Bambang Satoto

Fk Undip/RSUP dr . Kariadi
Semarang
Introduction
 The International Labour Organisation
(ILO) is a global agency whose responsible
to arange and oversee the international
labour standards
 “Pneumoconiosis” is a disease caused by
inhalation of mineral dust particles
Introduction
 Setting up a Radiographic Reading
System for exposed workers
 Last revision of ILO’s guideline --> 2011
Scope - ILO classification
Scope of the classification
 Provides a means for describing and
recording systematically the radiographic
abnormalities in the chest provoked by the
inhalation of dusts
 Any type of pneumoconiosis
 Only postero-anterior PA chest radiographs
ILO Classification System
 Printed guidelines
 Sets of standar films
 Comparing posteroanterior radiographs
with standar films
Uses for ILO Classification
Use of the classification
Epidemiological research
Screening and surveillance of workers in
dusty occupations
Clinical purposes
The classification promotes improved
international comparison of data concerning
the pneumoconioses
ILO Classification System
Three components
(1)Reading or recording form

(2) Standard radiographs (3) Written guidelines

- complete set (22 films) - complete classification
- quad set (14 films) - abbreviated
classification
- appendices
Recording ILO Classification

Film Quality
Small Opacities
(Profusion, size & shape & zone)

Large opacities
Pleural disease
Other symbols
ILO Classification - Film quality
Film quality
Four grades
1. Good
2. Acceptable : no technical defect likely to impair
classification
3. Acceptable : some technical defect likely to impair
classification but still adequate for classification
purposes
4. Unacceptable or for classification purposes
ILO Classification - Film quality
Good technical quality for chest radiographs
 Full inspiration
 Mediastinum and parenchyma visible
 Minimal underexposure or overexposure
 Limited scapular overlap
 Apices, lung bases & chest wall visible
ILO Classification
 Parenchyma abnormality
 Small opacity
 Large opacity
ILO Classification
Small opacities
Small opacities are described by :
 profusion = concentration of small opacities
 affected zones = zones in which small opacities are seen
 shape (rounded or irregular)
 Size p,q,r s,t,u
Profusion
 Based on concentration or the number
of fine opacities per unit area. Divided
into 4 categories, namely:
Profusion
 Category 0 : No opacity
 Category 1 : Little bit of opacities
 Category 2 : More opacities with vivid
bronchovascular marking
 Category 3 : Substantial opacities with
indistinct of whole or part of bronchovascular
marking.11
ILO Classification - Profusion
Small opacities : profusion 12 point scale
 The category of profusion is based on
comparisons with the standard radiographs
 The written descriptions are a guide but the
standard radiographs take precedence
Profusion
Profusion
 The first number indicates a profusion
that is more dominant than the number
behind it. Profusion is an important clue
to determine the severity of the disease.
The extent of the distribution of the
opacity is based on the affected area.11
 Imaging Of Pneumoconiosis

Zone Classification according to ILO

Small opacities : on the affected zone
 Each of the lung is divided into 3 zones
 The zone where the opacity appears is reported
Shape and Size
 Rounded opacities are divided according to
their diameter:
 p : opacities with diameters up to 1,5 mm,
 q : opacities with diameters in range of 1,5-3 mm,
 r : opacities with diameters in range of 3-10 mm.10
 Irregular opacities are divided according to
their width
 s : opacities with widths up to 1,5 mm,
 t : opacities with widths in range of 1,5-3 mm,
 u : opacities with widths in range of 3-10 mm.11
Shape and Size
 Two letters are used for reporting the
shape and size of the abnormality. The
first letter indicates a more dominant
abnormality; for example p/s, this means
that there are more rounded opacities of
size p, but there are also irregular
opacities of size s but less in number.11
Shape and Size
Small opacities : shape and size
 Written definition have been used as a guideline, but
the film must meet the standards
Large Opacities
 Large opacities are divided into 3
categories : A, B, and C.11
 Category A : there is one opacity with a
diameter between 1-5 cm; or several
opacities with a diameter of more than 1 cm
each, but their total diameter does not
exceed 5 cm.
Large Opacities
 Large opacities are divided into 3
categories : A, B, and C.11
 Category B : there is one or more opacities
with larger size or more quantity than A; but
the opacification area does not exceed the
area of the upper right lung field.
 Category C : there is one or more opacities
whose total area exceeds the area of the
right upper lung field or one third of the right
lung field.
Large Opacities
• Definition : opacity with the longest dimension up to 10 mm
• Divided into 3 categories : A , B, and C.
• The written definition applies to the films that meet the
standard
Pleural Abnormality
 Pleural plaque (localized pleural thickening)
 Obliteration of costophrenic angle
 Diffuse pleural thickening
Pleural Abnormality
 Thickening of the pleura
 Classified into localized thickening
(plaque) and wide (diffuse) thickening.
 Coded by (Y) if present or (N) if not.11
Pleural Abnormality
 The width of plaque or thickened pleura
is measured from the inner part of chest
wall to the adjacent lung surface
 It is categoried as:11
 a : about 3 - 5 mm
 b : about 5 -10 mm
 c : over about 10 mm
Pleural Abnormality
 Its longitudinal length follows the length of the chest wall
from the apex to the costophrenic sinus in the following
categories:
 1 : if the total length is up to one-quarter of the total
length of the chest wall from the apex to the
costophrenic sinus on one side
 2 : if the total length is between one-quarter to half of
the total length of the chest wall from the apex to the
costophrenic sinus on one side
 3 : if the total length is more then half of the total
length of the chest wall from the apex to the
costophrenic sinus on one side
Pleural Plaque
 If visible on the chest wall, recorded as in-
profile or en-face
Plaque pleura in-profile dan en-face
Pleural Abnormality
 Pleural Calcification
 In assessing the pleural plaques, it is
also necessary to look at the presence
or absence of pleural calcifications, and
whether they are located on the right
side or the left side.
 In general, if there is pleural calcification
on one side, pleural plaques will also be
found on that side
ILO Classification
Symbols
 They describe additional features related or not
to dust exposure
 Use of the symbols is obligatory
 Ease of recording by 2 letter abbreviations (29
symbols)
 aa : Aterosklerotik aorta
 at : apikal plaural thickning
 ax : Coalescence of small opacitas
 bu : Bulla, additional infarmation of
emphyisema
 ca: lung cencer
 cg: Calcified granuloma
 cn : Calsification of small
pneimoconiotoc opacities
 co : Abnormality of cardiac size and
shape
 cp : Cor pulmonale or pulmonae
hipertention
 cv : Cavitatio, liquefaction
 di : Marked distorton of intrathoracic
structures
 ef : Free pleural effusion
 em : Emphysema
 es : Egghshell calsification of hilar / or
mediastinal lymph nodes
 fr : Fractured rib ( s )
 hi : Enlargment of hilar and / or
mediatinal lymph node > 1. – 2 cm
 ho : Honeycomb lung
 id : Ill-defied diphragma countour
 ih : Ill-defined cardiac countour
 kl : Kerley line
 me : Malignant mesotelioma
 od : Other significant disease
 pa : Plate atelektasis
 pb : Prencimal band
 pi : Pleural thicning of an interlobular
fissure
 px : Pneumotharax
 ra : Round atelektasis
 rp : Rheumatoid pneumoconiosis
 tba : Tuberculosis, active ?
 tbu : Tuberculosis, inactive ?
ILO Classification
Comments
Comments are required if
1. The technical quality of the radiograph is not recorded
as 1
2. If the symbol OD is recorded
3. To identify any part of the reading of a chest
radiograph which is believed to be probably or
certainly not dust related