Who’s Reading My Chest X-ray?

Reading Time: 4 minutes read

New CDC Proposal Suggests Allowing Physician Assistants and Nurse Practitioners to Read Chest X-rays.

By Ann London BS. RT (R)(T) | Clinical Applications Specialist, Carestream

The U.S. Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (NIOSH) is deciding on expanding their federal program known as the “B Reader Program.”  This program trains and certifies physicians to read chest radiographs for workers participating in health surveillance programs. Identifying workers at risk of developing pneumoconiosis, caused by inhaling mineral dust including asbestos, silica and/or coal. As of October 2024, there are 184 certified B-readers across 35 states and 2 US territories.  

Should PAs and NPs be eligible for B Reader certification?

B Reader certification requires additional training and passing a formal exam, along with a retest every 5 years to maintain B Reader status. Radiologists complete over 20,000 hours of clinical experience before being certified to interpret radiographic images. Compared to only 500 hours of clinical experience for NPs and 2000 hours for PAs. Would these professionals feel confident to interpret a chest x-ray?

Chest X-rays account for somewhere around 12% of all medical imaging procedures, meaning roughly one of every 10 exams focuses on the chest. Chest radiographic exams can be difficult to interpret and a challenge for those less experienced.

While B Readers primary focus is diagnosing occupational lung disease, they are also responsible for recognizing and identifying all clinically important findings. Leading to another concern of falsely diagnosing patients or potentially missing other abnormalities which would result in a major risk to a patient’s diagnosis and care. Certified thoracic radiologists weighed in to the American College of Radiology (ACR) emphasizing the immense difficulty in identifying interstitial lung disease thresholds on chest X-rays, calling them “one of the most challenging tasks they’re asked to perform.”

If certified radiologists routinely have trouble with the intricacies of chest radiographs—identifying the differences in glass or reticular opacities, consolidations, and bronchial wall openings; differentiating between asbestosis, occupational bronchitis, and silicosis; ruling out malignancies, sarcoidosis, interstitial pneumonia, or something else—letting non-physicians read them as well may not give confidence to the patient having his or her exam read.

On the flip side, health care workers continue to feel the strain of busy schedules and staffing shortages, with a 2023 NIH study reporting 54-72% of diagnostic and interventional radiologists exhibited symptoms of burnout.

Especially in underdeveloped rural areas, these added responsibilities to NPs and PAs could greatly improve patient diagnostic wait times. While potentially expanding the role for NPs and PAs in the healthcare system by becoming certified B Readers. This would create more opportunities for career advancement, especially for those seasoned professionals.

For NPs and PAs currently providing screening services to occupation workers in underserved areas, becoming certified B Readers would greatly benefit these large populations including mine workers.

Time, money and energy also needs to be taken into consideration for becoming B Reader certified and renewing certifications—according to a former MD, who chose not to renew their B Reader certification due to the expense and travel involved. Asking the question, who should be responsible for the cost of certification and renewal, the individual or the hospital?

What Do You Think?

If the CDC proposal passes, could this lead to NPs and PAs being eligible to read additional exams in the future?

There are still a lot of unanswered questions surrounding this proposal and how the CDC expects the Reader Program to evolve.

We’ll have to wait to see how the rest of the medical and imaging communities react, but it’s an interesting proposal to say the least.

Do you have an opinion? Let us know in the comments or drop us a line on our social media channels: LinkedIn, Facebook, Instagram.