B Reader Exam Overview

At a glance

To become a NIOSH-certified B Reader, physicians must pass an examination administered by the NIOSH B Reader Program. To prepare, NIOSH provides information about eligibility, a study syllabus, and scheduling. Answers to frequently asked questions (FAQs) are also available.

NIOSH BViewer workstation showing two chest x-rays.

Exam eligibility and basics

U.S. licensed physicians are eligible to take the B Reader exam. International candidates may also take the exam by special arrangement.

NIOSH and the American College of Radiology (ACR) collaborated on an updated B Reader exam. It includes 72 images and is graded on five content domains.

Five content domains

  1. Multiple choice questions for concepts relevant to ILO classification.
    1. Questions are drawn from content in the NIOSH B Reader syllabus*.
  2. Assigning a quality score to the radiograph.
  3. Determining the presence or absence of small opacities.
    1. If small opacities are present, assigning a profusion score.
  4. Identifying when large opacities are present.
  5. Identifying pleural abnormalities.
    1. Presence of pleural plaques and costophrenic angle obliteration.

*An updated syllabus will be posted soon. Some pathology images are being revised.

Scheduling

NIOSH offers the exam free of charge at 1095 Willowdale Road, Morgantown, WV. Go to 2025 B Reader Examination Dates to determine when to take the exam.

To schedule:

International physicians must contact NIOSH at least 60 days before their preferred exam date. This allows processing of all necessary U.S. Department of Homeland Security forms.

Other exam locations

The ACR offers B Reader courses and administers the exam in-person in Reston, VA. More information can be found on the ACR Education Center website.

The University of Illinois Chicago (UIC) also administers the exam in Chicago, IL. More Information can be found on the UIC Mining Education and Research Center website. Email kkenne4@uic.edu for more information about scheduling.

Currently, there are no remote options to take the B reader exam.

Preparing

NIOSH strongly encourages adequate preparation prior to taking this exam. The NIOSH B Reader syllabus* is an important resource. The syllabus intends to familiarize you with the International Classification of Radiographs of Pneumoconioses. It also explains methods used to classify radiographs of dust-exposed workers. Most importantly, it provides examples showing the presence, shape, size, and profusion of opacities used in the ILO classification.

Additional resources when using the syllabus include:

Documents describing the ILO classification system and standard chest images used are located on the ILO website. Seminars and courses are occasionally offered by NIOSH, ACR, and UIC. Look for posted announcements on the respective websites.

*An updated syllabus will be posted soon. Some pathology images are being revised.

Taking the exam and grading

Physicians are given four hours and 20 minutes to complete the exam:

  • Four hours to review and classify images.
  • 20 minutes to complete multiple choice questions.

Correct answers for classifications are based on how the ILO experts classified test images. For many test items, partial credit is assigned for classifications close to experts' findings.

Individual images may not be graded for each of the exam's domains. For example, an image may only be graded for pleural changes.

Examinees must pass all the domains to pass the overall exam. International physicians are not graded on the multiple-choice section.

Exam results

Passing

After passing the B reader exam, U.S. licensed physicians become certified B readers. International physicians are notified they have successfully completed the B reader examination.

Certification is effective for five years, starting on the date the exam was graded.

Failing

There are no limits to the number of times examinees can take the exam. However, there are time restrictions:

-If you are not a B Reader and you fail you must wait 90 days before retaking the exam.

-B Readers who are taking the exam for recertification may retake the exam once with no waiting period.

-B Readers who fail a second time must wait 90 days before retaking the exam.

Exam results will be sent by mail within one month of the exam date. Notifications will also be emailed to those who provide their email addresses.

Maintaining certification

B Readers must retest every five years to maintain their B Reader certification. Testing can be done any time within the fifth year. A reader who fails must retake and pass before the end of their five-year approval period expires to retain certification.

Readers who do not maintain certification or fail the exam can request to have their name removed from the B reader list.

FAQs

Why do applicants need to pass all five domains to pass the overall exam?

ILO classification experts believe that proficient B Readers should demonstrate expertise in each domain.

Why does the exam include an image quality domain?

ILO classification experts believe assessing image quality is a crucial part of B Reader expertise. Therefore, they chose to include it in the revised exam.

Image quality concerns were reviewed in December 2022. Program B Readers subsequently made changes to the exam's image quality domain. Overall, 88% of applicants have passed this domain when initially taking the revised exam.

Why doesn't the syllabus include more study material about the image quality domain?

Image quality is discussed in:

During development, the syllabus authors believed this information was sufficient. In response to feedback, we are reviewing the study materials to determine if more information about image quality should be included.

Can you offer the syllabus in a different format?

We have contracted with the ACR to develop a more user-friendly version. In the meantime, if you have specific issues with the syllabus, contact us at cwhsp@cdc.gov.

I think I found discrepancies in the syllabus and/or answer keys, who can I contact?

We continue to review potential problems and will make updates if needed. Please contact us at cwhsp@cdc.gov if you have questions or concerns.

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Content Source:
National Institute for Occupational Safety and Health