Diagnostic radiologists must continue to provide services as B-readers for the National Institute for Occupational Safety and Health (NIOSH), the American College of Radiology (ACR) said in a May 6 bulletin.
In recent years, NIOSH has floated the idea of extending B-reader eligibility to nonphysician practitioners (NPPs).
B-readers classify chest radiographic images of workers participating in health surveillance programs associated with occupational exposures. However, B-reading is generally not the primary revenue stream for radiology providers that perform these services.
"This significant increase in NPP scope-of-practice, if promulgated, has potential implications for other radiology-related scope-of-practice issues at the federal and state levels," stated chair of the ACR Federal Regulatory Committee (FRC) Paul Wallner, DO, and colleagues in the update.
In March 2025, the ACR issued a call to action over the matter. Instead of opening the program to NPPs, the ACR suggested that NIOSH modernize and enhance case distribution to electronically and dynamically match cases with available B-readers more efficiently; extend certification to a 10-year cycle; and adjust occupational surveillance program incentives and compensation for radiologists.
"As with all scope-of-practice issues, physicians -- and, in this instance, diagnostic radiologists, who currently comprise approximately 70% of certified B-readers -- must continue to provide this service," Wallner and colleagues stressed.
Subsequent to the public comment period for the NPP proposal, no new regulations have been promulgated, according to the ACR.
The future looks encouraging but may still be uncertain. A letter to the editor in the December 2025 edition of Chest submitted by NIOSH staff members indicated that the agency ultimately received 1,270 comments, with 79% (1,005) disapproving of expanding the program to NPPs, and that the agency would consider incorporating many of the ACR's suggestions, according to the group.
In June 2026, the onsite B-reader certification course will no longer be offered, as the ACR plans for more convenient virtual and hybrid formats.
Find the bulletin here.
![Representative example of a 16-year-old male patient with underlying X-linked adrenoleukodystrophy. (A, B) Paired anteroposterior (AP) chest radiograph and dual-energy x-ray absorptiometry (DXA) report shows lumbar spine (L1 through L4) areal bone mineral density (BMD). The DXA report was reformatted for anonymization and improved readability. The patient had low BMD (Z score ≤ −2.0). (C) Model (chest radiography [CXR]–BMD) output shows the predicted raw BMD and Z score in comparison with the DXA reference standard, together with interpretability analyses using Shapley additive explanations (SHAP) and gradient-weighted class activation maps. The patient was classified as having low BMD, consistent with the reference standard. AM = age-matched, DEXA = dual-energy x-ray absorptiometry, RM2 = room 2, SNUH = Seoul National University Hospital, YA = young adult.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/04/ai-children-bone-density.0snnf2EJjr.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
