在六个结核病高负担和资源有限的国家，为地区医院级别的儿童结核病诊断实施数字化 X 射线摄影。

Implementation of digital chest radiography for childhood tuberculosis diagnosis at district hospital level in six high tuberculosis burden and resources limited countries.

机构信息

Translational Research on HIV and Endemic and Emerging Infectious Diseases (TransVIHMI), University of Montpellier, National Institute for Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), Montpellier, France.

National Institute for Health and Medical Research (INSERM) U 1219, French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux Population Health Centre, Bordeaux, France.

出版信息

Trop Med Int Health. 2024 Nov;29(11):979-989. doi: 10.1111/tmi.14053. Epub 2024 Nov 3.

DOI:10.1111/tmi.14053

PMID:39488906

Abstract

OBJECTIVES

Chest x-ray (CXR) plays an important role in childhood tuberculosis (TB) diagnosis, but access to quality CXR remains a major challenge in resource-limited settings. Digital CXR (d-CXR) can solve some image quality issues and facilitate their transfer for quality control. We assess the implementation of introducing d-CXR in 12 district hospitals (DHs) in 2021-2022 across Cambodia, Cameroon, Ivory Coast, Mozambique, Sierra Leone and Uganda as part of the TB-speed decentralisation study on childhood TB diagnosis.

METHODS

For digitisation of CXR, digital radiography (DR) plates were setup on existing analogue radiography devices. d-CXR were transferred to an international server at Bordeaux University and downloaded by sites' clinicians for interpretation. We assessed the uptake and performance of CXR services and health care workers' (HCW) perceptions of d-CXR implementation. We used a convergent mixed method approach utilising process data, individual interviews with 113 HCWs involved in performing or interpreting d-CXRs and site support supervision reports.

RESULTS

Of 3104 children with presumptive TB, 1642 (52.9%) had at least one d-CXR, including 1505, 136 and 1 children with one, two and three d-CXRs, respectively, resulting in a total of 1780 d-CXR. Of them, 1773 (99.6%) were of good quality and 1772/1773 (99.9%) were interpreted by sites' clinicians. One hundred and sixty-four children had no d-CXR performed despite attending the radiography department: 126, 37 and 1 with one, two and three attempts, respectively. d-CXRs were not performed in 21.6% (44/203) due to connectivity problem between the DR plate captor and the computer. HCW reported good perceptions of d-CXR and of the DR plates provided. The main challenge was the upload to and download from the server of d-CXRs due to limited internet access.

CONCLUSION

d-CXR using DR plates was feasible at DH level and provided good quality images but required overcoming operational challenges.

摘要

目的

胸部 X 光（CXR）在儿童结核病（TB）诊断中发挥着重要作用，但在资源有限的环境中，获得高质量的 CXR 仍然是一个主要挑战。数字 CXR（d-CXR）可以解决一些图像质量问题，并便于进行质量控制。我们评估了在 2021 年至 2022 年期间，在柬埔寨、喀麦隆、科特迪瓦、莫桑比克、塞拉利昂和乌干达的 12 家地区医院（DH）引入 d-CXR 的情况，这是儿童结核病诊断中 TB-speed 去中心化研究的一部分。

方法

为了对 CXR 进行数字化，在现有的模拟放射设备上安装了数字射线摄影（DR）板。d-CXR 被传输到波尔多大学的一个国际服务器上，并由现场的临床医生下载进行解释。我们评估了 CXR 服务的采用情况和卫生保健工作者（HCW）对 d-CXR 实施的看法。我们采用了一种收敛混合方法，利用过程数据、对 113 名参与执行或解释 d-CXR 的 HCW 进行的个人访谈以及现场支持监督报告。

结果

在 3104 名疑似结核病的儿童中，有 1642 名（52.9%）至少有一次 d-CXR，其中 1505、136 和 1 名儿童分别有一次、两次和三次 d-CXR，共进行了 1780 次 d-CXR。其中，1773 次（99.6%）质量良好，1772/1773 次（99.9%）由现场临床医生解释。尽管有 164 名儿童到放射科就诊，但仍有 164 名儿童未进行 d-CXR：126、37 和 1 名儿童分别进行了一次、两次和三次尝试。由于 DR 板捕获器与计算机之间的连接问题，203 次中有 44 次（21.6%）未进行 d-CXR。由于互联网接入有限，d-CXR 的上传和下载到服务器是主要挑战。