Patterns of progressive massive fibrosis on modern coal miner chest radiographs

Cara N. Halldin, David J. Blackley, Travis Markle, Robert Andrew Cohen, A. Scott Laney*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Clinical teaching generally asserts that large opacities of progressive massive fibrosis (PMF) on chest radiographs present primarily bilaterally in the upper lung zones, and with an elevated background profusion of small opacities. However, the contemporary basis for these descriptions is limited. Radiographs taken for the Coal Workers’ Health Surveillance Program during 2000–2015 and previously determined to have large opacities (“PMF radiographs”, n = 204), and a random sample previously deemed free of large opacities (n =22), were independently reevaluated by three National Institute for Occupational Safety and Health (NIOSH) B Readers. Large opacities were noted primarily in the upper right (41%) or upper left (28%) lung zone, but 31% were in middle or lower zones. Unilateral involvement was observed in 34% of readings, with right lung predominance (82%). The median small opacity profusion category for the radiographs with PMF was 2/1. The number of large opacities was not correlated with small opacity profusion category. The “classic” descriptions of PMF as bilateral, associated with elevated background profusions of small pneumoconiotic opacities, were each absent in a third of miners.

Original languageEnglish (US)
Pages (from-to)152-158
Number of pages7
JournalArchives of Environmental and Occupational Health
Issue number3
StatePublished - Apr 2 2020


  • Epidemiology
  • occupational diseases
  • occupational lung disease

ASJC Scopus subject areas

  • Toxicology
  • Environmental Science(all)
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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