This transcript has been edited for clarity.
“CDC considers letting nurse practitioners, physician assistants read X-rays under federal program.” Now that is a headline that gets my doctor groups buzzing, especially the ones with radiologists.
What this catchy headline is actually talking about is B reader training. Let’s talk about that, and whether or not nonphysicians can handle the task.
What Are B Readers?
First, how much do you know about B readers? Named after black lung disease, a B reader is someone who classifies radiologic images of workers, such as coal mine workers, who are at risk of getting pneumoconiosis from inhaling mineral dust.
Mineral dust, such as asbestos or silica dust, can lead to an inflammatory reaction that increases somebody’s risk of getting pulmonary disease. Because of all the global industries and potential exposures, pneumoconiosis is one of the world’s most common occupational diseases.
B readers and chest radiography screenings are used in the US Department of Labor, with the Occupational Safety and Health Administration, the Coal Workers’ Health Surveillance Program, and the US Department of Energy. They’re used in epidemiologic studies, clinical studies, and even in compensation lawsuits.
How to Become Qualified as a B Reader?
To become qualified as a B reader, a US physician must pass an exam that includes radiographs and questions about the International Labour Organization’s (ILO’s) classification. The ILO sets the guidelines on classifying pneumoconiosis.
Any physician can sit for this exam, even a pediatrician, but I looked at the syllabus and it’s daunting. I could take a 3-day course that’s offered by the American College of Radiology, but I think a board-certified radiologist is probably the right person for this task.
I’m trying to imagine what it would be like to look at a chest radiograph and consider the ground glass or reticular opacities, consolidations, and bronchial wall thickenings and then trying to differentiate between asbestosis and occupational bronchitis, or maybe it’s silicosis, while ruling out malignancy, sarcoidosis, or some interstitial pneumonia or whatever else is on the differential list that I don’t understand. This does not feel like a task that should be taken lightly.
Should B Reader Program Be Expanded to Include NPs and PAs?
Why exactly is there consideration to expand the scope to nurse practitioners (NPs) and physician assistants (PAs)? Currently, 184 US physicians are certified as B readers, and I wonder how much clinical or financial incentive there is for other physicians to go out and get certified. Nonetheless, the National Institute of Occupational Safety and Health put out a statement asking for comments about the pros and cons of expanding the program.
If you look at the statement, you’ll see question prompts around topics such as B reader demand, if certain populations may benefit from having an NP or a PA as a reader, pros and cons of the programs, and how state laws may play in with physician oversight.
The American College of Radiology already stated they’re going to submit a response, and I suspect that other advocacy groups will as well.
Nonphysician interpretation of images, such as ultrasounds, radiographs, and CT scans, has increased in recent years, and this has led to a debate about differences in training, the potential for misdiagnoses, and liability. One has to ask, how would expanding the scope of practice to B reader programs affect this trend?
One has to also wonder if there’s a financial motive in all of this. One study does suggest that financial conflicts of interest could affect the classification of pneumoconiosis. For example, a law firm looking to get compensation could reuse different B readers until they got the diagnosis they wanted.
Look, I’m speculating, and you might be as well. If you feel strongly about expanding the B reader program to NPs and PAs, for or against, you should comment directly to the Centers for Disease Control and Prevention. Also, comment below. Radiologists, I especially want to hear from you.
Alok S. Patel, MD, is a pediatric hospitalist, television producer, media contributor, and digital health enthusiast. He is a clinical assistant professor for the department of pediatrics at Stanford Children's Health in Palo Alto, California. Patel is a special correspondent for ABC News and regularly appears as an on-camera expert for several news outlets. He hosts The Hospitalist Retort video blog on Medscape.
COMMENTARY
Should NPs and PAs Be Allowed to Interpret Chest Radiographs?
DISCLOSURES
| February 21, 2025This transcript has been edited for clarity.
“CDC considers letting nurse practitioners, physician assistants read X-rays under federal program.” Now that is a headline that gets my doctor groups buzzing, especially the ones with radiologists.
What this catchy headline is actually talking about is B reader training. Let’s talk about that, and whether or not nonphysicians can handle the task.
What Are B Readers?
First, how much do you know about B readers? Named after black lung disease, a B reader is someone who classifies radiologic images of workers, such as coal mine workers, who are at risk of getting pneumoconiosis from inhaling mineral dust.
Mineral dust, such as asbestos or silica dust, can lead to an inflammatory reaction that increases somebody’s risk of getting pulmonary disease. Because of all the global industries and potential exposures, pneumoconiosis is one of the world’s most common occupational diseases.
B readers and chest radiography screenings are used in the US Department of Labor, with the Occupational Safety and Health Administration, the Coal Workers’ Health Surveillance Program, and the US Department of Energy. They’re used in epidemiologic studies, clinical studies, and even in compensation lawsuits.
How to Become Qualified as a B Reader?
To become qualified as a B reader, a US physician must pass an exam that includes radiographs and questions about the International Labour Organization’s (ILO’s) classification. The ILO sets the guidelines on classifying pneumoconiosis.
Any physician can sit for this exam, even a pediatrician, but I looked at the syllabus and it’s daunting. I could take a 3-day course that’s offered by the American College of Radiology, but I think a board-certified radiologist is probably the right person for this task.
I’m trying to imagine what it would be like to look at a chest radiograph and consider the ground glass or reticular opacities, consolidations, and bronchial wall thickenings and then trying to differentiate between asbestosis and occupational bronchitis, or maybe it’s silicosis, while ruling out malignancy, sarcoidosis, or some interstitial pneumonia or whatever else is on the differential list that I don’t understand. This does not feel like a task that should be taken lightly.
Should B Reader Program Be Expanded to Include NPs and PAs?
Why exactly is there consideration to expand the scope to nurse practitioners (NPs) and physician assistants (PAs)? Currently, 184 US physicians are certified as B readers, and I wonder how much clinical or financial incentive there is for other physicians to go out and get certified. Nonetheless, the National Institute of Occupational Safety and Health put out a statement asking for comments about the pros and cons of expanding the program.
If you look at the statement, you’ll see question prompts around topics such as B reader demand, if certain populations may benefit from having an NP or a PA as a reader, pros and cons of the programs, and how state laws may play in with physician oversight.
The American College of Radiology already stated they’re going to submit a response, and I suspect that other advocacy groups will as well.
Nonphysician interpretation of images, such as ultrasounds, radiographs, and CT scans, has increased in recent years, and this has led to a debate about differences in training, the potential for misdiagnoses, and liability. One has to ask, how would expanding the scope of practice to B reader programs affect this trend?
One has to also wonder if there’s a financial motive in all of this. One study does suggest that financial conflicts of interest could affect the classification of pneumoconiosis. For example, a law firm looking to get compensation could reuse different B readers until they got the diagnosis they wanted.
Look, I’m speculating, and you might be as well. If you feel strongly about expanding the B reader program to NPs and PAs, for or against, you should comment directly to the Centers for Disease Control and Prevention. Also, comment below. Radiologists, I especially want to hear from you.
Alok S. Patel, MD, is a pediatric hospitalist, television producer, media contributor, and digital health enthusiast. He is a clinical assistant professor for the department of pediatrics at Stanford Children's Health in Palo Alto, California. Patel is a special correspondent for ABC News and regularly appears as an on-camera expert for several news outlets. He hosts The Hospitalist Retort video blog on Medscape.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
TOP PICKS FOR YOU