B Reader Exam Overview

At a glance

To become a NIOSH-certified B Reader, physicians must pass a classification examination administered by the NIOSH B Reader Program. To help prepare for the exam, the Program provides information about exam eligibility, a study syllabus, and information on scheduling and taking the exam. To further assist physicians, answers to frequently asked questions (FAQs) are also available.

Exam eligibility and basics

U.S. licensed physicians are eligible to take the B Reader exam. The examination may also be taken by international candidates by special arrangement.

Experts from NIOSH and the American College of Radiology (ACR) recently collaborated to develop an updated B Reader exam. The revised exam includes 72 images and is graded on five domains.

Five content domains

  1. Multiple choice questions for concepts relevant to ILO classification.
    1. Questions are drawn from content in the NIOSH B Reader syllabus.
  2. Assigning a quality score to the radiograph.
  3. Determining the presence or absence of small opacities.
    1. If small opacities are present, assigning a profusion score.
  4. Identifying when large opacities are present.
  5. Identifying pleural abnormalities.
    1. Presence of pleural plaques and costophrenic angle obliteration.

Scheduling

NIOSH offers the exam free of charge at the NIOSH-Morgantown campus located at 1095 Willowdale Road, Morgantown, WV. Available B Reader exam dates are listed here: 2025 B Reader Examination Dates.

To schedule:

International physicians must contact NIOSH at least 60 days before their preferred exam date. This allows processing of all necessary U.S. Department of Homeland Security forms.

Other exam locations

The ACR offers B Reader courses and administers the exam in-person in Reston, VA. More information can be found on the ACR Education Center website.

The University of Illinois Chicago (UIC) also administers the exam in Chicago, IL. More Information can be found on the UIC Mining Education and Research Center website. Email kkenne4@uic.edu for more information about scheduling.

Currently, there are no remote options to take the B reader exam.

Preparing

NIOSH strongly encourages adequate preparation prior to taking this exam. The following resources are available to assist:

Documents describing the ILO classification system and standard chest images used are located on the ILO website. Seminars and courses are occasionally offered by NIOSH, ACR, and UIC. Look for posted announcements on the respective websites.

Taking the exam and grading

Physicians are given a total of four hours and 20 minutes to complete the exam:

  • Four hours to review and classify images.
  • 20 minutes to complete multiple choice questions.

Correct answers for classifications are based on how the ILO experts classified test images. For many test items, partial credit is assigned for classifications that are close to experts' findings.

Individual images may not be graded for each of the exam's domains. For example, an image may only be graded for pleural changes.

Examinees must pass all the domains to pass the overall exam. International physicians are not graded on the multiple-choice section.

Exam results

Passing

Upon successfully passing the B reader exam, U.S. licensed physicians become certified B readers. International physicians are notified they have successfully completed the B reader examination.

Certification is effective for five years, starting on the date the exam was graded.

Failing

There are no limits to the number of times examinees can take the exam. However, there are time restrictions:

-If you are not a B Reader and you fail you must wait 90 days before retaking the exam.

-B Readers who are taking the exam for recertification may retake the exam once with no waiting period.

-B Readers who fail a second time must wait 90 days before retaking the exam.

Exam results will be sent by mail within one month of the exam date. Notifications will also be emailed to those who provide their email addresses.

Maintaining certification

B Readers must retest every five years to maintain their B Reader certification. Testing can be done any time within the fifth year. A reader who fails must retake and pass before the end of their five-year approval period expires to retain certification.

Readers not maintaining certification or do not pass the exam can request removal of their name from the B reader list.

FAQs

Why do applicants need to pass all five domains to pass the overall exam?

ILO classification experts believed that a proficient B Reader should demonstrate expertise in each domain.

Why does the exam include an image quality domain?

ILO classification experts believed assessing image quality to be a crucial part of B Reader expertise. Therefore, they chose to include it in the revised exam.

Image quality concerns were reviewed in December 2022. Program B Readers subsequently made changes to the exam's image quality domain. Overall, 88% of the applicants have passed this domain on their initial attempt taking the revised exam.

Why doesn't the syllabus include more study material about the image quality domain?

Image quality is discussed in:

During development, the syllabus authors believed this information was sufficient. In response to feedback, we are reviewing the study materials and determining if more information about image quality should be included.

Can you offer the syllabus in a different format?

We have contracted with the ACR to develop a more user-friendly version for future use. In the meantime, if you have specific issues with the syllabus, contact us at cwhsp@cdc.gov.

I think I found discrepancies in the syllabus and/or answer keys, who can I contact?

We continue to review potential problems and will make updates if needed. Please contact us at cwhsp@cdc.gov if you have questions or concerns.

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Content Source:
National Institute for Occupational Safety and Health