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Comparison of X-Ray Films and Low-Dose Computed Tomographic Scans: Demonstration of Asbestos-Related Changes in 2760 Nuclear Weapons Workers Screened for Lung Cancer

Miller, Albert MD; Widman, Shannon A. MPH; Miller, Jeffrey A. MD; Manowitz, Amy MPH; Markowitz, Steven B. MD, DrPH

Journal of Occupational and Environmental Medicine: July 2013 - Volume 55 - Issue 7 - p 741–745
doi: 10.1097/JOM.0b013e3182954067
Original Articles

Objective: Increased availability and technical improvements of computed tomographic (CT) scanning encourages its use for detecting asbestos-related disease. We compared low-dose scans and x-ray films in 2760 workers potentially exposed to asbestos, to assess their ability to detect interstitial lung disease (ILD) and pleural thickening (PT).

Methods: A total of 2760 nuclear workers received radiography and CT scanning (2006 to 2009). X-ray films were read by a B reader for ILD and PT and CT scans by a thoracic radiologist, using a protocol for nodules, ILD, and PT.

Results: Of the 2760 workers, 271 showed circumscribed PT on CT scans, and 73 on x-ray films, 54 (74%) of which were confirmed on CT scans; 76 showed ILD on CT scans, and 15 on x-ray film, 10 (67%) of which were confirmed on CT scans.

Conclusions: Radiographic readings of PT and ILD were generally confirmed on CT scans. Computed tomographic scans detected three to five times more cases; the majority were minor.

From the Center for the Biology of Natural Systems (Drs A Miller, JA Miller, and Markowitz, Ms Widman, and Ms Manowitz), Queens College, City University of New York, Flushing; Albert Einstein College of Medicine (Dr A Miller), Bronx, NY; and Veterans Affairs Hospital (Dr JA Miller), East Orange, NJ.

Address correspondence to: Albert Miller, MD, Center for the Biology of Natural Systems, Queens College, City University of New York, 65-30 Kissena Blvd, Remsen Hall Room 311, Flushing, NY 11367 (

This study was funded by the Department of Energy for lung cancer screening of workers at its facilities.

Drs Albert Miller and Steven Markowitz have provided expert medical legal advice in a lawsuit involving low-dose computed tomographic scanning as a means for early lung cancer detection in heavy smokers.

The authors declare no conflicts of interest.

Copyright © 2013 by the American College of Occupational and Environmental Medicine