{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T21:58:07Z","timestamp":1787003887015,"version":"build-2736575974"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2015,7,27]],"date-time":"2015-07-27T00:00:00Z","timestamp":1437955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2015,7,27]],"date-time":"2015-07-27T00:00:00Z","timestamp":1437955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Molecular tests hold great potential for tuberculosis (TB) diagnosis, but are costly, time consuming and HIV-infected patients are often sputum scarce. Therefore, alternative approaches are needed. We evaluated automated digital chest radiography (ACR) as a rapid and cheap pre-screen test prior to Xpert MTB\/RIF (Xpert). 388 suspected TB subjects underwent chest radiography, Xpert and sputum culture testing. Radiographs were analysed by computer software (CAD4TB) and specialist readers and abnormality scores were allocated. A triage algorithm was simulated in which subjects with a score above a threshold underwent Xpert. We computed sensitivity, specificity, cost per screened subject (CSS), cost per notified TB case (CNTBC) and throughput for different diagnostic thresholds. 18.3% of subjects had culture positive TB. For Xpert alone, sensitivity was 78.9%, specificity 98.1%, CSS $13.09 and CNTBC $90.70. In a pre-screening setting where 40% of subjects would undergo Xpert, CSS decreased to $6.72 and CNTBC to $54.34, with eight TB cases missed and throughput increased from 45 to 113 patients\/day. Specialists, on average, read 57% of radiographs as abnormal, reducing CSS ($8.95) and CNTBC ($64.84). ACR pre-screening could substantially reduce costs and increase daily throughput with few TB cases missed. These data inform public health policy in resource-constrained settings.<\/jats:p>","DOI":"10.1038\/srep12215","type":"journal-article","created":{"date-parts":[[2015,7,27]],"date-time":"2015-07-27T06:41:31Z","timestamp":1437979291000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Automated chest-radiography as a triage for Xpert testing in resource-constrained settings: a prospective study of diagnostic accuracy and costs"],"prefix":"10.1038","volume":"5","author":[{"given":"R. H. H. M.","family":"Philipsen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. I.","family":"S\u00e1nchez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Maduskar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Melendez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Peters-Bax","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. G.","family":"Peter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Dawson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Theron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Dheda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"van Ginneken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2015,7,27]]},"reference":[{"key":"BFsrep12215_CR1","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1016\/S0140-6736(11)60438-8","volume":"377","author":"CC Boehme","year":"2011","unstructured":"Boehme, C. C. et al. Feasibility, diagnostic accuracy and effectiveness of decentralised use of the Xpert MTB\/RIF test for diagnosis of tuberculosis and multidrug resistance: a multicentre implementation study. Lancet. 377, 1495\u20131505 (2011).","journal-title":"Lancet."},{"key":"BFsrep12215_CR2","unstructured":"World Health Organization. WHO monitoring of Xpert MTB\/RIF roll-out. Available at: http:\/\/www.who.int\/tb\/laboratory\/mtbrifrollout\/en. (Accessed: 1st June, 2014)."},{"key":"BFsrep12215_CR3","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1186\/1471-2334-13-352","volume":"13","author":"M Shah","year":"2013","unstructured":"Shah, M., Chihota, V., Coetzee, G. Churchyard G. and Dorman S.E. Comparison of laboratory costs of rapid molecular tests and conventional diagnostics for detection of tuberculosis and drug-resistant tuberculosis in South Africa. BMC Infect Dis. 13, 352 (2013).","journal-title":"BMC Infect Dis."},{"key":"BFsrep12215_CR4","unstructured":"World Health Organization. Xpert MTB\/RIF implementation manual. Available at: http:\/\/apps.who.int\/iris\/bitstream\/10665\/112469\/1\/9789241506700_eng.pdf?ua=1. (Accessed: 1st June, 2014)."},{"key":"BFsrep12215_CR5","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/QAI.0b013e318246538f","volume":"60","author":"TO Abimbola","year":"2012","unstructured":"Abimbola, T. O. et al. Cost-effectiveness of tuberculosis diagnostic strategies to reduce early mortality among persons with advanced HIV infection initiating antiretroviral therapy. J Acquir Immune Defic Syndr. 60, e1\u2013e7 (2012).","journal-title":"J Acquir Immune Defic Syndr."},{"key":"BFsrep12215_CR6","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1097\/QAD.0b013e3283522d47","volume":"26","author":"JR Andrews","year":"2012","unstructured":"Andrews, J. R. et al. The cost-effectiveness of routine tuberculosis screening with Xpert MTB\/RIF prior to initiation of antiretroviral therapy: a model-based analysis. AIDS. 26, 987\u2013995 (2012).","journal-title":"AIDS."},{"key":"BFsrep12215_CR7","doi-asserted-by":"publisher","first-page":"e43307","DOI":"10.1371\/journal.pone.0043307","volume":"7","author":"SE Dorman","year":"2012","unstructured":"Dorman, S. E. et al. Performance characteristics of the Cepheid Xpert MTB\/RIF test in a tuberculosis prevalence survey. PLoS One. 7, e43307 (2012).","journal-title":"PLoS One."},{"key":"BFsrep12215_CR8","doi-asserted-by":"publisher","first-page":"e36966","DOI":"10.1371\/journal.pone.0036966","volume":"7","author":"G Meyer-Rath","year":"2012","unstructured":"Meyer-Rath, G. et al. The impact and cost of scaling up GeneXpert MTB\/RIF in South Africa. 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Trop Med Int Health. 17, 1142\u20131151 (2012).","journal-title":"Trop Med Int Health."},{"key":"BFsrep12215_CR11","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1183\/09031936.00145511","volume":"40","author":"G Theron","year":"2011","unstructured":"Theron, G. et al. Do adjunct TB tests, when combined with Xpert MTB\/RIF, improve accuracy and the cost of diagnosis in a resource-poor setting? Eur Respir J. 40, 161\u2013168 (2011).","journal-title":"Eur Respir J."},{"key":"BFsrep12215_CR12","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1183\/09031936.00147912","volume":"42","author":"A Pantoja","year":"2013","unstructured":"Pantoja, A., Fitzpatrick, C., Vassall, A., Weyer, K. & Floyd, K. Xpert MTB\/RIF for diagnosis of tuberculosis and drug-resistant tuberculosis: a cost and affordability analysis. Eur Respir J. 42, 708\u2013720 (2013).","journal-title":"Eur Respir J."},{"key":"BFsrep12215_CR13","unstructured":"World Health Organization. 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PLoS One. 9, e93757 (2014).","journal-title":"PLoS One."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/srep12215.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep12215","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep12215.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T09:58:45Z","timestamp":1672912725000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/srep12215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,7,27]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2015,12,18]]}},"alternative-id":["BFsrep12215"],"URL":"https:\/\/doi.org\/10.1038\/srep12215","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,7,27]]},"assertion":[{"value":"17 March 2015","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 June 2015","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 July 2015","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing financial interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"12215"}}