Incidental radiological findings during clinical tuberculosis screening in Lesotho and South Africa: a case series
Abstract Background Chest X-ray offers high sensitivity and acceptable specificity as a tuberculosis screening tool, but in areas with a high burden of tuberculosis, there is often a lack of radiological expertise to interpret chest X-ray. Computer-aided detection systems based on artificial intelli...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-023-04097-4 |
| _version_ | 1797559498664050688 |
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| author | Naomi Glaser Shannon Bosman Thandanani Madonsela Alastair van Heerden Kamele Mashaete Bulemba Katende Irene Ayakaka Keelin Murphy Aita Signorell Lutgarde Lynen Jens Bremerich Klaus Reither |
| author_facet | Naomi Glaser Shannon Bosman Thandanani Madonsela Alastair van Heerden Kamele Mashaete Bulemba Katende Irene Ayakaka Keelin Murphy Aita Signorell Lutgarde Lynen Jens Bremerich Klaus Reither |
| author_sort | Naomi Glaser |
| collection | DOAJ |
| description | Abstract Background Chest X-ray offers high sensitivity and acceptable specificity as a tuberculosis screening tool, but in areas with a high burden of tuberculosis, there is often a lack of radiological expertise to interpret chest X-ray. Computer-aided detection systems based on artificial intelligence are therefore increasingly used to screen for tuberculosis-related abnormalities on digital chest radiographies. The CAD4TB software has previously been shown to demonstrate high sensitivity for chest X-ray tuberculosis-related abnormalities, but it is not yet calibrated for the detection of non-tuberculosis abnormalities. When screening for tuberculosis, users of computer-aided detection need to be aware that other chest pathologies are likely to be as prevalent as, or more prevalent than, active tuberculosis. However, non-tuberculosis chest X-ray abnormalities detected during chest X-ray screening for tuberculosis remain poorly characterized in the sub-Saharan African setting, with only minimal literature. Case presentation In this case series, we report on four cases with non-tuberculosis abnormalities detected on CXR in TB TRIAGE + ACCURACY (ClinicalTrials.gov Identifier: NCT04666311), a study in adult presumptive tuberculosis cases at health facilities in Lesotho and South Africa to determine the diagnostic accuracy of two potential tuberculosis triage tests: computer-aided detection (CAD4TB v7, Delft, the Netherlands) and C-reactive protein (Alere Afinion, USA). The four Black African participants presented with the following chest X-ray abnormalities: a 59-year-old woman with pulmonary arteriovenous malformation, a 28-year-old man with pneumothorax, a 20-year-old man with massive bronchiectasis, and a 47-year-old woman with aspergilloma. Conclusions Solely using chest X-ray computer-aided detection systems based on artificial intelligence as a tuberculosis screening strategy in sub-Saharan Africa comes with benefits, but also risks. Due to the limitation of CAD4TB for non-tuberculosis-abnormality identification, the computer-aided detection software may miss significant chest X-ray abnormalities that require treatment, as exemplified in our four cases. Increased data collection, characterization of non-tuberculosis anomalies and research on the implications of these diseases for individuals and health systems in sub-Saharan Africa is needed to help improve existing artificial intelligence software programs and their use in countries with high tuberculosis burden. |
| first_indexed | 2024-03-10T17:46:15Z |
| format | Article |
| id | doaj.art-cd41b8f2cc23439d84920fac9535f2ec |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-03-10T17:46:15Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-cd41b8f2cc23439d84920fac9535f2ec2023-11-20T09:31:55ZengBMCJournal of Medical Case Reports1752-19472023-08-011711710.1186/s13256-023-04097-4Incidental radiological findings during clinical tuberculosis screening in Lesotho and South Africa: a case seriesNaomi Glaser0Shannon Bosman1Thandanani Madonsela2Alastair van Heerden3Kamele Mashaete4Bulemba Katende5Irene Ayakaka6Keelin Murphy7Aita Signorell8Lutgarde Lynen9Jens Bremerich10Klaus Reither11Faculty of Medicine, University of ZürichCenter for Community Based Research, Human Sciences Research CouncilCenter for Community Based Research, Human Sciences Research CouncilCenter for Community Based Research, Human Sciences Research CouncilSolidarMed, Partnerships for HealthSolidarMed, Partnerships for HealthSolidarMed, Partnerships for HealthRadboud University Medical CenterSwiss Tropical and Public Health InstituteInstitute of Tropical Medicine AntwerpDepartment of Radiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of BaselSwiss Tropical and Public Health InstituteAbstract Background Chest X-ray offers high sensitivity and acceptable specificity as a tuberculosis screening tool, but in areas with a high burden of tuberculosis, there is often a lack of radiological expertise to interpret chest X-ray. Computer-aided detection systems based on artificial intelligence are therefore increasingly used to screen for tuberculosis-related abnormalities on digital chest radiographies. The CAD4TB software has previously been shown to demonstrate high sensitivity for chest X-ray tuberculosis-related abnormalities, but it is not yet calibrated for the detection of non-tuberculosis abnormalities. When screening for tuberculosis, users of computer-aided detection need to be aware that other chest pathologies are likely to be as prevalent as, or more prevalent than, active tuberculosis. However, non-tuberculosis chest X-ray abnormalities detected during chest X-ray screening for tuberculosis remain poorly characterized in the sub-Saharan African setting, with only minimal literature. Case presentation In this case series, we report on four cases with non-tuberculosis abnormalities detected on CXR in TB TRIAGE + ACCURACY (ClinicalTrials.gov Identifier: NCT04666311), a study in adult presumptive tuberculosis cases at health facilities in Lesotho and South Africa to determine the diagnostic accuracy of two potential tuberculosis triage tests: computer-aided detection (CAD4TB v7, Delft, the Netherlands) and C-reactive protein (Alere Afinion, USA). The four Black African participants presented with the following chest X-ray abnormalities: a 59-year-old woman with pulmonary arteriovenous malformation, a 28-year-old man with pneumothorax, a 20-year-old man with massive bronchiectasis, and a 47-year-old woman with aspergilloma. Conclusions Solely using chest X-ray computer-aided detection systems based on artificial intelligence as a tuberculosis screening strategy in sub-Saharan Africa comes with benefits, but also risks. Due to the limitation of CAD4TB for non-tuberculosis-abnormality identification, the computer-aided detection software may miss significant chest X-ray abnormalities that require treatment, as exemplified in our four cases. Increased data collection, characterization of non-tuberculosis anomalies and research on the implications of these diseases for individuals and health systems in sub-Saharan Africa is needed to help improve existing artificial intelligence software programs and their use in countries with high tuberculosis burden.https://doi.org/10.1186/s13256-023-04097-4Case seriesChest X-rayNon-TB abnormalitiesCAD4TBSub-Saharan Africa |
| spellingShingle | Naomi Glaser Shannon Bosman Thandanani Madonsela Alastair van Heerden Kamele Mashaete Bulemba Katende Irene Ayakaka Keelin Murphy Aita Signorell Lutgarde Lynen Jens Bremerich Klaus Reither Incidental radiological findings during clinical tuberculosis screening in Lesotho and South Africa: a case series Journal of Medical Case Reports Case series Chest X-ray Non-TB abnormalities CAD4TB Sub-Saharan Africa |
| title | Incidental radiological findings during clinical tuberculosis screening in Lesotho and South Africa: a case series |
| title_full | Incidental radiological findings during clinical tuberculosis screening in Lesotho and South Africa: a case series |
| title_fullStr | Incidental radiological findings during clinical tuberculosis screening in Lesotho and South Africa: a case series |
| title_full_unstemmed | Incidental radiological findings during clinical tuberculosis screening in Lesotho and South Africa: a case series |
| title_short | Incidental radiological findings during clinical tuberculosis screening in Lesotho and South Africa: a case series |
| title_sort | incidental radiological findings during clinical tuberculosis screening in lesotho and south africa a case series |
| topic | Case series Chest X-ray Non-TB abnormalities CAD4TB Sub-Saharan Africa |
| url | https://doi.org/10.1186/s13256-023-04097-4 |
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