Introduction: Integrating Imaging and Clinical Evaluation

Clinical Overview

Clinical Approach to the Diagnosis and Treatment of Occupational Lung Diseases

Introduction: Integrating Imaging and Clinical Evaluation

Imaging is critical in the clinical evaluation and epidemiologic study of occupational lung diseases, and chest imaging technology has evolved in recent years. Advances include the use of digital chest imaging to classify presence and severity of pneumoconioses using the International Labour Office (ILO) system, as well as the increasing importance of high resolution chest computed tomography (HRCT). While the cost and radiation dose associated with HRCT are both falling, this technology has not been widely adopted throughout the world for medical surveillance of dust exposed workers, and as of yet there is not an ILO Classification System for HRCT images equivalent to that available for plain chest radiographic images, although such a system has been proposed and evaluated in research reports. This syllabus provides a general overview of the clinical approach to diagnosis and management of the major occupational lung diseases, with a focus on the integration of imaging findings with other components of the clinical evaluation, particularly the exposure history. In this way, prompt and accurate diagnosis, more effective treatment, appropriate control or elimination of exposures, and other prevention efforts, can be optimized [Cox and Lynch 2015]. ILO classifications are primarily used for dust exposed workers, but have also been used to classify the pattern and extent of interstitial changes in other occupational lung diseases including the granulomatous diseases associated with hypersensitivity pneumonitis, and chronic beryllium disease. We have also included a discussion of occupational asthma, chronic bronchitis, and emphysema, in an Appendix, although medical surveillance and diagnosis of workers at risk for these diseases rarely require chest imaging with ILO classification.