Yield of interview screening and chest X-ray abnormalities in a tuberculosis prevalence survey

BackgroundThe prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey.MethodsWe reviewed a random sample of 1140 adult (≥15 years) CXRs classified as ‘abnormal, suggestive of TB’ or ‘abnormal other’ during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated.FindingsCardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.InterpretationBased on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts.FundingNational Institute for Health Research (IMPALA-grant reference 16/136/35).

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Accuracy of computer-aided chest X-ray screening in the Kenya National Tuberculosis Prevalence Survey

10.1101/2021.10.21.21265321 ◽

2021 ◽

Author(s):

Brenda Mungai ◽

Jane Ong'ang'o ◽

Chu Chang Ku ◽

Marc YR Henrion ◽

Ben Morton ◽

...

Keyword(s):

Latent Class ◽

Latent Class Model ◽

Screening Methods ◽

Community Based ◽

Prevalence Survey ◽

Pulmonary Tb ◽

X Ray ◽

Computer Aided ◽

Chest X Ray ◽

Participant Characteristics

Background: Community–based screening for tuberculosis (TB) could improve detection but is resource intensive. We set out to evaluate the accuracy of computer–aided TB screening using digital chest X-ray (CXR) to determine if this approach met target product profiles (TPP) for community–based screening. Methods: CXR images from participants in the 2016 Kenya National TB Prevalence Survey were evaluated using CAD4TBv6 (Delft Imaging), giving a probabilistic score for pulmonary TB ranging from 0 (low probability) to 99 (high probability). We constructed a Bayesian latent class model to estimate the accuracy of CAD4TBv6 screening compared to bacteriologically–confirmed TB across CAD4TBv6 threshold cut–offs, incorporating data on Clinical Officer CXR interpretation, participant demographics (age, sex, TB symptoms, previous TB history), and sputum results. We compared model–estimated sensitivity and specificity of CAD4TBv6 to optimum and minimum TPPs. Results: Of 63,050 prevalence survey participants, 61,848 (98%) had analysable CXR images, and 8,966 (14.5%) underwent sputum bacteriological testing; 298 had bacteriologically–confirmed pulmonary TB. Median CAD4TBv6 scores for participants with bacteriologically–confirmed TB were significantly higher (72, IQR: 58–82.75) compared to participants with bacteriologically–negative sputum results (49, IQR: 44–57, p<0.0001). CAD4TBv6 met the optimum TPP; with the threshold set to achieve a mean sensitivity of 95% (optimum TPP), specificity was 83.3%, (95% credible interval [CrI]: 83.0%–83.7%, CAD4TBv6 threshold: 55). There was considerable variation in accuracy by participant characteristics, with older individuals and those with previous TB having lowest specificity. Conclusions: CAD4TBv6 met the optimal TPP for TB community screening. To optimise screening accuracy and efficiency of confirmatory sputum testing, we recommend that an adaptive approach to threshold setting is adopted based on participant characteristics.

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Model Helps Reduce Chest X-Ray Usage

Pediatric News ◽

10.1016/s0031-398x(05)70569-5 ◽

2005 ◽

Vol 39 (9) ◽

pp. 26

Keyword(s):

X Ray ◽

Chest X Ray

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Comment on Adar et al, page 106 - 114 Calcifications in the aortic arch on chest x-ray - Incidental finding or valuable surrogate marker for cardiovascular risk?

VASA ◽

10.1024/0301-1526/a000412 ◽

2015 ◽

Vol 44 (2) ◽

pp. 83-84

Author(s):

Sasan Partovi ◽

Daniel Staub

Keyword(s):

Cardiovascular Risk ◽

Aortic Arch ◽

Incidental Finding ◽

Surrogate Marker ◽

X Ray ◽

Chest X Ray

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Tuberculosis: Diagnostic Challenges in Rural Africa

Praxis ◽

10.1024/1661-8157/a003355 ◽

2019 ◽

Vol 108 (15) ◽

pp. 991-996

Author(s):

Ngisi Masawa ◽

Farida Bani ◽

Robert Ndege

Keyword(s):

Extrapulmonary Tuberculosis ◽

X Ray ◽

Molecular Tests ◽

Rural Settings ◽

Chest X Ray ◽

Screening Questions ◽

Rural Africa ◽

Tb Diagnostics ◽

Strip Test ◽

Urine Strip

Abstract. Tuberculosis (TB) remains among the top 10 infectious diseases with highest mortality globally since the 1990s despite effective chemotherapy. Among 10 million patients that fell ill with tuberculosis in the year 2017, 36 % were undiagnosed or detected and not reported; the number goes as high as 55 % in Tanzania, showing that the diagnosis of TB is a big challenge in the developing countries. There have been great advancements in TB diagnostics with introduction of the molecular tests such as Xpert MTB/RIF, loop-mediated isothermal amplification, lipoarabinomannan urine strip test, and molecular line-probe assays. However, most of the hospitals in Tanzania still rely on the TB score chart in children, the WHO screening questions in adults, acid-fast bacilli and chest x-ray for the diagnosis of TB. Xpert MTB/RIF has been rolled-out but remains a challenge in settings where the samples for testing must be transported over many kilometers. Imaging by sonography – nowadays widely available even in rural settings of Tanzania – has been shown to be a useful tool in the diagnosis of extrapulmonary tuberculosis. Despite all the efforts and new diagnostics, 30–50 % of patients in high-burden TB countries are still empirically treated for tuberculosis. More efforts need to be placed if we are to reduce the death toll by 90 % until 2030.

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Lingual Dystonia Treated with Botulinum Toxin - A Case Report

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v24i2.152 ◽

1970 ◽

Vol 24 (2) ◽

pp. 75-78

Author(s):

MA Hayee ◽

QD Mohammad ◽

H Rahman ◽

M Hakim ◽

SM Kibria

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin A ◽

Botulinum Toxin Type A ◽

Botulinum Toxin Type ◽

X Ray ◽

Medical College ◽

Lingual Dystonia ◽

History Of ◽

Chest X Ray

A 42-year-old female presented in Neurology Department of Sir Salimullah Medical College with gradually worsening difficulty in talking and eating for the last four months. Examination revealed dystonic tongue, macerated lips due to continuous drooling of saliva and aspirated lungs. She had no history of taking antiparkinsonian, neuroleptics or any other drugs causing dystonia. Chest X-ray revealed aspiration pneumonia corrected later by antibiotics. She was treated with botulinum toxin type-A. Twenty units of toxin was injected in six sites of the tongue. The dystonic tongue became normal by 24 hours. Subsequent 16 weeks follow up showed very good result and the patient now can talk and eat normally. (J Bangladesh Coll Phys Surg 2006; 24: 75-78)

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Hubungan antara Luas Lesi pada Foto Toraks Penderita TB Paru Dewasa yang Memiliki Riwayat Diabetes Melitus dengan Indeks Massa Tubuh di Rumah Sakit Hasan Sadikin Bandung

Jurnal Radiologi Indonesia ◽

10.33748/jradidn.v1i3.18 ◽

2016 ◽

Vol 1 (3) ◽

pp. 138-144

Author(s):

Ina Edwina ◽

Rista D Soetikno ◽

Irma H Hikmat

Keyword(s):

Chest Radiograph ◽

Chi Square ◽

Pulmonary Tb ◽

X Ray ◽

Consecutive Sampling ◽

Close Relationship ◽

Chi Square Test ◽

Chest X Ray ◽

The Relationship ◽

Diabetes Melitus

Background: Tuberculosis (TB) and diabetes mellitus (DM) prevalence rates are increasing rapidly, especially in developing countries like Indonesia. There is a relationship between TB and DM that are very prominent, which is the prevalence of pulmonary TB with DM increased by 20 times compared with pulmonary TB without diabetes. Chest X-ray picture of TB patients with DM is atypical lesion. However, there are contradictories of pulmonary TB lesion on chest radiograph of DM patients. Nutritional status has a close relationship with the morbidity of DM, as well as TB.Objectives: The purpose of this study was to determine the relationship between the lesions of TB on the chest radiograph of patients who su?er from DM with their Body Mass Index (BMI) in Hasan Sadikin Hospital Bandung.Material and Methods: The study was conducted in Department of Radiology RSHS Bandung between October 2014 - February 2015. We did a consecutive sampling of chest radiograph and IMT of DM patients with clinical diagnosis of TB, then the data was analysed by Chi Square test to determine the relationship between degree of lesions on chest radiograph of pulmonary TB on patients who have DM with their BMI.Results: The results showed that adult patients with active pulmonary TB with DM mostly in the range of age 51-70 years old, equal to 62.22%, with the highest gender in men, equal to 60%. Chest radiograph of TB in patients with DM are mostly seen in people who are obese, which is 40% and the vast majority of lesions are minimal lesions that is equal to 40%.Conclusions: There is a signifcant association between pulmonary TB lesion degree with BMI, with p = 0.03

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