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Free Content Automatic versus human reading of chest X-rays in the Zambia National Tuberculosis Prevalence Survey

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SETTING: Tuberculosis (TB) prevalence survey in Zambia between 2013 and 2014.

OBJECTIVE: To compare the performance of automatic software (CAD4TB 5) in chest X-ray (CXR) reading with that of field (general practitioners) and central (radiologists) readers.

DESIGN: A retrospective study comparing the performance of human and automatic reading was conducted. Two scenarios for central reading were evaluated: abnormalities not consistent with TB were considered to be ‘normal' or ‘abnormal'. Sputum culture was defined as the reference standard. Measures derived from receiver operating characteristic analysis were used to assess readers' performances.

RESULTS: Of 46 099 participants, 23 838 cases included all survey information; of these, 106 cases were culture-confirmed TB-positive. The performance of CAD4TB 5 was similar to that of field and central readers. Although there were significant differences in specificity when compared with field readings (P = 0.002) and central readings considering the first scenario (P < 0.001), these differences were not substantial (93.2% vs. 92.6% and 98.4% vs. 99.6%, respectively).

CONCLUSIONp: The performance of automatic CXR readings is comparable with that of human experts in a TB prevalence survey setting using culture as reference.
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Keywords: TB; automatic chest radiograph reading; prevalence survey

Document Type: Research Article

Affiliations: 1: Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, Thirona, Nijmegen, The Netherlands 2: Ministry of Health Headquarters, Lusaka, Zambia; Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands 3: University Teaching Hospital, Lusaka, Zambia

Publication date: 01 August 2017

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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