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Pune: Citizens, Activists Raise Alarm Over Unsafe Chest X-Ray Practices In TB Screening Campaign

Pune: Citizens, Activists Raise Alarm Over Unsafe Chest X-Ray Practices In TB Screening Campaign

Activists and residents are raising serious concerns over the use of unsafe chest X-rays under the tuberculosis (TB) screening campaign launched by the District TB Office, Aundh, Pune.

Health Activists, Sharath Shetty, said, "X-rays are being conducted in an unsafe and unscientific manner. He alleged that in several cases, staff members are being asked to hold the film cassette in their hands while the X-ray is taken. This is absolutely the wrong method. The person holding the cassette is unnecessarily exposed to radiation, which can harm the retina, thyroid and reproductive organs."

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Experts point out that standard safety protocols require the use of a vertical chest stand or a portable chest stand readily available in the market for such radiographs. 

"Ignoring these practices compromises the health of the staff tasked with running the campaign," added Shetty. 

Residents also alleged that the campaign is being run to just show increased numbers on geb documents rather than to ensure quality healthcare. Employees are under pressure to meet targets, but their own safety is being neglected. Residents demand strict action against the administration for compromising the health of the staff and the patients coming for the screening. 

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The residents even said, "one technician is often made to take more than 25 radiographs in a day. Ideally, a single technician should not exceed 15–20 shoots, after which another technician should take over," but shockingly, many X-ray staff members reportedly lack even basic protective gear such as masks and radiation shields, leaving them further exposed to hazards. 

The concerns call for an urgent review of safety standards in the ongoing TB screening drive, with health activists insisting that worker safety must not be sacrificed for the sake of statistics.

Dr Vikash Wadgaye, district tuberculosis officer, Pune rural, "The TV mukt Bharat health campaign under the central government initiative started in the month of July in Pune, and so far we have screened around 200-300 patients across the Pune district. We are conducting the TV screening in 40 small pockets across Pune." 

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"The mass screening is done to find out the hidden cases so the disease can be stopped from spreading. There is no compromise with the health of the X-ray technicians as the centre has provided us 40 additional lead aprons, which protect the technicians from the harmful radiation. Also, we have received only one handheld X-ray for Pune's rural belt, but across districts, distribution has begun. These portable machines can conduct 200–300 scans and detect small pockets of infection. The stand has not been provided; they are also costly, but we will receive them soon. But nobody's health is compromised as these devices are called handheld X-ray and are lead-emitting radiations of very mild intensity."

Chest X-ray Aids In Early Diagnosis Of Children Exposed To TB

November 16, 2022

3 min read

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In children exposed to tuberculosis, chest radiography helped in detecting asymptomatic coprevalent TB and predicting incident TB after baseline, according to a study in American Journal of Respiratory and Critical Care Medicine.

Further, isoniazid preventive therapy (IPT) was 82% effective in preventing a future diagnosis of incident TB in asymptomatic children with abnormal chest radiographs, according to researchers.

The study's primary outcomes included coprevalent TB, or TB that presented at the beginning of the study, and incident TB, or TB diagnosed within a 1-year follow-up period among children without initial coprevalent TB. Source: Adobe Stock

"The clinical management of TB-exposed children involves two different decision points," Chuan-Chin Huang, ScD, professor in the department of global health and social medicine at Harvard Medical School, and colleagues wrote. "First, making a definitive diagnosis of TB disease in children is challenging because they are much less likely than adults to have microbiologically confirmed disease, and it is, therefore, necessary to rely on 'clinical diagnosis' using a combination of findings from history, physical exam, radiologic imaging, and TB immune-based testing (eg, tuberculin skin test [TST] and interferon-g release assays), all of which have their limitations.

"Second, clinicians are often reluctant to initiate [TB preventive therapy] for TB infection in children with clinical or radiologic abnormalities compatible with intrathoracic TB (but for which they have low suspicion that TB is indeed the etiology) because of the concern that a child with undetected TB disease who is inadvertently treated with preventive monotherapy might develop drug resistance," Huang and colleagues added.

In a longitudinal cohort study, Huang and colleagues evaluated 4,452 children from September 2009 to August 2012 in Lima, Peru who were exposed to TB through household contacts to observe the diagnostic and prognostic characteristics of chest radiography in this patient population.

Researchers additionally sought to understand the protective efficacy of IPT in children who had abnormal chest radiographs. Clinicians screened the children by TST, symptom assessment and chest radiography.

The study's primary outcomes included coprevalent TB, or TB that presented at the beginning of the study, and incident TB, or TB diagnosed within a 1-year follow-up period among children without initial coprevalent TB.

Of the 4,448 children screened for TB symptoms, 908 (20%) had positive results. Further, 1,124 of the 4,280 children (25%) screened by TST were positive.

Additionally, 1,012 (23%) children underwent chest radiography, of which 79 (2%) came back abnormal, and 2,320 (54%) children received IPT.

Overall, 95 children were diagnosed with coprevalent TB.

Researchers observed that those with TB symptoms had a 4.71 (95% CI, 2.93-7.59) higher likelihood to be diagnosed with coprevalent TB than asymptomatic children.

Coprevalent TB also appeared more likely in symptomatic vs. Asymptomatic children with normal chest radiographs (adjusted RR = 4.21; 95% CI, 1.28-13.86), according to researchers.

Among those with abnormal radiographs, researchers found that coprevalent TB was 25.06 (95% CI, 1.02-613.76) times more likely among asymptomatic children and 34.23 (95% CI, 7.58-154.68) times more likely among symptomatic children.

In terms of incident TB, 95 children were diagnosed during 1-year follow-up.

Incident TB diagnosis appeared more common among children who had abnormal chest radiographs and who were asymptomatic (adjusted HR = 26.71; 95% CI, 10.44-68.3), as well as symptomatic (aHR = 25.94; 95% CI, 4.1-164.28), compared with children with normal chest X-rays and no symptoms.

IPT showed 82% efficacy in the children who were asymptomatic and had an abnormal chest radiography (aHR = 0.18; 95% CI, 0.04-0.95).

Among children with TB symptoms and normal chest radiography, researchers found that two of the five (40%) children not given IPT developed incident TB compared with none of the seven children given IPT.

Additionally, of the 35 children who had a positive TST and abnormal chest radiography, researchers found that 28 of their radiography results did not suggest TB. IPT was found to be 93% effective in this subgroup, as eight out of 14 children not receiving IPT developed incident TB compared with only one child of 14 who received IPT.

Overall, of 46 asymptomatic children who had an abnormal chest X-ray at enrollment, 28 were diagnosed with coprevalent or incident TB.

"Our study suggests that the addition of radiography for child TB contacts may not only allow for TB diagnosis earlier than would be accomplished through symptom screening alone but may also identify a subgroup of child contacts at high risk of later TB progression," Huang and colleagues wrote. "We also show that nonspecific [chest radiography] findings in child TB contacts may indicate incipient or subclinical TB disease that requires formal treatment. However, access to tuberculosis preventive therapy should not be constrained because it remains highly effective in asymptomatic contacts, even in those with [chest radiography] abnormalities."

This study by Huang and colleagues adds to the literature indicating the importance of child TB prevention and the need for solid evidence in older children/adolescents who are diagnosed with TB, according to an accompanying editorial by Ben J. Marais, MD, PhD, professor at The University of Sydney Children's Hospital at Westmead Clinical School, and Stephen M. Graham, MD, PhD, professor of international child health at the University of Melbourne.

"Closing persistent gaps in child TB prevention and detection is essential to meet targets formulated at the United Nations high-level meeting on the fight against TB," Marais and Graham wrote. "In the end, [TB preventive treatment] implementation and scale-up will only be achieved if it is perceived as a priority by TB programs and major donors, as demonstrated by the high [TB prevention treatment] coverage in HIV programs. This will require practical implementation plans, reliable drug supply and effective monitoring and evaluation systems."

Reference:

Marais BJ, et al. Am J Respir Crit Care Med. 2022; doi:10.1164/rccm.202205-1023ED.

Sources/DisclosuresCollapse Disclosures: Huang reports receiving a grant from the National Institute of Allergy and Infectious Diseases. Please see the study for all other authors' relevant financial disclosures. Marais and Graham report no relevant financial disclosures.

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AI Software May Successfully Diagnose Tuberculosis

Artificial intelligence (AI) may help clinicians diagnose tuberculosis in parts of the world where radiologists are scarce, a new study suggests.

AI software successfully identified tuberculosis (TB) from cellphone photos of chest X-ray images, researchers reported at a European conference this week.

"We've shown that AI software is at least as good at detecting TB as a trained radiologist and that a simple mobile phone photograph is sufficient for analysis," said study leader Dr. Frauke Rudolf, of the infectious diseases department at Aarhus University Hospital, in Denmark.

Chest X-rays play an important role in detecting TB in patients unable to produce good quality sputum (phlegm) samples for microbiological analysis. Using software to help diagnose conditions based on the X-rays could help in areas with limited resources and few radiologists.

Rudolf's team set out to determine the accuracy of this method. They compared the performance of AI software in assessing chest X-rays with that of two Ethiopian radiologists with different levels of experience.

The AI was given mobile phone photographs of non-digital chest X-rays.

Among 498 patients, 11% had been diagnosed with TB, 41 clinically and 16 through PCR tests, the study authors noted.

The software was as good or better than a trained radiologist at identifying the PCR-confirmed cases. It correctly identified 75% of all PCR-confirmed cases and about 86% of non-TB cases.

By comparison, the less-experienced radiologist's assessments correctly picked up about 63% of the PCR-confirmed cases and correctly identified nearly 92% of those who didn't have TB.

The experienced radiologist correctly chose 75% of the PCR-confirmed cases and 82% of those that didn't have TB.

"With an estimated 3 million undiagnosed patients in 2021, there is an urgent need to develop novel strategies and technologies aimed at improving TB detection in low-resource, high-incidence settings," Rudolf said in a news release from the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID).

TB is a major cause of death and disease worldwide, killing 1.6 million people each year. It is the 13th leading cause of death globally and the second biggest infectious killer, after COVID-19.

"In low-resource areas with a high incidence of TB but a shortage of radiologists, chest X-rays could be photographed with a mobile phone and the image sent to be analyzed remotely by the AI," Rudolf said. "This would allow more chest X-rays to be read properly and, crucially, allow more cases of TB to be diagnosed."

The study was scheduled for presentation Monday at the ECCMID, in Denmark. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

More information

The U.S. Centers for Disease Control and Prevention has more on tuberculosis.

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