BACKGROUND: Chest radiographs (CXRs) are used in tuberculosis (TB) prevalence surveys to identify participants for bacteriological examination. Expert readers are rare in most African countries. In our survey, clinical officers scored CXRs of 19 216 participants once. We assessed to what extent missed CXR abnormalities affected our TB prevalence estimate. METHODS: Two experts, a radiologist and pulmonologist, independently reviewed 1031 randomly selected CXRs, mixed with lms of confirmed TB cases. CXRs with disagreement on 'any abnormality' or 'abnormality consistent with TB' were jointly reviewed during a consensus panel. We compared the nal expert and clinical of cer classifications with bacteriologically confirmed TB as the gold standard. RESULTS: After the panel, 199 (19%) randomly selected CXRs were considered abnormal by both expert reviewers and another 82 (8%) by one reviewer. Agreement was good among the experts (κ 0.78, 95%CI 0.73-0.82) and moderate between the clinical officers and experts (κ range 0.50-0.62). The sensitivity of 'any abnormality' was 95% for the clinical officers and 83% and 81% for the respective experts. The specificities were respectively 73%, 74% and 80%. TB prevalence was underestimated by 1.5-5.0%. CONCLUSIONS: Acceptable CXR screening can be achieved with clinical officers. Reviewing a sample of CXRs by two experts allows an assessment of prevalence underestimation.
BACKGROUND: Chest radiographs (CXRs) are used in tuberculosis (TB) prevalence surveys to identify participants for bacteriological examination. Expert readers are rare in most African countries. In our survey, clinical officers scored CXRs of 19 216 participants once. We assessed to what extent missed CXR abnormalities affected our TB prevalence estimate. METHODS: Two experts, a radiologist and pulmonologist, independently reviewed 1031 randomly selected CXRs, mixed with lms of confirmed TB cases. CXRs with disagreement on 'any abnormality' or 'abnormality consistent with TB' were jointly reviewed during a consensus panel. We compared the nal expert and clinical of cer classifications with bacteriologically confirmed TB as the gold standard. RESULTS: After the panel, 199 (19%) randomly selected CXRs were considered abnormal by both expert reviewers and another 82 (8%) by one reviewer. Agreement was good among the experts (κ 0.78, 95%CI 0.73-0.82) and moderate between the clinical officers and experts (κ range 0.50-0.62). The sensitivity of 'any abnormality' was 95% for the clinical officers and 83% and 81% for the respective experts. The specificities were respectively 73%, 74% and 80%. TB prevalence was underestimated by 1.5-5.0%. CONCLUSIONS: Acceptable CXR screening can be achieved with clinical officers. Reviewing a sample of CXRs by two experts allows an assessment of prevalence underestimation.
Authors: Leonardo Martinez; Lin Xu; Cheng Chen; Juliet N Sekandi; Yongzhong Zhu; Changsheng Zhang; Christopher C Whalen; Limei Zhu Journal: Am J Trop Med Hyg Date: 2017-02-13 Impact factor: 2.345
Authors: Catriona J Waitt; Elizabeth C Joekes; Natasha Jesudason; Peter I Waitt; Patrick Goodson; Ganizani Likumbo; Samuel Kampondeni; E Brian Faragher; S Bertel Squire Journal: Eur Radiol Date: 2013-05-08 Impact factor: 5.315
Authors: Anna H van't Hoog; Helen K Meme; Kayla F Laserson; Janet A Agaya; Benson G Muchiri; Willie A Githui; Lazarus O Odeny; Barbara J Marston; Martien W Borgdorff Journal: PLoS One Date: 2012-07-06 Impact factor: 3.240
Authors: Anna H van't Hoog; Frank Cobelens; Anna Vassall; Sanne van Kampen; Susan E Dorman; David Alland; Jerrold Ellner Journal: PLoS One Date: 2013-12-18 Impact factor: 3.240