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This study proposes a novel lesion\u2010guided multimodal framework that fuses chest X\u2010ray (CXR) and lung sound data for TB detection, addressing the lack of synchronized datasets by leveraging a data\u2010driven pairing mechanism. A YOLOv8\u2010seg model was employed to localize pulmonary lesions, which are then mapped to anatomically corresponding auscultation sites using a rib\u2010guided quadrant extraction algorithm. This process generates a physiologically coherent paired dataset containing 450 CXR images and 2700 lung sound segments. A dual\u2010branch architecture is developed, consisting of a ResNet50 encoder for visual features and a convolutional recurrent neural network (CRNN) encoder for mel\u2010frequency cepstral coefficient (MFCC)\u2013based acoustic representations. Their probabilistic outputs are integrated using an optimized weighted decision\u2010level fusion strategy, with weights derived from unimodal validation performance. Simulation results show that the proposed multimodal framework outperforms both unimodal baselines, achieving 92% accuracy and an AUC of 0.98, compared with 0.95 (CXR\u2010only) and 0.81 (audio\u2010only). Qualitative Grad\u2010CAM and saliency analyses further confirm that the model focuses on interpretable radiographic lesions and crackle\u2010like audio patterns. These findings demonstrate that the proposed lesion\u2010guided multimodal framework offers a physiologically consistent and data\u2010efficient approach for TB screening, highlighting its potential for future clinically deployable diagnostic systems.<\/jats:p>","DOI":"10.1155\/acis\/8834581","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T12:12:03Z","timestamp":1780143123000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Clinical\u2010Contextual Framework for Multimodal Tuberculosis Detection From Asynchronous CXR and Lung Sound Data Using Lesion\u2010Guided Pairing and Decision Fusion"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9904-1191","authenticated-orcid":false,"given":"Yudi","family":"Candra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8184-4074","authenticated-orcid":false,"given":"Roslidar","family":"Roslidar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8749-3299","authenticated-orcid":false,"given":"Mulkan","family":"Azhary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6020-1275","authenticated-orcid":false,"given":"Fitri","family":"Arnia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5740-1938","authenticated-orcid":false,"given":"Kahlil","family":"Muchtar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"key":"e_1_2_11_1_2","unstructured":"World Health Organization Global Tuberculosis Report 2025 https:\/\/iris.who.int\/."},{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.21.0753"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.53347\/rID-17867"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.4103\/1817-1737.160831"},{"key":"e_1_2_11_5_2","volume-title":"Molecular WHO-Recommended Rapid Diagnostic Tests for Tuberculosis","author":"World Health Organization","year":"2023"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aej.2022.10.053"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.35882\/jeeemi.v7i1.572"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.52549\/ijeei.v12i4.5530"},{"key":"e_1_2_11_9_2","volume-title":"Lung Disease Early Screening and Classification","author":"LUDESC","year":"2025"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s44163-024-00179-4"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40537-023-00762-z"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13101748"},{"key":"e_1_2_11_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41551-023-01045-x"},{"key":"e_1_2_11_14_2","doi-asserted-by":"publisher","DOI":"10.36227\/techrxiv.175742700.07240558\/v1"},{"key":"e_1_2_11_15_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13071320"},{"key":"e_1_2_11_16_2","doi-asserted-by":"publisher","DOI":"10.47344\/tx89w092"},{"key":"e_1_2_11_17_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0296352"},{"key":"e_1_2_11_18_2","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2024.3414084"},{"key":"e_1_2_11_19_2","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering9070312"},{"key":"e_1_2_11_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/bib\/bbab569"},{"key":"e_1_2_11_21_2","unstructured":"SunL. 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