The purpose of this commentary is to bring the neglected phenomenon of subradiological silicosis and its implications to the attention of readers. We define subradiological silicosis as silicosis detectable on pathological examination of lung tissue but not visible radiologically. For extent of the phenomenon, we draw on a study using a large South African autopsy database of deceased miners and chest radiographs taken in life. At an International Labour Organization threshold of >1/0 only 43% of all pathologically detected cases were detected on chest radiograph, and only 62% of those classified on pathology as "moderate or marked" silicosis. Subradiological silicosis has a number of implications for research and practice: for dose-response studies of silicosis; for studies of the relationship between silica and conditions such as tuberculosis, lung cancer, and autoimmune disease, including the mechanistic role of fibrogenesis; for prognostication in silica exposed workers; and for workers' compensation criteria.
Keywords: South Africa; autopsy; pathology; radiology; silicosis.
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