Patterns of progressive massive fibrosis on modern coal miner chest radiographs

Abstract

Clinical teaching generally asserts that large opacities of progressive massive fibrosis (PMF) on chest radiographs present primarily bilaterally in the upper lung zones, and with an elevated background profusion of small opacities. However, the contemporary basis for these descriptions is limited.

Radiographs taken for the Coal Workers’ Health Surveillance Program during 2000–2015 and previously determined to have large opacities (“PMF radiographs”, n = 204), and a random sample previously deemed free of large opacities (n =22), were independently reevaluated by three National Institute for Occupational Safety and Health (NIOSH) B Readers. Large opacities were noted primarily in the upper right (41%) or upper left (28%) lung zone, but 31% were in middle or lower zones. Unilateral involvement was observed in 34% of readings, with right lung predominance (82%). The median small opacity profusion category for the radiographs with PMF was 2/1. The number of large opacities was not correlated with small opacity profusion category. The “classic” descriptions of PMF as bilateral, associated with elevated background profusions of small pneumoconiotic opacities, were each absent in a third of miners.

Keywords:

• Epidemiology
• occupational diseases
• occupational lung disease

Acknowledgments

The authors wish to acknowledge the contribution of the NIOSH Coal Workers’ Health Surveillance Team, the B Readers who participated in this study, and Drs. Eileen Storey, and Edward (Lee) Petsonk for their helpful reviews of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Agency disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. Mention of product names does not imply endorsement by NIOSH/CDC.

IRB

This study used existing radiographs, received a waiver of informed consent, and was approved by the NIOSH Institutional Review Board (15-DRDS-03XP).

Author contributions

CNH had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. CNH, DJB, TM, RC, and ASL contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.