The International Labour Office (ILO) International Classification of Radiographs for the Pneumoconioses is a system used for the recording of chest radiographic abnormalities related to the inhalation of dusts. In the ILO system, the size, shape and profusion of opacities on radiographs are classified in a detailed manner by trained observers using a set of standard radiographs. Rounded or nodular opacities are graded as p (< 1.5 mm diameter), q (1.5–3 mm), or r (3–10 mm). Irregular opacities are classified as s, t, or u, using the same size criteria. Large opacities (> 10 mm) are graded as A, B and C based on the combined dimensions of all large opacities present. The classification also scores the extent and thickness of plaques, pleural thickening, fissural thickening and calcified nodules. Profusion of the opacities is classified into four categories (0–3); category 0 indicates that there is no excess of small opacities above normal. The use of two profusion categories is useful when appearances lie between those of the standard radiographs. Despite acknowledged limitations and problems with the ILO classification (interobserver variability, the presence of background opacities that are unrelated to dust exposure, the relative insensitivity of the chest radiograph to early disease, and the misuse of the classification in legal settlements for compensation), it remains a useful shorthand whose meaning is widely understood for epidemiological studies.
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