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Home / The International Journal of Tuberculosis and Lung Disease, Volume 16, Number 11

Active case finding for pulmonary tuberculosis using mobile digital chest radiography: an observational study

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BACKGROUND: Mobile digital chest radiography (CXR) is used routinely to screen for pulmonary tuberculosis (PTB) in London among homeless populations, persons accessing drug treatment services and prisoners.

OBJECTIVE: 1) To establish the sensitivity and specificity of mobile digital CXR, and 2) to test the hypothesis that actively identified cases have reduced odds of sputum smear positivity vs. those presenting passively to health care services from the same populations.

METHODS: Sensitivity and specificity were calculated using a gold standard comparator of culture-confirmed cases of PTB reported to the national surveillance system within 90 days of screening. Logistic regression was used to determine whether actively detected cases had reduced odds of smear positivity compared to passively detected cases after adjustment for confounding.

RESULTS: The intervention had a sensitivity of 81.8% (95%CI 64.5–93.0) and a specificity of 99.2% (95%CI 99.1–99.3). After adjusting for confounding, there was evidence that cases identified through screening were less likely to be smear-positive than passively identified cases (OR 0.34, 95%CI 0.14–0.85; likelihood ratio test P = 0.022).

CONCLUSION: Digital CXR achieves a high level of sensitivity and specificity in an operational setting; targeted mobile radiographic screening can reduce the risk of onward transmission by identifying cases before they become infectious.

Keywords: hard to reach; impact; sensitivity; specificity; tuberculosis

Document Type: Research Article

Affiliations: 1: Find and Treat, University College London Hospitals NHS Foundation Trust, London, UK 2: University College London Centre for Infectious Disease Epidemiology, Department of Infection and Population Health, London, UK 3: University College London Centre for Infectious Disease Epidemiology, Department of Infection and Population Health, London, UK; Respiratory Diseases Department, Health Protection Services, Health Protection Agency, London, UK 4: Centre for Respiratory Medicine, University College London, Royal Free London, NHS Foundation Trust, London, UK 5: Respiratory Diseases Department, Health Protection Services, Health Protection Agency, London, UK

Publication date: 01 November 2012

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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