Should Nurse Practitioners Read X-Rays?

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By G Hatfield

Nurse practitioners’ (NP) scope of practice will potentially be expanded once again as the Centers for Disease Control and Prevention (CDC) considers allowing NPs to try their hand at reading a specific type of X-ray.

The CDC’s National Institute for Occupational Safety and Health (NIOSH) submitted a request for information regarding the B Reader Program from interested parties to determine whether they should allow nurse practitioners and physician assistants (PAs) to become B Readers.

The goal is to grant nurse practitioners and physician assistants eligibility to take and pass the NIOSH B Reader exam and become certified B Readers. According to the information request, the interested parties include experts in occupational respiratory health surveillance and radiology, nurse practitioners, physician assistants, and workers unions who represent workers exposed to mineral dust, and/or the workers themselves.

What is a B Reader?

According to NIOSH, the B Reader program “trains and certifies physicians in the International Labour Organization (ILO) International Classification of Radiographs of Pneumoconiosis.” In simpler terms, B Readers classify chest radiographs of employees participating in health surveillance programs, such as the NIOSH Coal Worker’s Health Surveillance Program.

The CDC’s goal is to increase access to B Readers across the country.

“NIOSH is interested in ensuring that B Readers are available to classify chest radiographs obtained in all states and territories,” the information request says.

What does NIOSH want to know?

NIOSH specifically is inquiring about the following questions from the interested parties, according to the information request:

  1. What is the current demand for B Readers, and would expanding the program to include nurse practitioners and physician assistants help meet this demand?
  2. Are there specific geographic areas or populations that might benefit from having nurse practitioners and physician assistants certified as B Readers?
  3. Are there any potential risks associated with expanding the B Reader certification to nurse practitioners and physician assistants and, if so, how can those risks be mitigated?
  4. ILO classification of chest radiographs is not the same as clinical interpretation. Are there states where scope of practice and standards of care allow nurse practitioners and physician assistants to perform clinical interpretation of chest radiographs without physician oversight? In states where physician oversight is required for clinical interpretation, is it also required for ILO classification? What would be the best approach to ensuring that appropriate clinical interpretations are obtained for all contemporary chest radiographs undergoing ILO classification by nurse practitioners and physician assistants?
  5. How do you anticipate different interested parties (e.g., physicians, nurse practitioners and physician assistants, industry representatives, workers, health profession boards) would view the potential expansion of the B Reader program to include non-physicians?
  6. What challenges might arise during the implementation of this expansion, and how could they be effectively managed?
  7. Do you have any other information or comments relevant to whether nurse practitioners and physician assistants should be able to become B Readers and, if so, the best way to implement that expansion?

The request’s comment period ends March 17, 2025.

If nurse practitioners become eligible to take the B Reader exam and become licensed B Readers once they pass, that will once again expand the role that nurse practitioners play in care delivery.

According to a 2024 report from the Association of American Medical Colleges (AAMC), the United States will face a shortage of 86,000 physicians by 2036. An increase in nurse practitioners and physician assistants will help fill that gap.

There are over 385,000 nurse practitioners across the country, according to the American Association of Nurse Practitioners (AANP). If all of them have the potential to get B Reader certified, that will be a significant step toward NIOSH’s goal of expanding access.

G Hatfield is the CNO editor for HealthLeaders.