Barcelona Institute for Global Health, Barcelona, Catalonia, Spain.
Medicine and Translational Research Department, University of Barcelona, Barcelona, Spain.
PLoS One. 2024 Apr 18;19(4):e0299293. doi: 10.1371/journal.pone.0299293. eCollection 2024.
Tuberculosis remains one of the top ten causes of mortality globally. Children accounted for 12% of all TB cases and 18% of all TB deaths in 2022. Paediatric TB is difficult to diagnose with conventional laboratory tests, and chest radiographs remain crucial. However, in low-and middle-income countries with high TB burden, the capacity for radiological diagnosis of paediatric TB is rarely documented and data on the associated radiation exposure limited.
A multicentre, mixed-methods study is proposed in three countries, Mozambique, South Africa and Spain. At the national level, official registry databases will be utilised to retrospectively compile an inventory of licensed imaging resources (mainly X-ray and Computed Tomography (CT) scan equipment) for the year 2021. At the selected health facility level, three descriptive cross-sectional standardised surveys will be conducted to assess radiology capacity, radiological imaging diagnostic use for paediatric TB diagnosis, and radiation protection optimization: a site survey, a clinician-targeted survey, and a radiology staff-targeted survey, respectively. At the patient level, potential dose optimisation will be assessed for children under 16 years of age who were diagnosed and treated for TB in selected sites in each country. For this component, a retrospective analysis of dosimetry will be performed on TB and radiology data routinely collected at the respective sites. National inventory data will be presented as the number of units per million people by modality, region and country. Descriptive analyses will be conducted on survey data, including the demographic, clinical and programmatic characteristics of children treated for TB who had imaging examinations (chest X-ray (CXR) and/or CT scan). Dose exposure analysis will be performed by children's age, gender and disease spectrum.
As far as we know, this is the first multicentre and multi-national study to compare radiological capacity, radiation protection optimization and practices between high and low TB burden settings in the context of childhood TB management. The planned comparative analyses will inform policy-makers of existing radiological capacity and deficiencies, allowing better resource prioritisation. It will inform clinicians and radiologists on best practices and means to optimise the use of radiological technology in paediatric TB management.
结核病仍然是全球十大死因之一。2022 年，儿童占所有结核病病例的 12%，占所有结核病死亡人数的 18%。传统的实验室检测方法难以诊断儿童结核病，胸部 X 光检查仍然至关重要。然而，在结核病负担高的中低收入国家，儿童结核病放射诊断能力很少有记录，相关辐射暴露数据也有限。
本研究拟在莫桑比克、南非和西班牙三个国家开展一项多中心、混合方法研究。在国家层面，将利用官方登记数据库，回顾性汇编 2021 年授权影像资源（主要为 X 光和计算机断层扫描（CT）设备）清单。在选定的卫生机构层面，将分别进行三项描述性横断面标准化调查，以评估放射学能力、儿童结核病诊断中放射影像学诊断的应用以及辐射防护优化：现场调查、临床医生为目标的调查和放射科工作人员为目标的调查。在患者层面，将对每个国家选定地点诊断和治疗结核病的 16 岁以下儿童进行潜在剂量优化评估。对于这一部分，将对在各自地点常规收集的结核病和放射学数据进行剂量测定的回顾性分析。国家清单数据将按每百万人口的单位数量，按模式、区域和国家呈现。将对调查数据进行描述性分析，包括接受影像学检查（胸部 X 光（CXR）和/或 CT 扫描）的结核病患儿的人口统计学、临床和方案特征。将按儿童年龄、性别和疾病谱进行剂量暴露分析。
据我们所知，这是第一项在儿童结核病管理背景下比较高和低结核病负担环境中的放射学能力、辐射防护优化和实践的多中心和多国研究。计划进行的比较分析将为决策者提供现有的放射学能力和不足情况，以便更好地进行资源优先排序。它将为临床医生和放射科医生提供最佳实践和优化儿童结核病管理中放射技术使用的方法。
