Incremental value of oblique chest radiographs in the diagnosis of asbestos-induced pleural disease.

To assess the value of oblique chest radiographs in the diagnosis of asbestos-related pleural disease, we identified 100 asbestos-exposed construction workers and provided separate interpretations of the postero-anterior (PA), left anterior oblique (LAO), and right anterior oblique (RAO) projections using the International Labour Office (ILO) system. We found that the LAO projection identified left-sided pleural thickening more effectively than the PA view and the RAO view improved diagnosis of right-sided disease comparably. Of 62 cases of bilateral pleural thickening, only 43 (68%) were diagnosed by the PA projection alone. The increased diagnostic efficiency of approximately 50% in identifying bilateral pleural thickening appears to justify the routine use of oblique chest films in screening asbestos-exposed populations. Since bilateral pleural thickening among asbestos-exposed workers is an indicator of significant asbestos exposure and increased risk of other asbestos-induced conditions, early detection of this abnormality can lead to interventions designed to reduce asbestos-related morbidity and mortality.