to 1.5 mm
 Q about1,5 mm to 3mm
 R exceeding 3mm
Small irregular opacities
 Small irregular opacities are classified by
width as s , t or u( same respective sizes as
for small rounded opacities
 Lung
zones: each lung is divided into upper
,middle and lower zones
 Profusion: The concentration of small
opacities are classified on the 4 point major
category( 0,1,2 or 3.
 With each major category divided into 3
giving 12 12 order sub categories of
increasing
profusion(0,0/1,1/0,1/1,1/2,2/1,2/2,2/3,
3/2,3/3 and 3/+
 Category
3 represents most profuse
 The major category(first number) represents
the profusion best fit the film.
 The minor category(second number)
represents the profusion seriously considered
as an alternative
 Category 0 refers to absence of small
opacities
 LARGE
OPACITIES:A large opacity is defined
as any opacity greater than 1cm
 Category A:One or more large opacities
whose combined dimension does not exceed
50 mm
 Category B: :One or more large opacities
with a combine dimension that exceed 50mm
but does not exceed the equivalent area of
the right upper lobe.
 Category: exceeds the equivalent area of the
right upper lobe.
Pleural abnormalities are reported with
respect to the type
 Pleural plaques or diffuse thickening
 Location: chest wall, diaphragm
 Presence of calcification
 Width: only of in profile pleural thickening
seen along the chest wall edge
 Extent: combined distance for involved chest
wall
 There
are about 29 symbols representing
important features related to dust diseases
and other etiologies e.g. : tba: active TB,
em: emphysema ,es: eggshell, hi : hilaradeno-pathy, ef: effusion.
Finally the reader comments on any other
abnormal feature in the chest radiograph
 The
differential diagnosis of a diffuse
reticulonodular infiltrate:
 • Pneumocystis carinni
 • Miliary tuberculosis
 • Lymphocytic interstitial pneumonia
 • Kaposi’s sarcoma
 • Sarcoidosis
 • Toxoplasma gondii
 • Cytomegalovirus
 * Thus needs investigation