title: Evaluation of a chest radiograph reading and recording system for tuberculosis in a HIV-positive cohort.
abstract: OBJECTIVE
  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.
  
  
  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 κ=0.35 and κ=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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Médecins Sans Frontières, Diagnostic Network, Amsterdam, The Netherlands. Electronic address: cara.kosack@oca.msf.org.
authors.forename: C S
authors.initials: CS
authors.lastname: Kosack
authors.affiliation: Médecins Sans Frontières, Diagnostic Network, Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Spijker
authors.affiliation: Médecins Sans Frontières, Diagnostic Network, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Halton
authors.affiliation: Epicentre, Paris, France; Institute of Research for Development, UMR233, University of Montpellier, INSERM U1175, France.
authors.forename: M
authors.initials: M
authors.lastname: Bonnet
authors.affiliation: Epicentre, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Nicholas
authors.affiliation: Department of Radiology, Alder Hey Children's Hospital, Liverpool, UK.
authors.forename: K
authors.initials: K
authors.lastname: Chetcuti
authors.affiliation: Médecins Sans Frontières, Public Health Department, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Mesic
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: W E
authors.initials: WE
authors.lastname: Brant
authors.affiliation: Diagnostic Imaging department, Royal Liverpool University Hospital & Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: E
authors.initials: E
authors.lastname: Joekes
authors.affiliation: Department of Paediatric Radiology, University or Bristol and Bristol Royal Hospital for Children, Bristol, UK.
authors.forename: S
authors.initials: S
authors.lastname: Andronikou
mesh_terms: D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging*