D. Rule 10.4 Method for Concensus Classification of Chest Radiographs in Pneumoconiosis Cases

1. Definitions. For purposes of this section, the following words and terms shall have the following meanings unless the context clearly indicates otherwise:

"ILO Classification" means the current International Labour Organization Classification of Radiographs of the Pneumoconioses as specified in Virginia Code § 65.2-504.

"Independent B-Reader Classification" means a chest radiograph ILO classification performed without consultation, collaboration, or review of another reader's findings and without access to the worker's occupational or exposure history.

"Majority" means agreement by at least two of three Pulmonary Committee Members.

"Median" means the middle profusion category when the three reported profusion scores are ordered from lowest to highest.

"Concensus Radiographic Report" means the standardized summary report prepared by the Pulmonary Committee Chairman applying the consensus rules set forth in this Rule 10.4.

"Evidentiary Record" means the complete record of medical evidence considered in the adjudicatory proceeding before the Virginia Workers' Compensation Commission, including all independent B-reader classifications and the consensus radiographic report.

"True Copy of the Subject Chest Radiograph" means a true and correct copy of the original digital data in the DICOM format maintained by the facility where the subject chest radiograph of the claimant was obtained without any alteration, modification, or reformatting of that data whatsoever.

2. Independent Review Requirement

a. Each Pulmonary Committee member shall be a currently certified National Institute for Occupational Safety and Health ("NIOSH") B-Reader.

b. Each Pulmonary Committee member shall independently review a true copy of the subject chest radiograph(s) consistent with the requirements set forth in 20 C.F.R. § 718.102 and 42 C.F.R.§ 37.51 using medical diagnostic monitors.

c. No Pulmonary Committee member shall consult with, communicate with, or review the classification of another Pulmonary Committee member prior to submitting their individual reading.

d. Each reading shall be recorded using the ILO Classification and the ILO Radiiographic Standard Images, including all required elements.

e. Attorneys for the parties, and any parties acting pro se, shall certify to the Commission that only true copies of the subject chest radiographs are being submitted for interpretation to the Commission and to any B-readersprivately retained by the parties.

3. Consensus Determination

Following submission of all three independent B-reader classifications, the Pulmonary Committee Chairman shall issue a Consensus Radiographic Report applying the following rules:3a. Type and Shape of Small Opacities

(1) Primary Small Opacity

The concensus primary small opacity (p, q, r, s, t, u) shall be determined as follows.

(a) If a majority exists for a small opacity, that classification shall be used.

(b) If no majority exists, the consensus primary small opacity shall be the most frequently reported small opacity among the three readings.

(2) Secondary small opacity

The consensus secondary small opacity shall be determined as follows.

(a) If a majority exists for a secondary small opacity, that classification shall be used.

(b) If no majority exists, the secondary classification shall be the second-most frequently reported small opacity.

(c) If no clear second-most frequently reported small opacity exists, the secondary classification shall be omitted.

(3) Split Classifications

When readers report different opacities (e.g., q/p):

(a) The first-listed small opacity shall be treated as the primary small opacity; and the second-listed small opacity shall be treated as the secondary small opacity.

(b) Frequency shall be calculated separately for primary and secondary small opacities.

b. Profusion and Small Opacities

(1) Majority Controls

If at least two of the three independent B-reader classifications report the same profusion category, that category shall constitute the consensus determination.

(2) Median Applies if No Majority

If no majority exists, the consensus profusion category shall be the median of the three reported profusion scores.

c. Large Opacities

(1) The presence and classification (Category A, B, or C) of large opacities shall be determined by majority.

(2) If at least two of the three independent B-reader classifications identify any Category A, B, or C large opacities, the consensus radiographic report shall reflect third stage pneumoconiosis in accordance with Virginia Code § 65.2-504(A)(3) and the Pneumoconiosis Table set forth in Rule 11.

d. Other Abnormalities

(1) Other radiographic abnormalities shall be reported on the Consensus Radiographic Report only where a majority of the independent Breaders identify the same abnormality.

(2) If any of the three Pulmonary Committee members report in their independent classifications that the worker should see a personal physician because of that reader's findings, Section 4E of the Consensus Radiographic Report shall be marked in the affirmative, and the Commission shall notify the claimant and/or the claimant's counsel.

4. Documentation and Evidentiary Record

a. The Consensus Radiographic Report shall:

(1) Identify the consensus determinations reached under subsection C; and

(2) Document the application of majority and, where applicable, median rules.

b. All three independent B-reader classifications, in full and withoutn alteration, shall be included in the evidentiary record and shall be provided to the parties together with the Consensus Radiographic Report.

5. Purpose and Construction

This rule shall be construed to:

a. Promote consistency, transparency, and medical reliability;

b. Preserve the contributions of individual ILO classifications; and

c. Provide a clear, consistent, and administrable framework for resolving differences in the ILO classificationof radiographic images in pneumoconiosis cases.