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Early detection of the disease, by routine standard chest X-ray, is one of the essential measures for secondary prevention. ILO has provided the guideline for radiographs reading for pneumoconioses according to the ILO classification to support the medical screening test and clinical purposes. The aim of this article is to describe the history and concept of the AIR Pneumo.Asian Intensive Reader of Pneumoconioses (AIR Pneumo) is a quality assurance program to train and certify physicians who works for prevention of pneumoconises, which is one of the major occupational health problems worldwide. The system is useful for epidemiological research, screening and surveillance of high-risk workers, diagnosis and compensation. Because of variability of reading by physicians, some organisation, e.g., US NIOSH, has developed the certification testing, called B –reader.Since its first Bangkok workshop in 2006, AIR Pneumo has conducted 17 workshops 6 times in Thailand, 4 times in Brazil, twice in Japan, and one in each in Philippines and India. As Bangkok workshops invited international participants, most of physicians from ASEAN countries and D.R. Congo has attended the workshops.The classification system holds its uniqueness in possessing standard radiographs that show profusion 0 to 3 for each types of small opacities, large opacities and pleural abnormalities. By using standard radiograph side-by-side to the subject radiographs that physicians are reading and classifying, higher inter reader agreement can be achieved. Understanding and using the classification properly demands certain amount of training. In accordance with WHO/ILO Global Programme for Elimination of Silicosis, ILO has been encouraging GPES participating nations to educate physicians to increase proficiency of reading radiographs of pneumoconioses. The AIR Pneumo, an academia based quality assurance of physicians proficiency in reading pneumoconiosis radiographs is sustainable approach with active involvement of local experts in GPES participant nations.