Radiographic readings for asbestosis: Misuse of science - Validation of the ILO classification

Background: Radiographic readings for pneumoconiosis (both asbestosis and silicosis), even those using the International Labour Office (ILO) Classification, have received widespread negative coverage in the media and strong judicial rebuke. Methods: The medical literature over the past 90 years was reviewed for the relationships between radiographic severity (standardized as the ILO profusion score) and indices of exposure to silica or asbestos, tissue burden of silica particles or asbestos fibers, histologic fibrosis, various measurements of pulmonary function and mortality. Results Evidence from many different disciplines has demonstrated that the ILO profusion score correlates with occupational exposure, dust burden in the lung, histologic fibrosis and, more recently, with physiologic impairment and mortality. Conclusions: The ILO Classification has therefore been validated as a scientific tool. Its fraudulent misuse by "hired-gun" physicians, attorneys and elements of the compensation system to falsify claims of asbestosis and/or silicosis (often in the same claimant) must be condemned.