title: High sensitivity of chest radiograph reading by clinical officers in a tuberculosis prevalence survey.
abstract: BACKGROUND
  Chest radiographs (CXRs) are used in tuberculosis (TB) prevalence surveys to identify participants for bacteriological examination. Expert readers are rare in most African countries. In our survey, clinical officers scored CXRs of 19 216 participants once. We assessed to what extent missed CXR abnormalities affected our TB prevalence estimate.
  
  
  METHODS
  Two experts, a radiologist and pulmonologist, independently reviewed 1031 randomly selected CXRs, mixed with lms of confirmed TB cases. CXRs with disagreement on 'any abnormality' or 'abnormality consistent with TB' were jointly reviewed during a consensus panel. We compared the nal expert and clinical of cer classifications with bacteriologically confirmed TB as the gold standard.
  
  
  RESULTS
  After the panel, 199 (19%) randomly selected CXRs were considered abnormal by both expert reviewers and another 82 (8%) by one reviewer. Agreement was good among the experts (κ 0.78, 95%CI 0.73-0.82) and moderate between the clinical officers and experts (κ range 0.50-0.62). The sensitivity of 'any abnormality' was 95% for the clinical officers and 83% and 81% for the respective experts. The specificities were respectively 73%, 74% and 80%. TB prevalence was underestimated by 1.5-5.0%.
  
  
  CONCLUSIONS
  Acceptable CXR screening can be achieved with clinical officers. Reviewing a sample of CXRs by two experts allows an assessment of prevalence underestimation.
authors.affiliation: Kenya Medical Research Institute (KEMRI)/Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya. a.h.vanthoog@amc.uva.nl
authors.forename: A H Van't
authors.initials: AH
authors.lastname: Hoog
authors.forename: H K
authors.initials: HK
authors.lastname: Meme
authors.forename: H
authors.initials: H
authors.lastname: van Deutekom
authors.forename: A M
authors.initials: AM
authors.lastname: Mithika
authors.forename: C
authors.initials: C
authors.lastname: Olunga
authors.forename: F
authors.initials: F
authors.lastname: Onyino
authors.forename: M W
authors.initials: MW
authors.lastname: Borgdorff
mesh_terms: D002983:Clinical Competence / Q000592:standards; D006282:Health Personnel / Q000592:standards; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008400:Mass Chest X-Ray / Q000592:standards; D015588:Observer Variation; D011159:Population Surveillance; D011237:Predictive Value of Tests; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology*