TRAINING IN THE ILO

CLASSIFICATION OF RADIOGRAPHS
FOR THE PNEUMOCONIOSIS IN
BRAZIL, 1994-2007

Eduardo Algranti, Division of Medicine,

FUNDACENTRO, São Paulo, Brazil
 Background
• Brazilian labour legislation (December 1994)
demands that:

Workers exposed to fibrogenic dusts should have
an admissional, demissional and yearly chest X-
ray

Workers exposed to non-fibrogenic dusts should
have an admissional, demissional and every 3
years until 15 years of tenure and every 2 years
afterwards

There are no directives as to the skills of readers
 Background
• FUNDACENTRO, alone or in collaboration with
other institutions, is conducting ILO Radiological
Classification training seminars since 1985
• We aimed at analysing the profile of physicians
seeking training and their opinions about the
seminars and the routine application of the
classification
 Methods
• ID information of all physicians who attended an
ILO Radiological Classification between 1994 and
2007 was kept in an electronic databank
• Elaboration of a 4-block questionnaire asking for
full identification, information on medical
background, information on the training and use of
the ILO classification and, opinions about the
training seminars
• Questionnaires were sent by post and/or by e-mail
to all physicians registered in the databank
 Results
• 20/356 (5,6%) of the registers did not contain
contact data (address, phone number or e-mail)
• Only 112/336 (33.3%) questionnaires sent were
completed and returned. 16/336 (4,8%) physicians
were not found (returned address or e-mail)
• Brazilian states with larger number of trained
physicians were: Minas Gerais, São Paulo, Paraná
and Rio de Janeiro
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34
States with more trained physicians
State n Responders (%)

MG 94 46 (49)

SP 68 20 (29)

PR 34 8 (23)

RJ 20 6 (30)
 Results

• From the 112 responders 58 (52%)

practiced one medical specialty only. 54
mentioned 2 medical specialties
 Physicians practising one medical specialty

30 28

25

20 18

15 12
10

0
Radiologia Medicina do Trabalho Pneumologia
 Physicians practising more than one specialty - first reference
Physicians practising more than one specialty - second reference
25 20
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15 20 11
2010
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 Institutional link

60
Private
Public sector
sector

35 25 50
33
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20
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15 10 11
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5 3 5
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Basic UnitsPrivate
Industry Ref Center
OSHinfirm Hospital
Expert University
Radiology Foudation Private
Private Compensation
Hospital Others
Others
OH 0OH WH clinic clinic board
university
physician physician Public Private Both
 How often do you apply the classification?

60 54
50

40
28
30

20 15 13
10

0
Weekly Monthly Occasional Do not use
 Refered problems
• The quality of the chest films to be analysed
is poor
• There are few available experienced readers
to discuss cases
• There is a poor comparability of the
analysed chest films with the ILO Standard
Set
• Feeling insecure in applying the
classification
 Conclusions
• ILO training seminars are sought mainly by
radiologists, occupational medicine practitioners,
pneumologists and clinicians
• Selection of participants for the training seminars
should be improved
• Opinions regarding duration and sufficiency of the
training seminars depend on the medical background
of physicians
• The interest in responding the questionnaire is linked
to a routine in using the classification and, possibly,
to demands from normative/inspection bodies
 Conclusions
• There is an urgent need of improving chest
X-ray quality in the periodical evaluation of
workers exposed to mineral dusts
• There is a need of creating efficient and
effective channels of communication for
physicians interested in the ILO
classification, as well as means of
continued/refresh training in the subject
 Actions taken
• Set up of a group composed of
representatives of 3 medical societies, plus
Ministries of Health, Labour, Welfare and 2
invited experts to discuss
Criteria for physician’s admission for training
Training contents
Training schedules
Certification and recertification
 Recommendations
• It is recommended that ILO make available
informations on accepted forms of training in the
ILO classification and, of levels of training
(Example: definitions of a “trained reader”,
“certified reader”)
• It is recommended that forms of assessing
proficiency of readers should be make available
• It is recommended that institutions/countries make
available self-training sets for continued/refresh
training (as the NIOSH Syllabus)