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The effect of a tuberculosis chest X-ray image reference set on non-expert reader performance

Waitt, Catriona J., Joekes, Elizabeth, Jesudason, Natasha, Waitt, Peter I., Goodson, Patrick, Likumbo, Ganizani, Kampondeni, Samuel, Faragher, Brian and Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 (2013) 'The effect of a tuberculosis chest X-ray image reference set on non-expert reader performance'. European Radiology, Vol 23, Issue 9, pp. 2459-2468.

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Abstract

Objectives
In low-resource settings, limitations in diagnostic accuracy of chest X-rays (CXR) for pulmonary tuberculosis (PTB) relate partly to non-expert interpretation. We piloted a TB CXR Image Reference Set (TIRS) to improve non-expert performance in an operational setting in Malawi.

Methods
Nineteen doctors and clinical officers read 60 CXR of patients with suspected PTB, at baseline and using TIRS. Two officers also used the CXR Reading and Recording System (CRRS). Correct treatment decisions were assessed against a “gold standard” of mycobacterial culture and expert performance.

Results
TIRS significantly increased overall non-expert sensitivity from 67.6 (SD 14.9) to 75.5 (SD 11.1, P = 0.013), approaching expert values of 84.2 (SD 5.2). Among doctors, correct decisions increased from 60.7 % (SD 7.9) to 67.1 % (SD 8.0, P = 0.054). Clinical officers increased in sensitivity from 68.0 % (SD 15) to 77.4 % (SD 10.7, P = 0.056), but decreased in specificity from 55.0 % (SD 23.9) to 40.8 % (SD 10.4, P = 0.049). Two officers made correct treatment decisions with TIRS in 62.7 %. CRRS training increased this to 67.8 %.

Conclusion
Use of a CXR image reference set increased correct decisions by doctors to treat PTB. This tool may provide a low-cost intervention improving non-expert performance, translating into improved clinical care. Further evaluation is warranted.

Item Type: Article
Additional Information: The final publication is available at Springer via http://dx.doi.org/10.1007/s00330-013-2840-z
Subjects: QY Clinical Pathology > QY 25 Laboratory techniques and procedure
WA Public Health > Preventive Medicine > WA 243 Diagnositic services
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
WF Respiratory System > Tuberculosis > WF 225 Mass chest X-ray
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1007/s00330-013-2840-z
Depositing User: Martin Chapman
Date Deposited: 04 Nov 2014 10:42
Last Modified: 06 Feb 2018 13:07
URI: http://archive.lstmed.ac.uk/id/eprint/4522

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