@article {Philipsen:2019:1027-3719:805,
title = "Automated chest X-ray reading for tuberculosis in the Philippines to improve case detection: a cohort study",
journal = "The International Journal of Tuberculosis and Lung Disease",
parent_itemid = "infobike://iuatld/ijtld",
publishercode ="iuatld",
year = "2019",
volume = "23",
number = "7",
publication date ="2019-07-01T00:00:00",
pages = "805-810",
itemtype = "ARTICLE",
issn = "1027-3719",
eissn = "1815-7920",
url = "https://www.ingentaconnect.com/content/iuatld/ijtld/2019/00000023/00000007/art00006",
doi = "doi:10.5588/ijtld.18.0004",
keyword = "TB, computerised image analysis, chest radiography, computer-aided detection",
author = "Philipsen, R. H. H. M. and S{\’a}nchez, C. I. and Melendez, J. and Lew, W. J. and van Ginneken, B.",
abstract = "
BACKGROUND: DetecTB (Diagnostic Enhanced Tools for Extra Cases of TB), an intensified tuberculosis (TB) case-finding programme targeting prisons and high-risk communities was implemented on Palawan Island, the Philippines.
OBJECTIVE: To evaluate the performance of TB
detection based on computerised chest radiography (CXR) readings.
DESIGN: Data from 14094 subjects were analysed from September 2012 to June 2014. All CXRs were read by a physician and by software. Individuals with TB symptoms or CXR abnormalities according to the physician
underwent Xpert	extregistered MTB/RIF testing, the remaining persons were considered TB-negative (screening reference). A subset of 200 CXRs was read by an independent human reader (radiological reference). This reader also re-read a subset of the most abnormal cases as identified using
the software but read as normal by the physician (discordant cases).
RESULTS: A total of 10755 individuals were included in the analysis, 2534 of whom had a positively assessed CXR; 298 cases were Xpert-positive. Using the screening reference, the area under the receiver
operating characteristic curve for software readings was 0.93 (95%CI 0.920.94), with a sensitivity of 0.98 (95%CI 0.970.99) and a specificity of 0.69 (95%CI 0.400.98). Based on the radiological reference, the physician performed slightly worse than the software (sensitivity,
0.82, 95%CI 0.740.89 and specificity, 0.87, 95%CI 0.810.96 vs. sensitivity, 0.83, 95%CI 0.710.93 and specificity, 0.87, 95%CI 0.750.95), although this was not statistically significant. Of the 291 discordant cases, 70% were assessed as positive, resulting in a 22%
increase in TB detection when extrapolated to the full cohort.
CONCLUSION: The performance of automated CXR reading is comparable to that of the attending physicians in DetecTB, and its use as a second reader could increase TB detection.",
}