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Digital Chest X-Ray with Computer-aided Detection for Tuberculosis Screening within Correctional Facilities.

Kavindhran Velen1, Farzana Sathar1, Christopher J Hoffmann2

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Annals of the American Thoracic Society
|December 16, 2021
PubMed
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Digital chest X-ray (d-CXR) with computer-aided detection (CAD) significantly improved tuberculosis (TB) case finding in South African inmates. Adding d-CXR doubled the detection of undiagnosed TB compared to symptom screening alone.

Keywords:
GeneXpert MTB/RIF Ultracorrectional facilitiesmass screeningprisonstuberculosis

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Area of Science:

  • Public Health
  • Infectious Diseases
  • Radiology

Background:

  • The Global Plan to End Tuberculosis (TB) necessitates improved case-finding in key populations, including inmates.
  • Optimizing screening approaches is crucial for reaching at least 90% of individuals in high-risk groups.

Purpose of the Study:

  • To assess the added value of digital chest X-ray (d-CXR) with computer-aided detection (CAD) to symptom-based screening for TB detection among inmates.
  • To evaluate the impact of d-CXR and CAD on TB yield in a correctional facility setting.

Main Methods:

  • A study involving 3,576 adult inmates in South African correctional facilities.
  • Screening included symptom assessment and d-CXR with CAD. Individuals with symptoms or CAD score ≥50 provided sputum for GeneXpert MTB/RIF Ultra (Xpert Ultra) and liquid culture.
  • An additional 800 symptom-negative inmates with CAD score <50 also underwent Xpert Ultra testing.

Main Results:

  • 28 new TB cases were diagnosed (7.8 per 1,000 population).
  • Symptom-based screening alone would have yielded 3.6 per 1,000 population, while d-CXR alone would have yielded 7.0 per 1,000 population.
  • The addition of d-CXR identified twice as many undiagnosed TB cases compared to symptom screening alone.

Conclusions:

  • Digital chest X-ray (d-CXR) with computer-aided detection (CAD) significantly enhances TB case finding in correctional facilities.
  • Combining d-CXR with symptom screening can overcome the limitations of subjective symptom assessment.
  • This integrated approach holds promise for improving TB control in vulnerable inmate populations.