title: Digital platform for improving non-radiologists' and radiologists' interpretation of chest radiographs for suspected tuberculosis - a method for supporting task-shifting in developing countries.
abstract: BACKGROUND
  Shifting X-ray interpretation to non-radiologists can help to address radiologist shortages in developing countries.
  
  
  OBJECTIVE
  To determine the change in accuracy of non-radiologists and radiologists for the radiographic diagnosis of paediatric tuberculosis after a short skill-development course.
  
  
  METHODS
  Participants interpreted 15 paediatric chest radiographs before and after a 30-minute course using three possible responses: (1) diagnostic for tuberculosis, (2) abnormal but inconclusive for diagnosis of tuberculosis and (3) normal. We compared proportions of correct diagnoses, sensitivity, and specificity, before and after the course.
  
  
  RESULTS
  We included 256 participants comprising 229 non-radiologists (134 radiographers, 32 paediatricians, 39 Médecins Sans Frontières clinicians and 24 physicians including paediatricians) and 27 radiologists. Mean change proportions of correct diagnosis ranged from -27% to 53% for individuals and 9% to 20% for groups. All groups showed a statistically significant improvement. Mean change in diagnostic sensitivity ranged from -38% to 100% for individuals and from 16% to 41% for groups. All groups showed a statistically significant improvement. Mean change in specificity ranged from -57% to 57% for individuals and from -15% to -4% for groups. The decrease was statistically significant for physicians, paediatricians and radiographers.
  
  
  CONCLUSIONS
  The course resulted in increased correct diagnoses and improved sensitivity at the expense of specificity.
authors.affiliation: Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa.
authors.forename: Namakula S
authors.initials: NS
authors.lastname: Semakula-Katende
authors.affiliation: Department of Radiology/CRIC Bristol, University of Bristol, Bristol, UK. docsav@mweb.co.za.|Department of Radiology, Bristol Royal Hospital for Children, Bristol, UK. docsav@mweb.co.za.|, Upper Maudlin Str, Bristol, BS2 8BJ, UK. docsav@mweb.co.za.
authors.forename: Savvas
authors.initials: S
authors.lastname: Andronikou
authors.affiliation: Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa.
authors.forename: Susan
authors.initials: S
authors.lastname: Lucas
mesh_terms: D002648:Child; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Chest; Children; Non-radiologists; Radiography; Radiologists; Training; Tuberculosis