title: Reliability and validity of chest radiograph surveillance programs.
abstract: OBJECTIVE
  Due to the lack of consensus in the literature in the use of posteroanterior (PA) vs PA with right and left oblique views as the optimum radiograph surveillance methodology to investigate pleural changes, a study was undertaken to evaluate the reliability, sensitivity, and specificity of these two approaches.
  
  
  METHODS
  Three experienced radiologist B readers used the 1980 International Labor Office classification system for pneumoconiosis to independently read chest radiographs of workers with individual identifiers masked. All radiographs were read first as a PA view only. Unknown to the B readers, each subject's PA was then matched to his or her corresponding right and left oblique views (film triad) and re-read several weeks later.
  
  
  METHODS
  The respiratory health of 652 workers exposed to refractory ceramic fiber was assessed as part of cross-sectional and longitudinal surveillance programs.
  
  
  RESULTS
  kappa Statistics for interreader and intrareader reliability between the PA view and film triad methods were calculated. Sensitivity, specificity, and positive predictive value were assessed by comparing the initial cross-sectional study to the longitudinal study. The film triad method had considerably higher interreader reliability (kappa = 0.59) compared to the PA-only method (kappa = 0.44). Results from the initial cross-sectional study were then compared to findings evaluated longitudinally. The film triad again was superior, demonstrating a positive predictive value of 73.7% compared to only 47.8% for the PA method.
  
  
  CONCLUSIONS
  It is our recommendation that the film triad method be used in surveillance studies where both parenchymal and pleural changes are anticipated.
authors.affiliation: University of Cincinnati, College of Medicine, Cincinnati, OH 45226-1998, USA. CJL9@CDC.GOV
authors.forename: C C
authors.initials: CC
authors.lastname: Lawson
authors.forename: M K
authors.initials: MK
authors.lastname: LeMasters
authors.forename: G
authors.initials: G
authors.lastname: Kawas Lemasters
authors.forename: S
authors.initials: S
authors.lastname: Simpson Reutman
authors.forename: C H
authors.initials: CH
authors.lastname: Rice
authors.forename: J E
authors.initials: JE
authors.lastname: Lockey
mesh_terms: D002516:Ceramics; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D007616:Kaolin / Q000009:adverse effects; D008137:Longitudinal Studies; D019016:Mineral Fibers / Q000009:adverse effects; D015588:Observer Variation; D009784:Occupational Diseases / Q000000981:diagnostic imaging*; D010994:Pleura / Q000000981:diagnostic imaging; D010995:Pleural Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity
chemical_list: D019016:Mineral Fibers; C103119:RCF-1 fiber; D007616:Kaolin