1. INTERPRETATION OF OCCUPATIONAL CHEST X-RAYS
DR Khanyakude S MASHAO
MBCHB,MMED RAD(D),DOH
RADIOLOGIST MBOD I

2. Ilo classification film quality
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

3. Ilo classification quality defects
Quality defects include
Under-inflation
Improper position
Artifacts
Over-exposure
Film processing/post processing in case of digital
Under-exposure

4. Ilo classification parenchymal abnormalities
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

5. Ilo classification parenchymal abnormalities
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 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/+

6. Ilo classification parechymal abnormalities
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

7. Ilo classification parechymal abnormalities
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.

8. Ilo classification pleural abnormalities
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

9. Ilo classification any other abnormality
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 : hilar- adeno-pathy, ef: effusion.
Finally the reader comments on any other abnormal feature in the chest radiograph

10. Differential diagnosis of reticulonodular lung diseases
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

13. sarcoidosis

14. sarcodosis

15. Sarcoidosis stage iv

16. pneumoconiosis

17. PNEUMOCONIOSIS

18. PNEUMOCONIOSIS (PMF)

19. EGG SHELL CALCIFICATIONS

20. Pneumocystis carinni

21. THANK YOU