Kosack C. S., Spijker S., Halton J., Bonnet Maryline, Nicholas S., Chetcuti K., Mesic A., Brant W. E., Joekes E., Andronikou S. (2017). Evaluation of a chest radiograph reading and recording system for tuberculosis in a HIV-positive cohort. Clinical Radiology, 72 (6), p. 519.e1-519.e9. ISSN 0009-9260.
Titre du document
Evaluation of a chest radiograph reading and recording system for tuberculosis in a HIV-positive cohort
Kosack C. S., Spijker S., Halton J., Bonnet Maryline, Nicholas S., Chetcuti K., Mesic A., Brant W. E., Joekes E., Andronikou S.
Source
Clinical Radiology, 2017,
72 (6), p. 519.e1-519.e9 ISSN 0009-9260
AIM: To assess the impact of introducing a chest radiograph reading and recording system (CRRS) with a short training session, on the accuracy and inter-reader variability of tuberculosis (TB) interpretation of chest radiographs (CXRs) by a group of non-expert readers in a human immunodeficiency virus (HIV)-positive cohort. MATERIALS AND METHODS: A set of 139 CXRs was reviewed by a group of eight physicians pre- and post-intervention at two clinics in Shan State, Myanmar, providing HIV/TB diagnosis and treatment services. The results were compared against the consensus of expert radiologists for accuracy. RESULTS: Overall accuracy was similar pre- and post-intervention for most physicians with an average area under the receiver operating characteristic curve difference of 0.02 (95% confidence interval: -0.03, 0.07). The overall agreement among physicians was poor pre- and post-intervention (Fleiss k=0.35 and k=0.29 respectively). The assessment of agreement for specific disease patterns associated with active TB in HIV-infected patients showed that for intrinsically subtle findings, the agreement was generally poor but better for the more intrinsically obvious disease patterns: pleural effusion (Cohen's kappa range = 0.37-0.67) and milliary nodular pattern (Cohen's kappa range = 0.25-0.52). CONCLUSION: This study demonstrated limited impact of the introduction of a CRRS on CXR accuracy and agreement amongst non-expert readers. The role in which CXRs are used for TB diagnosis in a HIV-positive cohort in similar clinical contexts should be reviewed.
