title: Screening for pulmonary tuberculosis in a Tanzanian prison and computer-aided interpretation of chest X-rays.
abstract: METHODS
  Tanzania is a high-burden country for tuberculosis (TB), and prisoners are a high-risk group that should be screened actively, as recommended by the World Health Organization. Screening algorithms, starting with chest X-rays (CXRs), can detect asymptomatic cases, but depend on experienced readers, who are scarce in the penitentiary setting. Recent studies with patients seeking health care for TB-related symptoms showed good diagnostic performance of the computer software CAD4TB.
  
  
  OBJECTIVE
  To assess the potential of computer-assisted screening using CAD4TB in a predominantly asymptomatic prison population.
  
  
  METHODS
  Cross-sectional study.
  
  
  RESULTS
  CAD4TB and seven health care professionals reading CXRs in local tuberculosis wards evaluated a set of 511 CXRs from the Ukonga prison in Dar es Salaam. Performance was compared using a radiological reference. Two readers performed significantly better than CAD4TB, three were comparable, and two performed significantly worse (area under the curve 0.75 in receiver operating characteristics analysis). On a superset of 1321 CXRs, CAD4TB successfully interpreted >99%, with a predictably short time to detection, while 160 (12.2%) reports were delayed by over 24 h with conventional CXR reading.
  
  
  CONCLUSIONS
  CAD4TB reliably evaluates CXRs from a mostly asymptomatic prison population, with a diagnostic performance inferior to that of expert readers but comparable to local readers.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Steiner
authors.affiliation: National Institute of Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania.
authors.forename: C
authors.initials: C
authors.lastname: Mangu
authors.affiliation: PharmAccess Foundation, Dar es Salaam, Tanzania.
authors.forename: J
authors.initials: J
authors.lastname: van den Hombergh
authors.affiliation: Department of Tuberculosis Control, Municipal Health Service, Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: van Deutekom
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: van Ginneken
authors.affiliation: National Institute of Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania ; Division of Infectious Disease and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Clowes
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Mhimbira
authors.affiliation: Muhimbili Medical Research Centre, Dar es Salaam, Tanzania.
authors.forename: S
authors.initials: S
authors.lastname: Mfinanga
authors.affiliation: Division of Infectious Disease and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany ; German Centre for Infection Research, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Rachow
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Reither
authors.affiliation: National Institute of Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania ; Division of Infectious Disease and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany ; German Centre for Infection Research, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hoelscher
keywords: chest X-ray; computer-aided diagnosis; tuberculosis