Screening for pulmonary tuberculosis in a Tanzanian prison and computer-aided interpretation of chest X-rays

• Published in: Public health action Vol. 5; no. 4; pp. 249 - 254
• Main Authors: Steiner, A., Mangu, C., van den Hombergh, J., van Deutekom, H., van Ginneken, B., Clowes, P., Mhimbira, F., Mfinanga, S., Rachow, A., Reither, K., Hoelscher, M.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 21.12.2015
• Subjects: Chest X-Ray; Computer-Aided Diagnosis; Original; Tuberculosis; chest X-ray; computer-aided diagnosis; tuberculosis
• ISSN: 2220-8372; 2220-8372
• DOI: 10.5588/pha.15.0037

Setting: Tanzania is a high-burden country for tuberculosis (TB), and prisoners are a high-risk group that should be screened actively, as recommended by the World Health Organization. Screening algorithms, starting with chest X-rays (CXRs), can detect asymptomatic cases, but depend on experienced readers, who are scarce in the penitentiary setting. Recent studies with patients seeking health care for TB-related symptoms showed good diagnostic performance of the computer software CAD4TB.Objective: To assess the potential of computer-assisted screening using CAD4TB in a predominantly asymptomatic prison population.Design: Cross-sectional study.Results: CAD4TB and seven health care professionals reading CXRs in local tuberculosis wards evaluated a set of 511 CXRs from the Ukonga prison in Dar es Salaam. Performance was compared using a radiological reference. Two readers performed significantly better than CAD4TB, three were comparable, and two performed significantly worse (area under the curve 0.75 in receiver operating characteristics analysis). On a superset of 1321 CXRs, CAD4TB successfully interpreted >99%, with a predictably short time to detection, while 160 (12.2%) reports were delayed by over 24 h with conventional CXR reading.Conclusion: CAD4TB reliably evaluates CXRs from a mostly asymptomatic prison population, with a diagnostic performance inferior to that of expert readers but comparable to local readers.