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Free Content Chest radiograph reading and recording system: evaluation for tuberculosis screening in patients with advanced HIV

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SETTING: An antiretroviral treatment (ART) service in Gugulethu township, Cape Town, South Africa.

OBJECTIVE: To assess the inter-observer agreement when using the chest radiographic reading and reporting system (CRRS) to detect radiographic abnormalities in patients with advanced human immunodeficiency virus (HIV) associated immunodeficiency being actively screened for tuberculosis (TB). Second, to assess the associated performance characteristics of radiology as a routine screening test for detection of culture-confirmed pulmonary TB.

DESIGN: Radiographs from a study in which patients were actively screened for TB just before starting ART were independently reported by two CRRS-certified readers blinded to clinical status.

RESULTS: Good kappa statistic agreements between observers were found when reporting any radiological abnormality consistent with TB among all patients (n = 203, κ = 0.63, 95%CI 0.52–0.73) and among those with culture-confirmed TB (n = 53,  = 0.61, 95%CI 0.40–0.83). However, in comparison with sputum culture, the sensitivity (0.68, 95%CI 0.54–0.79) and specificity (0.53, 95%CI 0.45–0.61) of radiology in this patient group were low.

CONCLUSION: This study provides evidence of the good inter-observer agreement using the CRRS standardised reporting methodology when used among patients with advanced HIV-associated immunodeficiency and a high prevalence of culture-proven pulmonary TB. The utility of radiology as a screening test for TB in this patient group, however, remains limited.
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Keywords: CRRS; HIV; antiretroviral; radiology; screening; tuberculosis

Document Type: Regular Paper

Affiliations: 1: University of Cape Town Lung Institute, Division of Pulmonology & E16 Respiratory Clinic, Groote Schuur Hospital, Cape Town, South Africa 2: Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Publication date: January 1, 2010

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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