Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
College of Medicine, Helse Nord TB Initiative, University of Malawi, Blantyre, Malawi.
Trop Med Int Health. 2021 Nov;26(11):1427-1437. doi: 10.1111/tmi.13658. Epub 2021 Aug 1.
The prevalence of diseases other than tuberculosis (TB) detected during chest X-ray screening is poorly described in sub-Saharan Africa. Computer-assisted digital chest X-ray technology is available for TB screening and has the potential to be a screening tool for non-communicable diseases as well. Low- and middle-income countries are in a transition period where the burden of non-communicable diseases is increasing, but health systems are mainly focused on addressing infectious diseases.
Participants were adults undergoing computer-assisted chest X-ray screening for tuberculosis in a community-wide tuberculosis prevalence survey in Blantyre, Malawi. Adults with abnormal radiographs by field radiographer interpretation were evaluated by a physician in a community-based clinic. X-ray classifications were compared to classifications of a random sample of normal chest X-rays by radiographer interpretation. Radiographic features were classified using WHO Integrated Management for Adult Illnesses (IMAI) guidelines. All radiographs taken at the screening tent were analysed by the Qure.ai qXR v2.0 software.
5% (648/13,490) of adults who underwent chest radiography were identified to have an abnormal chest X-ray by the radiographer. 387 (59.7%) of the participants attended the X-ray clinic, and another 387 randomly sampled normal X-rays were available for comparison. Participants who were referred to the community clinic had a significantly higher HIV prevalence than those who had been identified to have a normal CXR by the field radiographer (90 [23.3%] vs. 43 [11.1%] p-value < 0.001). The commonest radiographic finding was cardiomegaly (20.7%, 95% CI 18.0-23.7). One in five (81/387) chest X-rays were misclassified by the radiographer. The overall mean Qure.ai qXR v2.0 score for all reviewed X-rays was 0.23 (SD 0.20). There was a high concordance of cardiomegaly classification between the physician and the computer-assisted software (109/118, 92.4%).
There is a high burden of cardiomegaly on a chest X-ray at a community level, much of which is in patients with diabetes, heart disease and high blood pressure. Cardiomegaly on chest X-ray may be a potential tool for screening for cardiovascular NCDs at the primary care level as well as in the community.
在撒哈拉以南非洲，胸部 X 光筛查中发现的结核病以外疾病的流行情况描述得很差。计算机辅助数字胸部 X 光技术可用于结核病筛查，也有可能成为非传染性疾病的筛查工具。中低收入国家正处于一个转型期，非传染性疾病的负担正在增加，但卫生系统主要侧重于解决传染病问题。
参与者是在马拉维布兰太尔进行社区范围结核病患病率调查中接受计算机辅助胸部 X 光筛查的成年人。经现场放射技师解读为异常的 X 光片的成年人由社区诊所的医生进行评估。放射科分类与放射技师解读的随机正常胸部 X 射线样本的分类进行比较。使用世界卫生组织成人综合疾病管理（IMAI）指南对 X 射线特征进行分类。在筛查帐篷中拍摄的所有 X 射线都由 Qure.ai qXR v2.0 软件进行分析。
接受胸部 X 射线检查的成年人中，有 5%（648/13490）的成年人被放射技师判断为 X 射线异常。387 名（59.7%）参与者参加了 X 射线诊所，另外还提供了 387 张随机抽样的正常 X 射线进行比较。被转介到社区诊所的参与者的 HIV 患病率明显高于被现场放射技师判断为正常 CXR 的参与者（90[23.3%]比 43[11.1%]，p 值<0.001）。最常见的放射学发现是心脏扩大（20.7%，95%CI 18.0-23.7）。五分之一（81/387）的胸部 X 射线被放射技师错误分类。所有接受审查的 X 射线的平均 Qure.ai qXR v2.0 评分均为 0.23（SD 0.20）。医生和计算机辅助软件在心脏扩大分类上有很高的一致性（109/118，92.4%）。
在社区层面，胸部 X 射线检查中存在很高的心脏扩大负担，其中大部分是在糖尿病、心脏病和高血压患者中。胸部 X 射线上的心脏扩大可能是初级保健和社区中筛查心血管非传染性疾病的潜在工具。
