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Chest radiographs during isoniazid therapy

W C Bailey, C A Sellers, S O Lantz

The American Review of Respiratory Disease

|May 1, 1977

Summary

Routine chest X-rays for tuberculin reactors undergoing isoniazid therapy offer little value. Repeat imaging showed no significant changes, leading to a policy change to avoid unnecessary radiation and costs.

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Area of Science:

Public Health
Infectious Disease Epidemiology
Radiology

Background:

Tuberculin reactors often undergo serial chest radiographs during isoniazid preventive therapy (IPT).
The clinical utility of these serial radiographs, particularly normal ones, has been questioned.
Previous studies suggested limited value in repeat imaging for IPT patients.

Purpose of the Study:

To evaluate the diagnostic value of serial chest radiographs in individuals receiving isoniazid preventive therapy.
To determine if repeat chest radiographs provide significant information beyond baseline imaging for tuberculin reactors.

Main Methods:

A study involving 1,524 tuberculin reactors was conducted.
Chest radiographs were assessed at the start, during, and at the end of isoniazid therapy.
Radiographic changes were analyzed in patients with normal and abnormal baseline findings.

Main Results:

No significant changes were observed in chest radiographs of 1,524 patients throughout their isoniazid therapy.
In a combined analysis with a prior study (551 reactors), 2,075 patients showed no value from repeat radiographs.
Specifically, normal chest radiographs remained normal, and abnormal ones showed no significant interval changes.

Conclusions:

Repeating normal chest radiographs for tuberculin reactors who completed at least 9 months of isoniazid preventive therapy provides no additional diagnostic value.
The cost and potential risks of radiation from repeat radiographs outweigh their limited benefit.
A revised policy now avoids repeating normal chest radiographs in this patient population.

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