Evaluation of a chest radiograph reading and recording system for tuberculosis in a HIV-positive cohort

C S Kosack, S Spijker, J Halton, M Bonnet, S Nicholas, K Chetcuti, A Mesic, W E Brant, E Joekes, S Andronikou

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)


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 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).

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.

Original languageEnglish
Pages (from-to)519.e1-519.e9
JournalClinical Radiology
Issue number6
Early online date21 Feb 2017
Publication statusE-pub ahead of print - 21 Feb 2017


  • HIV Seropositivity
  • Humans
  • Radiography, Thoracic
  • Sensitivity and Specificity
  • Tuberculosis, Pulmonary
  • Journal Article


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