Bailey W C, Sellers C A, Lantz S O, Hardy G E
Am Rev Respir Dis. 1977 May;115(5):877-8. doi: 10.1164/arrd.1977.115.5.877.
For most tuberculin reactors, chest radiographs are obtained at the beginning of, at various intervals through the course of, and at the end of the year of isoniazid preventive therapy. A study of 1,524 tuberculin reactors was performed to determine the value of chest radiographs obtained after therapy was begun; 1,315 had normal radiographs at the beginning and end of therapy, and 209 had radiographic abnormalities at both times. No significant changes were noted in any of the 1,524 patients' radiographs. Similar results had been reported for 551 tuberculin reactors in an earlier study. This provides a total of 2,075 patients for whom no value could be found in the subsequent radiographs. We found no value in repeating normal chest radiographs of positive reactors if they had completed at least 9 months of the properly recommended 12 months of isoniazid preventive therapy. The lack of value of repeat radiographs, coupled with their fixed cost and the potential risk of unnecessary radiation, dictated our change in policy--we no longer repeat normal chest radiographs in such persons.
对于大多数结核菌素反应阳性者，在异烟肼预防性治疗开始时、治疗过程中的不同间隔时间以及治疗结束当年均需拍摄胸部X光片。对1524名结核菌素反应阳性者进行了一项研究，以确定治疗开始后拍摄的胸部X光片的价值；其中1315人在治疗开始和结束时X光片正常，209人在这两个时间点均有影像学异常。1524名患者的X光片均未发现明显变化。在一项早期研究中，对551名结核菌素反应阳性者也报告了类似结果。这样一来，共有2075名患者，其后续X光片未发现有价值的信息。我们发现，如果阳性反应者已完成至少9个月（推荐疗程为12个月）的适当异烟肼预防性治疗，重复拍摄正常的胸部X光片并无意义。由于重复拍摄X光片没有价值，再加上其固定成本以及不必要辐射的潜在风险，我们改变了政策——不再对这类人群重复拍摄正常的胸部X光片。
