{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:34:50Z","timestamp":1793140490584,"version":"4.5.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T00:00:00Z","timestamp":1734480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>World Health Organization (WHO) tuberculosis (TB) screening guidelines recommend computer-aided detection (CAD) software for chest radiograph (CXR) interpretation. However, studies evaluating their diagnostic and prognostic accuracy are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective cohort study of household contacts of rifampicin-resistant TB in South Africa. Participants underwent baseline CXR and sputum investigation (routine [single spontaneous] and enhanced [additionally 2\u20133 induced]) for prevalent TB and follow-up for incident TB. Three CXR-CAD software products (CAD4TBv7.0, qXRv3.0.0, and Lunit INSIGHT v3.1.4.111) were compared. We evaluated their performance to detect routine and enhanced prevalent and incident TB, comparing performance with blood tests (Xpert MTB host-response, erythrocyte sedimentation rate, C-reactive protein, QuantiFERON) in a subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>483 participants were followed up for 4.6 years (median). There were 23 prevalent (7 routinely diagnosed) and 38 incident TB cases. The AUC ROCs (95% CIs) to identify prevalent TB for CAD4TBv7.0, qXRv3.0.0, and Lunit INSIGHT v3.1.4.111 were .87 (.77\u2013.96), .88 (.79\u2013.97), and .91 (.83\u2013.99), respectively. More than 30% with scores above recommended CAD thresholds who were bacteriologically negative on routine baseline sputum were subsequently diagnosed by enhanced sputum investigation or during follow-up. The AUC performance of baseline CAD to identify incident cases ranged between .60 and .65. Diagnostic performance of CAD for prevalent TB was superior to blood testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest that the potential of CAD-CXR screening for TB is not maximized as a high proportion of those above current thresholds, but with a negative routine confirmatory sputum, have true TB disease that may benefit intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciae528","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T07:17:23Z","timestamp":1731914243000},"page":"626-636","source":"Crossref","is-referenced-by-count":15,"title":["Diagnostic Accuracy of Chest X-ray Computer-Aided Detection Software for Detection of Prevalent and Incident Tuberculosis in Household Contacts"],"prefix":"10.1093","volume":"80","author":[{"given":"Liana","family":"Macpherson","sequence":"first","affiliation":[{"name":"MRC Clinical Trials Unit, University College London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0662-4899","authenticated-orcid":false,"given":"Sandra V","family":"Kik","sequence":"additional","affiliation":[{"name":"FIND , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4446-0730","authenticated-orcid":false,"given":"Matteo","family":"Quartagno","sequence":"additional","affiliation":[{"name":"MRC Clinical Trials Unit, University College London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Lakay","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marche","family":"Jaftha","sequence":"additional","affiliation":[{"name":"Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nombuso","family":"Yende","sequence":"additional","affiliation":[{"name":"Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shireen","family":"Galant","sequence":"additional","affiliation":[{"name":"Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saalikha","family":"Aziz","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remy","family":"Daroowala","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7927-6506","authenticated-orcid":false,"given":"Richard","family":"Court","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1385-1643","authenticated-orcid":false,"given":"Arshad","family":"Taliep","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keboile","family":"Serole","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene T","family":"Goliath","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nashreen Omar","family":"Davies","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Jackson","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Douglass","sequence":"additional","affiliation":[{"name":"Rutgers\u2013New Jersey Medical School, Center for Emerging Pathogens , Newark, New Jersey ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6028-3351","authenticated-orcid":false,"given":"Bianca","family":"Sossen","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Mukasa","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4801-2030","authenticated-orcid":false,"given":"Friedrich","family":"Thienemann","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Department of Internal Medicine, University Hospital of Zurich, University of Zurich , Zurich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taeksun","family":"Song","sequence":"additional","affiliation":[{"name":"Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Ruhwald","sequence":"additional","affiliation":[{"name":"FIND , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2753-1800","authenticated-orcid":false,"given":"Robert J","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Francis Crick Institute , London ,","place":["United Kingdom"]},{"name":"Department of Infectious Diseases, Imperial College London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7086-2621","authenticated-orcid":false,"given":"Anna K","family":"Coussens","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research (WEHI) , Parkville ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4278-9316","authenticated-orcid":false,"given":"Hanif","family":"Esmail","sequence":"additional","affiliation":[{"name":"MRC Clinical Trials Unit, University College London , London ,","place":["United Kingdom"]},{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"WHO Collaborating Centre for TB Research and Innovation, Institute for Global Health, University College London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Imaging of TB Household Contacts Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Clifton E","family":"Barry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerrold J","family":"Ellner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoAnne L","family":"Flynn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torben","family":"Heinsohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"C Robert","family":"Horsburgh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen R","family":"Jacobson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanus T","family":"Malherbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Padmini","family":"Salgame","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Sheerin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Streicher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mpho","family":"Tlala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E","family":"Via","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Walzl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Warren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Warwick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,12,18]]},"reference":[{"key":"2025031715501372500_ciae528-B1","volume-title":"Global tuberculosis report 2024","author":"World Health Organization","year":"2024"},{"key":"2025031715501372500_ciae528-B2","doi-asserted-by":"crossref","first-page":"934","DOI":"10.5588\/ijtld.19.0764","article-title":"A comparison of digital chest radiography and Xpert\u00ae MTB\/RIF in active case finding for tuberculosis","volume":"24","author":"Nguyen","year":"2020","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025031715501372500_ciae528-B3","doi-asserted-by":"crossref","first-page":"665","DOI":"10.5588\/ijtld.19.0501","article-title":"Automated chest radiography and mass systematic screening for tuberculosis","volume":"24","author":"Madhani","year":"2020","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025031715501372500_ciae528-B4","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1111\/tmi.12534","article-title":"National tuberculosis prevalence surveys in Asia, 1990\u20132012: an overview of results and lessons learned","volume":"20","author":"Onozaki","year":"2015","journal-title":"Trop Med Int Health"},{"key":"2025031715501372500_ciae528-B5","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1111\/tmi.13485","article-title":"National tuberculosis prevalence surveys in Africa, 2008\u20132016: an overview of results and lessons learned","volume":"25","author":"Law","year":"2020","journal-title":"Trop Med Int Health"},{"key":"2025031715501372500_ciae528-B6","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1136\/thoraxjnl-2020-216409","article-title":"Gender-based differences in community-wide screening for pulmonary tuberculosis in Karachi, Pakistan: an observational study of 311 732 individuals undergoing screening","volume":"77","author":"Habib","year":"2022","journal-title":"Thorax"},{"key":"2025031715501372500_ciae528-B7","doi-asserted-by":"crossref","first-page":"e830","DOI":"10.1093\/cid\/ciaa1402","article-title":"Subclinical tuberculosis disease-a review and analysis of prevalence surveys to inform definitions, burden, associations, and screening methodology","volume":"73","author":"Frascella","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2025031715501372500_ciae528-B8","volume-title":"Module 2: Screening WHO operational handbook on tuberculosis. Systematic screening for tuberculosis disease","author":"World Health Organization","year":"2021"},{"key":"2025031715501372500_ciae528-B9","author":"The Stop TB Partnership","year":"2023"},{"issue":"9","key":"2025031715501372500_ciae528-B10","doi-asserted-by":"crossref","first-page":"e543","DOI":"10.1016\/S2589-7500(21)00116-3","article-title":"Tuberculosis detection from chest x-rays for triaging in a high tuberculosis-burden setting: an evaluation of five artificial intelligence algorithms","volume":"3","author":"Zhen Qin","year":"2021","journal-title":"Lancet Digit Health"},{"key":"2025031715501372500_ciae528-B11","doi-asserted-by":"crossref","first-page":"15000","DOI":"10.1038\/s41598-019-51503-3","article-title":"Using artificial intelligence to read chest radiographs for tuberculosis detection: a multi-site evaluation of the diagnostic accuracy of three deep learning systems","volume":"9","author":"Qin","year":"2019","journal-title":"Sci Rep"},{"key":"2025031715501372500_ciae528-B12","doi-asserted-by":"crossref","first-page":"e573","DOI":"10.1016\/S2589-7500(20)30221-1","article-title":"Chest x-ray analysis with deep learning-based software as a triage test for pulmonary tuberculosis: a prospective study of diagnostic accuracy for culture-confirmed disease","volume":"2","author":"Khan","year":"2020","journal-title":"Lancet Digit Health"},{"key":"2025031715501372500_ciae528-B13","doi-asserted-by":"crossref","first-page":"e0221339","DOI":"10.1371\/journal.pone.0221339","article-title":"A systematic review of the diagnostic accuracy of artificial intelligence-based computer programs to analyze chest x-rays for pulmonary tuberculosis","volume":"14","author":"Harris","year":"2019","journal-title":"PLoS One"},{"key":"2025031715501372500_ciae528-B14","doi-asserted-by":"crossref","first-page":"1700953","DOI":"10.1183\/13993003.00953-2017","article-title":"Computer-aided reading of tuberculosis chest radiography: moving the research agenda forward to inform policy","volume":"50","author":"Ahmad Khan","year":"2017","journal-title":"Eur Respir J"},{"key":"2025031715501372500_ciae528-B15","first-page":"100388","article-title":"Evaluation of chest X-ray with automated interpretation algorithms for mass tuberculosis screening in prisons: a cross-sectional study","volume":"17","author":"Soares","year":"2023","journal-title":"Lancet Reg Health Am"},{"key":"2025031715501372500_ciae528-B16","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/S2213-2600(23)00097-8","article-title":"The natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis","volume":"11","author":"Sossen","year":"2023","journal-title":"Lancet Respir Med"},{"key":"2025031715501372500_ciae528-B17","doi-asserted-by":"publisher","article-title":"High resolution imaging and five-year tuberculosis contact outcomes","author":"Esmail","DOI":"10.1101\/2023.07.03.23292111"},{"key":"2025031715501372500_ciae528-B18","volume-title":"WHO consolidated guidelines on tuberculosis. Module 2: screening\u2014systematic screening for tuberculosis disease","author":"World Health Organization","year":"2021"},{"key":"2025031715501372500_ciae528-B19","first-page":"1143","article-title":"Data centre profile: the provincial health data centre of the Western Cape Province, South Africa","volume":"4","author":"Boulle","year":"2019","journal-title":"Int J Popul Data Sci"},{"key":"2025031715501372500_ciae528-B20","doi-asserted-by":"crossref","first-page":"25265","DOI":"10.1038\/srep25265","article-title":"An automated tuberculosis screening strategy combining X-ray-based computer-aided detection and clinical information","volume":"6","author":"Melendez","year":"2016","journal-title":"Sci Rep"},{"key":"2025031715501372500_ciae528-B21","doi-asserted-by":"crossref","first-page":"880","DOI":"10.5588\/ijtld.16.0851","article-title":"Automatic versus human reading of chest X-rays in the Zambia National Tuberculosis Prevalence Survey","volume":"21","author":"Melendez","year":"2017","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025031715501372500_ciae528-B22","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.5588\/ijtld.17.0827","article-title":"Computer-assisted chest radiography reading for tuberculosis screening in people living with diabetes mellitus","volume":"22","author":"Koesoemadinata","year":"2018","journal-title":"Int J Tuberc Lung Dis"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciae528\/61196604\/ciae528.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/80\/3\/626\/61196604\/ciae528.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/80\/3\/626\/61196604\/ciae528.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T11:50:53Z","timestamp":1742212253000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/80\/3\/626\/7925268"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,18]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,12,18]]},"published-print":{"date-parts":[[2025,3,17]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciae528","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,3,15]]},"published":{"date-parts":[[2024,12,18]]}}}