OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at https://www.osha.gov.

November 30, 2005

Dr. Jim Rafferty
Arbor Occupational Medicine
2995 Baseline Road, Suite 310
Boulder, CO 80303

Dear Dr. Rafferty:

Thank you for your July 21, 2005, letter to the Occupational Safety and Health Administration (OSHA). You have a few questions regarding OSHA's general industry asbestos standard, 29 CFR 1910.1001, as applied to medical surveillance of asbestos workers and chest roentgenograms. (Roentgenograms are also known as radiographs or x-ray films.)

This reply letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within your original correspondence. Your paraphrased questions and our replies are below.

Question 1: Appendix E states that chest roentgenograms shall be recorded on an interpretation form following the format of the CDC/NIOSH (M) 2.8 form. After sending my x-ray films to a reader, is it necessary that I be provided with a copy of the aforementioned form for my records, or is it acceptable for me to receive a dictated report from the reader, assuming that he/she records his/her findings on such a form that is kept in his/her office?

Reply: You do not need to maintain a copy of the interpretation form, as long as the form is maintained elsewhere and the employer can ensure this medical record is retained as required by the recordkeeping provisions of the standard, 1910.1001(m)(3). However, while this disposition of medical records may be more convenient for you, it may be less practical for the employer if this medical record is requested in accordance with 1910.1001(m)(5). Maintenance of medical records is a responsibility of the employer. If the employer contracts occupational medical services, the employer's contract should specify the maintenance and disposition of medical records.

We also refer you to 29 CFR 1910.1020, Access to employee exposure and medical records, which contains related requirements for employers and physicians or other health care personnel in charge of employee medical records.

Finally, OSHA has previously responded to related inquiries regarding maintenance of employee medical records, including x-rays. Specifically, we refer you to four of these letters of interpretation, copies of which are enclosed, but are also posted on OSHA's website, http://www.osha.gov, as follows:

Question 2: Appendix E states that roentgenograms shall be interpreted and classified by only a B-reader, board certified radiologist, or an experienced physician with known expertise in pneumoconiosis. Can I assume that any radiologist will have sufficient expertise in pneumoconiosis to the extent necessary to read asbestos-related x-rays? Or, must I verify his/her experience and/or training by some other means?

Reply: A board eligible/certified radiologist may be assumed to be qualified to read chest roentgenograms in accordance with 1910.1001, Appendix E, without further verification by the employer or ordering physician.

Question 3: Is it acceptable and sufficient for me to have my asbestos-related [x-ray] films read by an A-reader? In addition, what is an A-reader, and are A-readers acknowledged by OSHA as being readers that are qualified to read x-rays to rule out pneumoconiosis?

Reply: Mandatory Appendix E, paragraph (b) states, "Roentgenograms shall be interpreted and classified only by a B-reader, a board eligible/certified radiologist, or an experienced physician with known expertise in pneumoconiosis." This requirement of the standard does not include "A-readers," therefore, OSHA does not recognize A-readers as qualified to read asbestos-related x-ray films.

The National Institute for Occupational Safety and Health (NIOSH) certifies physicians through their B-Reader Examination for proficiency in the classification of chest radiographs for the pneumoconioses. Examinations are offered at the Appalachian Laboratory for Occupational Safety and Health (ALOSH), Morgantown, WV. A passing score results in approval as a NIOSH B-reader. Each B-reader receives a certificate and is required to recertify at four-year intervals. An A-reader is a person meeting a lower-level qualification than a B-reader. An A-reader is a physician who has demonstrated a specified level of proficiency in classifying the pneumoconioses by one of three methods:

  • Proper classification of six sample chest radiographs,submitted to the ALOSH and evaluated by a panel of B-readers;
     
  • Completion of one of the American College of Radiology's Symposium on the Classification of Radiology for the Pneumoconioses; or,
     
  • A B-reader who fails to recertify before the expiration of their four-year certification.
     

 

 

More information on the NIOSH B-reader Program can be found at http://www.cdc.gov/niosh.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov. If you have any further questions, please feel free to contact the Office of Health Enforcement at (202) 693-2190.

Sincerely,



Richard E. Fairfax, Director
Directorate of Enforcement Programs