Automated chest radiography and mass systematic screening for tuberculosis

Madhani, Falak; Maniar, R; Burfat, Aziza; Ahmed, M. A.; Farooq, Saira; Sabir, Aamir Bin; Domki, Abdul Khalique; Page-Shipp, Liesl; Khowaja, Saira; Safdar, Nauman; Khan, Aamir; Khan, Palwasha

doi:10.5588/ijtld.19.0501

Cited by 24 publications

(23 citation statements)

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“…The threshold of 70 was chosen, in accordance with rational use of GeneXpert cartridges. 3 Data management and analysis: The CAD4TB data was stored in a password protected software for patient confidentiality. The individuals referred to the TB center for Gene-Xpert analysis were registered online and allocated a unique patient ID.…”

Section: Study Design and Selection Of Input Data: This Screening Study Was Conducted By Radiology Department Medical Teaching Institute mentioning

confidence: 99%

“…2 In 2016, as part of the ambitious ZERO TB drive, a private organization Indus Health Network initiated screening for early diagnosis of TB nationally by using mobile X-ray unit equipped with computer aided detection for tuberculosis (CAD4TB) software as a screening tool prior to laboratory testing. 3 Pulmonary Tuberculosis is frequently diagnosed on clinical and radiological findings. 4 TB screening for active case finding is an essential tool towards developing high quality TB control services.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of computer aided reading of chest x-ray in screening for pulmonary tuberculosis in comparison with Gene-Xpert

Nishtar¹,

Burki²,

Ahmad³

et al. 2021

Pak J Med Sci

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Background & Objectives: Pakistan ranked fifth amongst 22 high-burden Tuberculosis countries, and it is an epidemic in Pakistan, hence screening is performed nationally, as part of the ambitious ZERO TB drive. Our objective was to assess the diagnostic accuracy of Computer Aided Detection (CAD4TB) software on chest Xray in screening for pulmonary tuberculosis in comparison with gene-Xpert. Methods: The study was conducted by Radiology Department Lady Reading Hospital Peshawar in affiliation with Indus Hospital network over a period of one year. Screening was done by using mobile Xray unit equipped with CAD4TB software with scoring system. All of those having score of more than 70 and few selected cases with strong clinical suspicion but score of less than 70 were referred to dedicated TB clinic for Gene-Xpert analysis. Results: Among 26,997 individuals screened, 2617 (9.7%) individuals were found presumptive for pulmonary TB. Sputum samples for Gene-Xpert were obtained in 2100 (80.24%) individuals, out of which 1825 (86.9%) were presumptive for pulmonary TB on CAD4TB only. Gene-Xpert was positive in 159 (8.7%) patients and negative in 1,666(91.3%). Sensitivity and specificity of CAD4TB and symptomatology with threshold score of ≥70 was 83.2% and 12.7% respectively keeping Gene-Xpert as gold standard. Conclusion: Combination of chest X-ray analysis by CAD4TB and symptomatology is of immense value to screen a large population at risk in a developing high burden country. It is significantly a more effective tool for screening and early diagnosis of TB in individuals, who would otherwise go undiagnosed. Abbreviations: TB = Tuberculosis, WHO = World Health Organization, CAD4TB = Computer aided detection for tuberculosis, CXR = Chest X-Ray, CAR = Computer aided reading. doi: https://doi.org/10.12669/pjms.38.1.4531 How to cite this:Nishtar T, Burki S, Ahmad FS, Ahmad T. Diagnostic accuracy of computer aided reading of chest x-ray in screening for pulmonary tuberculosis in comparison with Gene-Xpert. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4531 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Study Design and Selection Of Input Data: This Screening Study Was Conducted By Radiology Department Medical Teaching Institute mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of computer aided reading of chest x-ray in screening for pulmonary tuberculosis in comparison with Gene-Xpert

Nishtar¹,

Burki²,

Ahmad³

et al. 2021

Pak J Med Sci

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“…5 In the 1930s-1960s, mobile X-ray units were an integral part of TB programmes in industrialised countries. 6 7 In the past decade, some middle-income countries in Asia have incorporated mobile X-ray units for active case finding into their TB programmes, [8][9][10][11] and other countries have used mobile X-ray units in prevalence surveys and pilot projects. However, this strategy is not yet used widely in countries with high TB burdens.…”

Section: Introductionmentioning

confidence: 99%

Identifying barriers and facilitators to implementation of community-based tuberculosis active case finding with mobile X-ray units in Lima, Peru: a RE-AIM evaluation

et al. 2021

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ObjectivesIdentify barriers and facilitators to integrating community tuberculosis screening with mobile X-ray units into a health system.MethodsReach, effectiveness, adoption, implementation and maintenance evaluation.Setting3-district region of Lima, Peru.Participants63 899 people attended the mobile units from 7 February 2019 to 6 February 2020.InterventionsParticipants were screened by chest radiography, which was scored for abnormality by computer-aided detection. People with abnormal X-rays were evaluated clinically and by GeneXpert MTB/RIF (Xpert) sputum testing. People diagnosed with tuberculosis at the mobile unit were accompanied to health facilities for treatment initiation.Primary and secondary outcome measuresReach was defined as the percentage of the population of the three-district region that attended the mobile units. Effectiveness was defined as the change in tuberculosis case notifications over a historical baseline. Key implementation fidelity indicators were the percentages of people who had chest radiography performed, were evaluated clinically, had sputum samples collected, had valid Xpert results and initiated treatment.ResultsThe intervention reached 6% of the target population and was associated with an 11% (95% CI 6 to 16) increase in quarterly case notifications, adjusting for the increasing trend in notifications over the previous 3 years. Implementation indicators for screening, sputum collection and Xpert testing procedures all exceeded 85%. Only 82% of people diagnosed with tuberculosis at the mobile units received treatment; people with negative or trace Xpert results were less likely to receive treatment. Suboptimal treatment initiation was driven by health facility doctors’ lack of familiarity with Xpert and lack of confidence in diagnoses made at the mobile unit.ConclusionMobile X-ray units were a feasible and effective strategy to extend tuberculosis diagnostic services into communities and improve early case detection. Effective deployment however requires advance coordination among stakeholders and targeted provider training to ensure that people diagnosed with tuberculosis by new modalities receive prompt treatment.

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“…If prolonged cough had been used as the only positive screening criterion, just 31.6% the people diagnosed with TB by the initiative would have been detected. In Pakistan, a fleet of mobile X-ray trucks were used to screen over 127,000 people in the community and also those visiting hospital outpatient departments [14]. Just 45.0% of the people screened by CXR reported a prolonged cough.…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

Nguyen

Codlin²,

Vo³

et al. 2020

TropicalMed

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Across Asia, a large proportion of people with tuberculosis (TB) do not report symptoms, have mild symptoms or only experience symptoms for a short duration. These individuals may not seek care at health facilities or may be missed by symptom screening, resulting in sustained TB transmission in the community. We evaluated the yields of TB from 114 days of community-based, mobile chest X-ray (CXR) screening. The yields at each step of the TB screening cascade were tabulated and we compared cohorts of participants who reported having a prolonged cough and those reporting no cough or one of short duration. We estimated the marginal yields of TB using different diagnostic algorithms and calculated the relative diagnostic costs and cost per case for each algorithm. A total of 34,529 participants were screened by CXR, detecting 256 people with Xpert-positive TB. Only 50% of those diagnosed with TB were detected among participants reporting a prolonged cough. The study’s screening algorithm detected almost 4 times as much TB as the National TB Program’s standard diagnostic algorithm. Community-based, mobile chest X-ray screening can be a high yielding strategy which is able to identify people with TB who would likely otherwise have been missed by existing health services.

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Automated chest radiography and mass systematic screening for tuberculosis

Cited by 24 publications

References 0 publications

Diagnostic accuracy of computer aided reading of chest x-ray in screening for pulmonary tuberculosis in comparison with Gene-Xpert

Diagnostic accuracy of computer aided reading of chest x-ray in screening for pulmonary tuberculosis in comparison with Gene-Xpert

Identifying barriers and facilitators to implementation of community-based tuberculosis active case finding with mobile X-ray units in Lima, Peru: a RE-AIM evaluation

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

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