Objective A systematic review of studies published in Chinese journals reporting deviation in pneumoconiosis diagnosis was conducted, to explore the main reasons and to improve diagnostic quality in the future.

Methods The original articles related to pneumoconiosis diagnosis published in Chinese journals during the period from Jan 1, 1991 to Dec 31, 2018 in the various database were searched and selected by defined evaluation index, and reviewed systematically.

Results A total of 16 appropriate articles were found from 331 articles, and the study time varied from 1991 to 2014. Most studies were that experts from superior diagnostic institutions re-read the chest X-ray films that have been diagnosed with pneumoconiosis by the sampled diagnostic institutions, some were re-read by diagnostic professionals themselves, and the results of the two readings were compared and analyzed. The analysis indicators included the pneumoconiosis stage, the form of small shadows, the intensity, the density of small shadows in each lung area, clustering of small shadows or large shadow, and pleural lesions. The consistent rate was the major evaluation indicator. The consistent rate of two times reading by the group reading (85.9%-94.0%) was higher than individual reading (15%-64%). The consistent rate of diagnosis made by group members varied 40.0%-84.2% and mostly higher than 60%. The major factors affecting the consistency included the professional level of diagnostic experts (e.g., professional title and specialty), the quality of radiograph, and the typical characteristics (e.g., shape of small shadows, intensity and density in each lung area).

Conclusion The deviation in diagnosis of pneumoconiosis always exist, regardless of group reading or individual reading. The necessary training should be taken to ensure the quality of diagnosis.