Impact of Standardized Scheme on the Detection of Chest X-Ray Abnormalities and Radiographic Diagnosis of Pulmonary Tuberculosis in Adult (original) (raw)
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Intra-observer and overall agreement in the radiological assessment of tuberculosis
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2006
To assess the intra-observer and overall agreement in the interpretation of chest X-rays (CXRs) performed for detecting tuberculosis (TB) among immigrants in Switzerland. Four hundred digitalised CXRs from the files of immigrant registration centres were selected and read twice in random order by three readers. The readers had to assess (1) if the picture was normal or abnormal; (2) if an abnormality was suggestive of TB; and (3) if the suspicion of TB needed an immediate examination (potentially smear-positive TB). The intra-observer and overall agreements were expressed as kappa with standard error. Due to losses for technical reasons, 377 of the 400 pictures were analysed. The intra-observer agreement was 0.39-0.90 for any abnormality, and 0.60-0.82 for TB needing an urgent examination. The overall agreements were: 0.55 (all three readers) and 0.84 (two best readers) for any abnormality, and 0.64 (all three readers) and 0.80 (two best readers) for active TB. The intra-observer an...
BMC Infectious Diseases, 2012
Background: Inter-rater agreement in the interpretation of chest X-ray (CXR) films is crucial for clinical and epidemiological studies of tuberculosis. We compared the readings of CXR films used for a survey of tuberculosis between raters from two Asian countries. Methods: Of the 11,624 people enrolled in a prevalence survey in Hanoi, Viet Nam, in 2003, we studied 258 individuals whose CXR films did not exclude the possibility of active tuberculosis. Follow-up films obtained from accessible individuals in 2006 were also analyzed. Two Japanese and two Vietnamese raters read the CXR films based on a coding system proposed by Den Boon et al. and another system newly developed in this study. Interrater agreement was evaluated by kappa statistics. Marginal homogeneity was evaluated by the generalized estimating equation (GEE). Results: CXR findings suspected of tuberculosis differed between the four raters. The frequencies of infiltrates and fibrosis/scarring detected on the films significantly differed between the raters from the two countries (P < 0.0001 and P = 0.0082, respectively, by GEE). The definition of findings such as primary cavity, used in the coding systems also affected the degree of agreement. Conclusions: CXR findings were inconsistent between the raters with different backgrounds. High inter-rater agreement is a component necessary for an optimal CXR coding system, particularly in international studies. An analysis of reading results and a thorough discussion to achieve a consensus would be necessary to achieve further consistency and high quality of reading.
Chest radiographs and their reliability in the diagnosis of tuberculosis
2005
Radiology plays an important role in the diagnosis of pulmonary tuberculosis. Many medical practitioners believe in and rely primarily on the chest x-ray for the diagnosis of pulmonary tuberculosis. This study attempts to evaluate the reliability and validity of chest radiographs. This study was carried out in the tuberculosis clinic of BPKIHS. 75 radiographs were chosen for the study and viewed by 25 physicians of varying qualifications. Their findings were compared with the gold standard. The overall sensitivity and specificity was 78% and 51% respectively. There was poor agreement between the best physician and the best radiologist. This study has demonstrated an unsatisfactory sensitivity and specificity of chest x-rays in the diagnosis of pulmonary tuberculosis. The over-diagnosis and over-treatment due to chest x-rays could lead to an unmanageable burden on the resources of a poor country like Nepal. Private practitioners should be made aware about the importance of bacteriological diagnosis of tuberculosis before initiating drug therapy.
Accuracy of the chest x-ray in screening for tuberculosis in Uganda: A cross-sectional study
2020
BACKGROUND: The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be sub-optimal. CXR as a screening tool for pulmonary TB was evaluated in this study, as well as factors related to its false positive results. METHODS: A cross sectional study of 4441 records of consented/assented participants ≥15 years. Participants with a cough ≥2 weeks and/or any abnormality in the lung on CXR were included in the study. Löwenstein-Jensen (LJ) culture was used as the gold standard. The CXR were categorised as Abnormal meaning presence of any CXR abnormality suggestive of active tuberculosis. Symptoms were categorised as abnormal meaning presence of any of cough ≥ 2 weeks, fever, weightloss or night sweats. RESULTS: The CXR had sensitivity 93%, specificity 65% compared to culture results while symptoms had sensitivity ...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2013
To compare the accuracy of automated reading (CAD4TB) with the interpretation of digital chest radiograph (CXR) by clinical officers for the detection of tuberculosis (TB). D E S I G N : A retrospective analysis was performed on 161 subjects enrolled in a TB specimen bank study. CXRs were analysed using CAD4TB, which computed an image abnormality score (0-100). Four clinical officers scored the CXRs for abnormalities consistent with TB. We compared the automated readings and the readings by clinical officers against the bacteriological and radiological results used as reference. We report here the area under the receiver operating characteristic curve (AUC) and kappa (κ) statistics. R E S U LT S : Of 161 enrolled subjects, 97 had bacterio-
The International Journal of Tuberculosis and Lung Disease
Tuberculosis (TB) suspects from Rhodes Chest Clinic, Nairobi, Kenya, were subjected to three sputum smear microscopy (Ziehl-Neelsen) examinations and a chest X-ray (CXR). Results were compared with Löwenstein-Jensen culture as the gold standard to establish the efficiency of the routine diagnostic process. All laboratory tests and the CXR were available for 993 (71%) of the 1398 enrolled suspects. Of these, 554 (56%) were culture-positive. The routine diagnostic process was very sensitive, able to detect 92% of culture-positive cases but missing 8%. The specificity was low (66%), and 23% of the patients started on treatment were culturenegative, mainly due to the low specificity of the CXR. It may be possible to increase the efficiency of the diagnostic process by specifying better criteria for CXR examination, improving the quality of CXR reading and counselling patients to return when complaints persist.
IOSR Journals , 2019
Introduction-Tuberculosis is one of India major public health problems. Though it’s treatable, but still umpteen number of people are afflicted every year with high morbidity and mortality. Early diagnosis is the essence in the management of pulmonary tuberculosis to prevent further progression of disease and permanent damage by fibrosis. The objectives of our study are: 1) To evaluate spectrum of pulmonary abnormalities on HRCT in patients with suspected PTB but with both normal and abnormal chest radiograph. 2) To determine the value of HRCT in predicting disease activity in Pulmonary Tuberculosis. 3) To determine the pattern of HRCT findings in active & inactive Pulmonary Tuberculosis. Material and method This prospective study in which data has been collected from 66 suspected patients of pulmonary tuberculosis from August 2015 to November 2016 who were referred to the department of radio diagnosis, GRMC, Gwalior from department of medicine and department of chest TB for evaluation. Well informed consent was obtained and each suspected patient of pulmonary tuberculosis underwent chest X ray using MARS 50/FC/ALLPOSE, ALLENGER and HRCT using a 128-slice volume scanner (SIEMENS SOMATOM Definition AS+: 95157) and sputum smear examination for AFB. Images were assessed for pattern and distribution of lung abnormalities. Result: Male preponderance was noted with majority of them belonging to 50-59 yr of age group.Majority of patients belong to active tuberculosis with a percentage of 57.5%(56+1.5%),next was relapsing tuberculosis.Final diagnosis of active tuberculosis correlates well with sputum examination which was 100% accurate.X RAY chest diagnosed active TB in 22 cases and all were AFB positive on sputum examination.Sputum smear examination is investigation of choice for diagnosis of TB,but the sensitivity is low .HRCT is helpful in differentiating active vs inactive TB better than plain chest radiograph and recognizing extent of pulmonary TB. Conclusion: HRCT can be beneficial in certain cases, imparting crucial information for the diagnosis and management of the disease. HRCT is advocated if tuberculosis is suspected clinically and the chest X-ray findings are normal or inconclusive; for authentication of diagnosis and discernment of activity