INTERPRETATION OF

ILO RADIOGRAPH
FOR PNEUMOCONIOSIS

Mukhtar Ikhsan
Dept. of Pulmonology & Respiratory Medicine
University of Indonesia - Islamic State University
Jakarta
 Roles for Chest Radiography
Important tool for clinical evaluation of
pulmonary diseases
(Especially - infectious lung diseases)
Diffuse lung diseases or the interstitial lung
diseases
Neoplastic diseases
Useful in clinical care, assisting in both
diagnosis and evaluating response to therapy
Found application in epidemiologic and
research for occupational and environmental
lung disorders
 Chest Radiography in Dust
Exposed Workers
Chest radiography has been useful tool in
screening and surveillance of dust
exposed workers
Chest radiograph has been helpful in
exposure-response relationships
evaluation
Documents failures of dust control
 Limitations of Radiographic
Imaging
Imperfect tool, not diagnostic gold standard
Airway disorders not always seen
Functional impairment not well evaluated
or assessed
Cannot provide certainty about the etiology
of observed findings due to limited lung
response patterns
Normal CXR (PA view)
Normal Alveoli and Interlobular Septa
7
 Pendahuluan (1)
‫ ﺦ‬Klasifikasi ILO menerangkan &
mencatat secara sistematis kelainan
radiologis dada akibat inhalasi debu
‫ ﺦ‬Untuk menerangkan kelainan radiologik
yang terjadi pada berbagai jenis
pneumokoniosis
 Pendahuluan (2)
‫ ﺦ‬Kelainan radiologik tidak dapat
menggambarkan kelainan fungsi paru
‫ ﺦ‬Derajat kelainan radiografi tidak dapat
digunakan untuk menilai kecacatan paru
‫ ﺦ‬Tidak ada aspek hukum untuk kompensasi
terhadap kelainan radiologik
 Tujuan
‫ ﺦ‬Untuk mengkodifikasi kelainan radiologi
pneumokoniosis dengan cara sederhana
dan reproducible
‫ ﺦ‬Digunakan secara internasional untuk:
- penelitian epidemiologik
- screening dan surveillance
- tujuan klinik
 Prosedur
‫ﺦ‬ Foto standar ILO dan formulir
pembacaan digunakan dalam prosedur
pembacaan
‫ﺦ‬ Tidak ada kelainan patognomonis
untuk pneumokoniosis
‫ﺦ‬ Protokol standar dan dan riwayat klinis
diperlukan untuk tujuan klinis
Teknik Membaca
‫ ﺦ‬Kualiti foto toraks
‫ ﺦ‬Kelainan parenkim
* Small opacities
* Large opacities
‫ ﺦ‬Kelainan pleura
‫ ﺦ‬Kelainan spesifik
 Kualiti Foto Toraks
1. Good
2. Acceptable, with no technical defect
to impair classification
3. Acceptable, with technical defect
to impair classification
4. Unacceptable
AbnormalitasParenkim

‫ﺦ‬ Small opacities

‫ ﺦ‬Large opacities
Small Opacities

‫ﺦ‬ Profusion
‫ﺦ‬ Affected zone
‫ﺦ‬ Shape
‫ﺦ‬ Size
 Kerapatan (profusion)
Kategori 0 : tidak ada perselubungan atau
kerapatan kurang dari 1
Kategori 1 : ada perselubungan tetapi sedikit
Kategori 2 : perselubungan banyak, tetapi
corakan paru masih tampak
Kategori 3 : perselubungan banyak sehingga
corakan paru tidak terlihat
 Profusion
‫ ﺦ‬Konsentrasi kelainan di lapangan paru
‫ ﺦ‬Ada 4 kategori dan 12 subkategori
Category
0 1 2 3

Sub- 0/- 0/0 0/1 1/0 1/1 1/2 2/1 2/2 2/3 3/2 3/3 3/+
category
 Zona Yang Terkena

‫ ﺦ‬Dibedakan antara area kanan dan kiri

‫ ﺦ‬Setiap area dibagi menjadi 3 zona:
- Atas
- Tengah
- Bawah
 Shape and Size
*Small rounded opacities (sro)/ Bercak kecil bulat (bkb)
*Small irregular opacities (sio)/ Bercak kecil tak
beraturan/bkt
 Small opacities : shape and size
Two letters must be used to record
shape and size
 Large Opacities
Ukuran bercak Kategori
Diameter >10 mm - 50 mm atau beberapa A
bercak berdiameter 10 mm tetapi hasil
penjumlahan <50 mm

Satu atau beberapa bercak > kategori A,

tetapi luas bercaknya tidak melebihi luas B
lapangan atas paru kanan

Satu atau beberapa bercak yang luas

daerahnya melebihi luas lapangan atas C
paru kanan
 Abnormalitas Pleura
‫ ﺦ‬Pleral plaque (penebalan pleura
terlokalisir)
* Site
* Calcification
* Extent
‫ ﺦ‬Costophrenic angle obliteration
‫ ﺦ‬Diffuse pleural thickening
 Pleural Plaque
‫ ﺦ‬Biasanya di pleura parietal
‫ ﺦ‬Dapat dilihat pada diafragma dan dinding
dada (in profile atau face on)
‫ ﺦ‬Dilihat :
◦ Site
◦ Calcification
◦ Extent (chest wall):
 1 : ¼ lateral chest wall
 2 : ¼ - ½ lateral chest wall
 3 : > ½ lateral chest wall
Pleural plaques in-profile and face-on
Costophrenic angle obliteration
Costophrenic angle obliteration is
recorded as present or absent for
the right and the left sides
Diffuse Pleural Thickening (DPT)

* Pleural thickening in the presence of,

and in continuity with, an obliteration
of the costophrenic angle

* DPT is recorded as present or absent

for the right and the left side
 Other Abnormality:
There are 21 "obligatory" symbols representing important
features related to dust diseases of the lungs and other etiologies.
These symbols are: aa atherosclerotic aorta; at apical pleural
thickening; ax coalescence of small opacities; bu bulla(e); ca cancer;
cg calcified granuloma or lymph node; cn calcification of small
pneumoconiotic opacities; co abnormal cardiac shape or size; cp
cor pulmonale; cv cavity; di dimarked distortion of an intrathoracic
structure; ef pleural effusion; em emphysema; es eggshell
calcification; fr rib fracture(s); hi enlargement of non-calcified
hilar nodes; ho honeycombing; id ill-defined diaphragm border;
ih ill-defined heart border; kl septal (Kerley) lines; and me
mesothelioma. Finally, the reader comments on any other
abnormal features of the chest radiograph or
other relevant information.
 Symbols
* They describe additional features
related or not to dust exposure
* Use of the symbols is obligatory
* Ease of recording by 2 letter
abbreviations (29 symbols)
Symbols
Symbols
 KESIMPULAN
1. Penunjang diagnosis penting pada
pneumokoniosis adalah pemeriksaan radiologis
2. Cara pembacaan foto adalah menurut standar
ILO tahun 2000
3. Sebelumnya dibaca, kualitas foto harus dinilai
3. Gambaran yang dinilai antara lain kelainan
parenkim, pleura, dan lain-lain
4. Pembaca foto mencantumkan kesimpulan
akhir
 Terima Kasih
 Matur
Nuwun
 Thank You

 Syukron

 Arigato
Gozaimasu