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Advancing the diagnosis of child TB: CXR Image Library

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Today, The Union is releasing Diagnostic CXR Atlas for Tuberculosis in Children Image Library. The online image library contains a collection of chest x-rays (CXRs) from children less than 15 years of age and who present with symptoms and signs of tuberculosis (TB).

We have developed this library to increase access to appropriate capacity building resources on CXRs in children, especially for frontline health professionals working in resource-limited settings.

In March 2022, The Union launched Diagnostic CXR Atlas for Tuberculosis in Children: A Guide to Chest X-ray Interpretation. This second edition of the widely used Atlas, first published in 2003, was revised extensively with the aim of assisting non-specialist healthcare workers in high tuberculosis (TB)-burden settings to interpret chest x-rays (CXRs) from children investigated for TB.

CXRs are a critical component of the child TB diagnostic approach and yet, in many contexts, healthcare workers feel a pressing need to strengthen their ability to interpret CXR images. To become confident and good at interpreting CXRs requires looking at many images and discussing them with more experienced colleagues, specialists and mentors. Such experienced colleagues may not be available in all health facilities where children who are presumed to have TB present themselves.

The images within the online library are arranged into seven categories that are explained in the above-mentioned Atlas. They are:

  • Uncomplicated lymph node disease
  • Cavitary disease
  • Complicated lymph node disease
  • Consolidations
  • Military TB
  • Pleural effusions
  • Other

As it is important for healthcare workers interpreting CXRs to recognise various normal patterns, also images of normal CXRs after their technical quality has been assured have been included.

Dr Megan Palmer, who is the lead author and coordinator of the library, noted that despite substantial progress in the prevention and treatment of TB approximately 250,000 children still die from this curable disease every year. A significant policy-practice gap remains in the settings with a high burden of TB. Megan said: “I believe that this image library makes yet another contribution to narrowing this unfortunate gap and enhances child survival.”