COAL WORKERS' HEALTH SURVEILLANCE PROGRAM

Digital Imaging Activity

For over 70 years, worker health monitoring and screening for the pneumoconiosis has employed chest x-rays acquired using film-based technology. However, the use of film is rapidly being replaced by digital chest x-ray images. This has led to a steady reduction in the availability of medical facilities for coal miners to obtain their periodic x-rays. To remedy this situation, NIOSH has been preparing to transition the CWHSP from film to digital imaging. This process necessitates the following activities addressing a number of issues:

1. acquisition of a sound foundation of knowledge to assure that digital radiography is implemented in a fashion providing equivalent results to existing film-based technology;
2. procurement of appropriate computer hardware and software for the storage and viewing of digital images;
3. development of solutions to issues concerning confidential internet transfer of digital images to NIOSH;
4. development of guidelines for acquisition and viewing of digital chest images for the purpose of classification for the presence and severity of changes associated with pneumoconiosis;
5. modification of federal regulations to permit the use of digital images;
6. partner with the International Labor Office (ILO) in issues related to classification of chest images for the presence and severity of changes related to pneumoconiosis. NIOSH is in preliminary discussions with ILO about working to develop the next generation of digitally-acquired standard radiographs for use in the classification system.

Many of these tasks are now complete and it is intended that the others, which are in process, will be completed soon. The following provides current information on the status of the various tasks.

1. NIOSH has acquired the necessary hardware and software to enable the use of digital chest images. We have demonstrated secure and reliable transfer of images to B Readers, and can receive x-ray readings electronically from them. We are currently ensuring that each of the B Readers associated with the CWHSP has a viewing station that meets our guidelines.
2. NIOSH is currently approving facilities for digital radiographs. In this way, facilities will be able to immediately participate in our program once we receive approved federal regulations.
3. NIOSH has prepared and published guidelines for the acquisition and viewing of digital chest images for the purpose of classification for the presence and severity of changes associated with pneumoconiosis according to the ILO system . These guidelines have been subject to peer and public review. As technology changes, periodic updates to the guidelines may be necessary. However, wherever possible, the guidelines are performance-based and not technology-specific.
4. NIOSH proposed federal regulations in January 2012 to enable use of digital chest imaging in the CWHSP. NIOSH then drafted final regulations that were responsive to public comments. On September 13, 2012, NIOSH achieved the major milestone of publishing the final regulations enabling use of modern, digital chest images in the CWHSP. The new regulations became effective on October 15, 2012.
5. The International Labor Office has published Guidelines for the Use of the ILO International Classification of Radiographs of Pneumoconiosis, Revised Edition 2011 on 11/17/2011 and DVD, containing the digital (digitized) standard images, was made available for purchase by ILO on 2/17/2012. Ordering information for the DVD of the digital standard images is also available on the ILO website . The NIOSH BViewer software was posted on 4/17/2012 to allow loading of the ILO reference set.

If you are interested in other issues that are not mentioned here, please contact (CWHSP@cdc.gov). If these questions are of general interest, we will consider adding them to this update. Please check back periodically with this page to obtain future progress updates. You may also be interested in our companion update web page focused on digital imaging .