International Classification of HRCT.pdf
International Classification of HRCT.pdf
Y. Kusaka, K.G. Hering, J.E. Parker (Eds.)
International Classification of HRCT
for Occupational and Environmental Respiratory Diseases
Y. Kusaka, K.G. Hering, J.E. Parker (Eds.)
International Classification of HRCT
for Occupational and Environmental
Respiratory Diseases
With 94 Figures, including 27 in Color
Springer
Yukinori Kusaka, M.D., Ph.D.
Industrial Health Consultant
Professor and Chairman
Department of Environmental Health, School of Medicine
Fukui Medical University
23-3 Shimoaizuki, Matsuoka-cho, Fukui 910-1193, Japan
Kurt G Hering, M.D.
Chief
Department of Diagnostic Radiology, Radiooncology and Nuclear Medicine
Radiologische Klinik, Knappschaftskrankenhaus, Dortmund
Wieckesweg 27,44309 Dortmund, Germany
John E. Parker, M.D.
Professor
Pulmonary and Critical Care Medicine
Robert C. Byrd Health Sciences Center, West Virginia University
HSC 475A-9166, Morgantown, West Virginia 26506-9166, U.S.A.
Cover Illustration'. From Georgius Agricola {\556) De Re Metallica, Herbert Clark Hoover
and Lou Henry Hoover, translators (1950) Dover Publications, Inc., New York, with permis-
This book was financially supported by the Japan Society for the Promotion of Science (Grant-
in-Aid for Publication of Scientific Research Result: Grant No. 165303).
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Foreword
Environmental and occupational exposure to mineral dusts (i.e., pneumoconiosis)
has long been known to be an important cause of lung disease. Since the latter half
of the twentieth century, the number of pneumoconiosis cases recognized by phy-
sicians has increased significantly, related to both an increased likelihood of ex-
posure to toxic materials in industry and more detailed surveillance of workers.
Our ability to diagnose and subsequently avoid, control, and regulate these
harmful exposures has been based on understanding their relationship to clinical
symptoms and pathologic lung abnormalities. Fundamental to this understanding
has been the widely used system for classification of chest radiographic abnor-
malities in pneumoconiosis introduced by the International Labour Office (ILO).
Based on this system, the type and degree of lung abnormality could be readily
assessed in a population of exposed subjects, and correlations made with exposure
severity or duration, morbidity, and mortality. However, the limitations of the ILO
system have long been recognized. Chest radiographs are insensitive to the di-
agnosis of early abnormalities produced by pneumoconioses, and they lack speci-
ficity as well; a number of findings considered abnormal on chest radiographs us-
ing ILO criteria are in fact nonspecific and may not be related to pneumoconiosis
at all.
The development of high-resolution computed tomography (HRCT) over the
last 20 years has revolutionized the diagnosis of all types of lung disease, includ-
ing pneumoconiosis. The anatomic detail provided by HRCT, in combination with
detailed correlations of HRCT lung abnormalities and histologic findings, has
provided a powerful tool for assessment of these diseases. However, a compre-
hensive system for the classification and quantification of the lung abnormalities
typically seen in patients with pneumoconiosis has been lacking. Without ques-
tion, a HRCT system for the classification and quantification of pneumoconiosis,
similar to the ILO system, would be valuable in our attempts to accurately diag-
nose and effectively prevent these diseases.
This monograph provides just such a system. Based on a fundamental under-
standing of HRCT, both its technical aspects and anatomic correlations, the au-
thors have provided a detailed and comprehensive description of significant
HRCT findings and methods for appropriately recording them. They have consid-
ered all aspects of the HRCT diagnosis of pneumoconiosis, including the technical
aspects of CT, radiation exposure and risks associated with HRCT, the use of ap-
propriate terminology in the description of abnormalities, coding systems (includ-
ing a review of the ILO system), and pathologic correlations, and they also pro-
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