Academic literature on the topic 'Tuberculosis Medical screening Mass Chest X-ray Tuberculosis'

BACKGROUND: Systematic screening for TB using automated chest radiography (ACR) with computer-aided detection software (CAD4TB) has been implemented at scale in Karachi, Pakistan. Despite evidence supporting the use of ACR as a pre-screen prior to Xpert® MTB/RIF diagnostic testing in presumptive TB patients, there has been no data published on its use in mass screening in real-world settings.METHOD: Screening was undertaken using mobile digital X-ray vehicles at hospital facilities and community camps. Chest X-rays were offered to individuals aged ≥15 years, regardless of symptoms. Those with a CAD4TB score of ≥70 were offered Xpert testing. The association between Xpert positivity and CAD4TB scores was examined using data collected between 1 January and 30 June 2018 using a custom-built data collection tool.RESULTS: Of the 127 062 individuals screened, 97.2% had a valid CAD4TB score; 11 184 (9.1%) individuals had a CAD4TB score ≥70. Prevalence of Xpert positivity rose from 0.7% in the <50 category to 23.5% in the >90 category. The strong linear association between CAD4TB score and Xpert positivity was found in both community and hospital settings.CONCLUSION: The strong association between CAD4TB scores and Xpert positivity provide evidence that an ACR-based pre-screening performs well when implemented at scale in a high-burden setting.

Tuberculosis is a life-threatening disease that mainly affects underdeveloped as well as developing nations. While lethal it is often resistive to antibiotics and the safest way to treat a patient is to detect the disease's presence as soon as possible. Various techniques have been developed to diagnose tuberculosis and radiography of the chest is one of such methods that works well for over a decade.. Though an effective method still the success depends on the medical officer who examines the chest X-rays. Thus ,this paper proposes an approach for detecting X-ray abnormalities using deep learning. The systems output is assessed on two open Montgomery and Shenz en chest X-ray datasets and accuracy of 84 percent is achieved.

Setting: Fifteen purposively selected districts in Zimbabwe in which targeted active screening for tuberculosis (Tas4TB) was conducted among TB high-risk groups (HRGs). There were 230 patients started on TB treatment on the basis of chest X-ray (CXR) results without corresponding bacteriological confirmation.Objectives: To determine 1) the percentage of agreements in digital CXR ratings by medical officers against final ratings by radiologist(s), 2) inter-rater agreement in CXR ratings between medical officers and radiologists, and 3) number (and proportion) of patients belonging to HRGs who were over-treated during Tas4TB.Design: This was a cross-sectional study using programme data.Results: A total of 168 patients had their CXRs rated by two independent radiologists. Discordances among the radiologists were resolved by a third index radiologist, who provided the final rating. κ scores were 0.01 (field ratings vs. Radiologist A); 0.02 (field ratings vs. Radiologist B); 0.74 (Radiologists A vs. B). The percentage agreement for field and final radiologist rating was 70% (95%CI 64–78). Around 29% (95%CI 23–36) of the patients were potentially over-treated during Tas4TB.Conclusion: Over a quarter of patients with presumptive TB are potentially over-treated during Tas4TB. Over-treatment is highest among those with previous contact with TB patients. Trainings of radiographers and medical officers may improve CXR ratings.

Introduction: Radiological imaging has a key role in multidrug-resistant (MDR) pulmonary tuberculosis (TB) screening and diagnosis. However, new cases of MDR pulmonary TB are often overlooked; therefore, its transmission might continue before its diagnosis. The most widely used and affordable radiological modality is a chest radiograph. This study aims to describe the characteristics of primary and secondary MDR pulmonary TB chest x-ray findings for differential diagnosis. Methods: This study was an analytic observational study with a retrospective design. Researchers evaluated medical record data of primary and secondary MDR pulmonary TB patients who underwent chest x-ray examinations. The patient's chest x-rays were then evaluated. Evaluated variables were lung, pleural, and mediastinal abnormalities and severity category. Results: The most common chest x-ray finding in primary MDR pulmonary TB was consolidation (96.2%), which was mostly unilateral (52.0%), accompanied by cavities (71.2%), most of which were multiple (83.8%) with a moderate category of severity. The most common chest x-ray finding in secondary MDR pulmonary TB was consolidation (100%), which was mostly bilateral (60.4%), accompanied by cavities (80.2%), most of which were multiple (90.1%) with severe category of severity. Pleural thickening (47.5%) was also found. Conclusion: There was a significant difference between primary and secondary MDR pulmonary TB in terms of mild severity category, and pleural thickening. Mild severity category is mostly found in primary MDR-TB and pleural thickening is mostly found in secondary TB.

BackgroundThe prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey.MethodsWe reviewed a random sample of 1140 adult (≥15 years) CXRs classified as ‘abnormal, suggestive of TB’ or ‘abnormal other’ during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated.FindingsCardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.InterpretationBased on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts.FundingNational Institute for Health Research (IMPALA-grant reference 16/136/35).

Abstract Background Repeated chest X-rays serve as an essential screening tool to identify and describe new or stable (i.e., unchanged) lung abnormalities suggestive of pulmonary tuberculosis (TB) disease. The time for which a patient’s chest X-ray has not demonstrated appreciable change prior to treatment, or pretreatment chest X-ray stability duration, has been considered clinically useful in distinguishing inactive from active disease at four or 6 months. This relationship, however, has not been previously quantified. Methods This study relied on retrospective medical record review to assess the relationship of documented pretreatment chest X-ray stability duration thresholds relative to four and 6 months with a future clinical or culture-confirmed (Class 3) diagnosis of pulmonary TB disease. Multivariable logistic regression quantified this association among 146 patients who were evaluated and started on treatment for pulmonary TB disease in the San Diego County tuberculosis clinic between May 2012 and March 2017. Results After adjusting for age and Class B1 TB, Pulmonary status, a CXR stability duration of 4 months or more was not significantly associated with a Class 3 pulmonary TB diagnosis (adjusted odds ratio [AOR], 0.830; 95% confidence interval [CI], 0.198–3.48). Results were similar for the 6-month cut-point after adjusting for age and Class B1 Pulmonary status (AOR, 0.970; 95% CI, 0.304–3.10). Compared with less than 4 months, CXR stability durations of four to 6 months (AOR, 0.778; 95% CI, 0.156–3.89) and greater than 6 months (AOR, 0.875; 95% CI, 0.187–4.10) were also not significantly associated with a Class 3 TB diagnosis after adjusting for covariates. Conclusion Repeated chest X-rays remain a valuable tool for clinicians identifying and describing new or unchanged lung abnormalities suggestive of pulmonary TB disease. This study found no statistically significant association between pretreatment chest X-ray stability duration and subsequent TB disease diagnosis, with a wide range of estimates compatible with the data, suggesting the stability duration cut points relative to four and 6 months may not be as informative as previously understood. Disclosures All authors: No reported disclosures.

In automated chest X-ray screening (to detect pulmonary abnormality: Tuberculosis (TB), for instance), the presence of foreign element such as buttons and medical devices hinders its performance. In this paper, using digital chest radiographs, the authors present a new technique to detect circular foreign element, within the lung regions. They first compute edge map by using several different edge detection algorithms, which is followed by morphological operations for potential candidate selection. These candidates are then confirmed by using circular Hough transform (CHT). In their test, the authors have achieved precision, recall, and F1 score of 96%, 90%, and 92%, respectively with lung segmentation. Compared to state-of-the-art work, their technique excels performance in terms of both detection accuracy and computational time.

Introduction: Tuberculosis infection is very common, and it continues to be the major public health problem in Nepal. Published data about the epidemiology of TB in children is scarce in Nepal, though it is considered one of the most common causes of childhood morbidity in the country. Aims and objectives: To calculate the prevalence of tuberculosis in children aged 0-15 years and to study their clinico-laboratory profile. Methodology: This is a hospital based study conducted in Nobel Medical College Teaching Hospital, Biratnagar over a period of one year. We analyzed 289 children aged 0-15 years suspected of having tuberculosis on clinical grounds and subjected to further screening tests. Results: Majority of the children were males and most of the children were 5-15 years of age. 15 of the cases were diagnosed as tuberculosis out of which one case was bacteriologically confirmed pulmonary tuberculosis and be 5.2 %. Fever and cough were the most common clinical presentations and mantoux test and chest X-ray were most suggestive in majority of the cases. Conclusions: This study supports the use of history and thorough clinical examination and high index of clinical suspicion for diagnosis of childhood tuberculosis.

e19124 Background: Chest X ray (CXR) has been the most common screen procedure for detection of lung cancer. However, if patients had old inflammatory shadows such as tuberculosis, calcification and fibrotic changes, it would become increasingly difficult to detect the lung cancer. In that case, a comparative review of the CXR to the previous one helps the detection of new shadows. We examined whether the repeat participants (pts) who received the medical checkup annually, may have a profit for the lung cancer detection screening. Methods: Our clinic “MedCity21” is a university outpatient clinic to undergo a complete medical checkup in private health screening program. The pts with abnormalities detected in CXR were announced by call request and invited to our specialty clinic for chest CT scan as further examination. We examined the varieties of abnormal shadows by CXR and CT scans, and compared the differences between the repeat and the first-time pts using the chi-square tests, in 2018 and 2019 respectively. Results: In 2018, a total of 12540 with repeat / first-time pts of 6898/5642 pts (55/45%) were enrolled. The CXR abnormalities requiring further examinations were a total of 335 (2.6%) with those of 138/188 pts (p < 0.01). After the call requests, a total of 239 (71.3%) with those of 109/130 pts in 2018 received chest CT scan in our specialty clinic. In 2019, a total of 13690 pts with those of 7748/5942 (56.6/43.4%) were enrolled. The CXR abnormalities requiring further examinations were a total of 323 (2.4%) with those of 137/186 pts (p < 0.01). After the call requests, a total of 224 (69.3%) pts with those of 104/120 pts received chest CT scan in our specialty clinic. The varieties of abnormal shadows by CT scans showed that 8.3/20.8% (p < 0.01) in 2018 and 11.5/21.7% (p = 0.04) in 2019 of old inflammatory shadows, 11.0/6.9% (p = 0.27) in 2018 and 14.4/1.7% (p < 0.01) in 2019 of acute inflammatory shadows, respectively. The nodule was detected in 11.9/11.5% in 2018 and 8.7/10.8% in 2019 with no significant differences. Lung cancer was detected in 3/3 pts in 2018, and 1/3 pts in 2019. Conclusions: The repeat pts in each year, had significantly lower rate of CXR abnormalities detection, and had lower rate of the detection of old inflammatory changes as significant. In private health screening program, the repeat pts may have higher profits for the avoidance of further examination for lung cancer detection than the first-time pts.

碩士
中山醫學大學
醫療產業科技管理學系碩士班
106
Foreword: Since April 2006, Taiwan began to implement the Directly Observed Treatment Short-Course, DOTS Plan. The province''s incidence rate dropped from 63.2 per 100,000 population to 45.7 per 100,000 population in 2015. However, the incidence of tuberculosis is concentrated in the elderly population. The elderly have more than twice the incident rate compare with the young and middle-aged population. Sometimes, ten times the incident rate. The physiology of the elderly is deteriorating and the immunity is declining. As a result, the tuberculosis cells that are lurking in the body are waiting for the disease, causing tuberculosis. The incidence is higher in the older population. Coupled with the inconvenience of the elderly, the inability to take care of selves, living alone, and many other reasons, many of them live in nursing home, making this high-risk group are prone to outbreaks. Therefore, this highlight the need to implement comprehensive TB screening for the elderly population. Research purposes: The purpose of this study is to understand the resources and equipment consumed by the residents of the barrier-free X-ray to point-to-point screening for the residents of each institution, and the materials and equipment required for each X-ray tour by barrier-free X-ray tour. Costs such as depreciation and medical personnel expenses are used as cost analysis for X-ray inspection to assess their medical economic benefits. Research methods: This study is a cross-sectional study. The population of the elderly in Changhua County is used as a target. The age distribution of the elderly population and the status of screening for tuberculosis are counted, and the basis for chest X-ray screening was been used. The cost method performs the medical resources consumed by the activity in each activity. Then allocate the overhead according to the cost driver and the cost pool to calculate the cost. Finally, compares the difference between the cost of executing the plan and the government budget. This research also count the depreciation charges for X-ray tour vehicles, and the number of medical points (money) spent on the calculation of three sets of tests for suspected tuberculosis. Result: The Changhua County Health Bureau''s "106 Changhua County Health Bureau Chest X-ray roving screening, interpretation and tracking entrusted service" case, a total of 56 screen tours, including 48 institutions and 8 company or schools. The total number of X-ray inspections was 3,229. The number of abnormalities was 1,240 by the physician, accounting for 38.40% of the total subjects. Nursing home: 2,829 people. The total number of abnormalities was 1,191, which was 42.10%. Group contacts: 400 people. The total number of abnormalities was 49, and the proportion of all subjects in the group contact was 12.25%. The number of abnormal notifications was 15 and the final diagnosis was 7 with a total hospital cost of 1,428,133 yuan and a government grant of 1,341,344 yuan. The cost of a hospital for each patient is 204,019 yuan, and the cost of a government grant for each patient is 191,620.yuan Conclusion: The X-rays of the residents’ lungs in the nursing home are reconsidered as abnormally higher than all the subjects in the group contact. Most of the elderly patients who are required to stay in the nursing home are not healthy elderly people. Most of them have heart, lung diseases or ever infected in the lungs. In addition, the proportion of screening for tuberculosis in residents of nursing institutions is still much higher than that of the general public. The cost of finding a hospital for each patient is 204,019 yuan. The cost of government funding for patients is 191,620. Compared with previous studies, this means the cost of a confirmed case of tuberculosis will become higher and higher in the future, especially for residents of nursing home, which are more expensive due to inconvenient movements. For the hospitals that plan the project, regardless of the depreciation expenses of the X-ray tour vehicle, the hospital costs of are still higher than this screen plan. As long as you find a tuberculosis patient who is infected, the cost of treating patients according to health insurance, affecting the income of the caregiver or family members who are unable to work due to infection. In no more than eight years, the cost of treatment can be saved will much more than the cost of the project. In did, this screen plan is hold economic benefits. Finally, In this plan, a total of seven confirmed patients were found. According to the number of patients found and the spread speed of the disease in such proportions, the positive economic benefits could be achieved within two years. It can approve that the X-ray screening plan for residents’ lungs in nursing home is useful.