Accuracy of an automated system for tuberculosis detection on chest radiographs in high-risk screening

With 10.4 million new cases and 1.8 million deaths in 2015, tuberculosis (TB) remains a major health concern. Prevalence is highest in Africa and overall incidence in Asia.1 Although TB incidence in the West has decreased, increases in TB rates have been reported in high-risk populations, especially in urban settings. Despite efforts to develop new TB diagnostics, screening is still commonly performed using chest radiography, followed by sputum culture, Xpert (Cepheid, Sunnyvale, CA, USA) testing or smear microscopy. Early studies reported limited specificity and variable levels of inter- and intra-reader agreement in interpreting chest radiographs (CXRs) for TB detection. However, modern digital radiography provides a quick and reliable technique with low marginal and operational costs, and its use, together with standardised scoring, may improve performance and reader agreement.