{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:43:45Z","timestamp":1792014225577,"version":"4.4.0"},"reference-count":39,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization under Technical Services Agreement\u2014Project","doi-asserted-by":"publisher","award":["2020\/1071278-0"],"award-info":[{"award-number":["2020\/1071278-0"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Computer-aided detection (CAD) of pulmonary tuberculosis (TB) and silicosis among ex-miners from the South African gold mines has the potential to ease the backlog of lung examinations in clinical screening and medical adjudication for miners\u2019 compensation. This study aimed to determine whether CAD systems developed to date primarily for TB were able to identify TB (without distinction between prior and active disease) and silicosis (or \u201cother abnormality\u201d) in this population. Methods: A total of 501 chest X-rays (CXRs) from a screening programme were submitted to two commercial CAD systems for detection of \u201cany abnormality\u201d, TB (any) and silicosis. The outcomes were tested against the readings of occupational medicine specialists with experience in reading miners\u2019 CXRs. Accuracy of CAD against the readers was calculated as the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Sensitivity and specificity were derived using a threshold requiring at least 90% sensitivity. Results: One system was able to detect silicosis and\/or TB with high AUCs (&gt;0.85) against both readers, and specificity &gt; 70% in most of the comparisons. The other system was able to detect \u201cany abnormality\u201d and TB with high AUCs, but with specificity &lt; 70%. Conclusion: CAD systems have the potential to come close to expert readers in the identification of TB and silicosis in this population. The findings underscore the need for CAD systems to be developed and validated in specific use-case settings.<\/jats:p>","DOI":"10.3390\/ijerph191912402","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T21:03:10Z","timestamp":1664485390000},"page":"12402","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Accuracy of Computer-Aided Detection of Occupational Lung Disease: Silicosis and Pulmonary Tuberculosis in Ex-Miners from the South African Gold Mines"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5736-9237","authenticated-orcid":false,"given":"Rodney","family":"Ehrlich","sequence":"first","affiliation":[{"name":"Division of Occupational Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9958-9772","authenticated-orcid":false,"given":"Stephen","family":"Barker","sequence":"additional","affiliation":[{"name":"School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"te Water Naude","sequence":"additional","affiliation":[{"name":"Division of Occupational Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa"},{"name":"Diagnostic Medicine, Cape Town 7708, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Rees","sequence":"additional","affiliation":[{"name":"School of Public Health, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Kistnasamy","sequence":"additional","affiliation":[{"name":"Office of the Compensation Commissioner for Occupational Diseases, Johannesburg 2001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9782-553X","authenticated-orcid":false,"given":"Julian","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9103-4051","authenticated-orcid":false,"given":"Annalee","family":"Yassi","sequence":"additional","affiliation":[{"name":"School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1002\/ajim.22030","article-title":"A century of miners\u2019 compensation in South Africa","volume":"55","author":"Ehrlich","year":"2012","journal-title":"Am. J. Ind. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100065","DOI":"10.1016\/j.jmh.2021.100065","article-title":"Access of migrant gold miners to workers\u2019 compensation for occupational lung disease: Quantifying a legacy of injustice","volume":"4","author":"Ehrlich","year":"2021","journal-title":"J. Migration Health"},{"key":"ref_3","unstructured":"Padarath, A., and English, R. (2013). Occupational health challenges facing the Department of Health. South African Health Review 2012\/2013, Health Systems Trust."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1016\/S0140-6736(12)61698-5","article-title":"Southern African declaration targets TB in mining sector","volume":"380","author":"Baleta","year":"2012","journal-title":"Lancet"},{"key":"ref_5","unstructured":"The World Bank (2014). Benefits and Costs of Reducing Tuberculosis among Southern Africa\u2019s Mineworkers\u2014Overview, World Bank Group. Available online: https:\/\/documents.worldbank.org\/en\/publication\/documents-reports\/documentdetail\/333441468114546136\/benefits-and-costs-of-reducing-tuberculosis-among-southern-africas-mineworkers-overview."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Ehrlich, R., Akugizibwe, P., Siegfried, N., and Rees, D. (2021). Silica exposure, silicosis and tuberculosis\u2014A systematic review. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-10711-1"},{"key":"ref_7","unstructured":"(2022, July 07). TB in the Mining Sector in Southern Africa (TIMS) (Website, Undated). Available online: https:\/\/www.timssa.co.za\/Whoweare\/AboutTIMS.aspx."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12992-018-0376-3","article-title":"Tackling injustices of occupational lung disease acquired in South African mines: Recent developments and ongoing challenges","volume":"14","author":"Kistnasamy","year":"2018","journal-title":"Glob. Health"},{"key":"ref_9","unstructured":"Broughton, T. (2022, July 07). Landmark Silicosis Settlement Made Order of Court. Groundup. Available online: https:\/\/www.groundup.news\/article\/landmark-silicosis-settlement-made-order-court\/."},{"key":"ref_10","unstructured":"Tshiamiso Trust (Website, Undated) (2022, July 07). Medical Workshop on Sustainable Models of Medical Service Delivery for Mineworkers in Southern Africa. Available online: https:\/\/www.tshiamisotrust.com\/resources\/medical-workshop\/."},{"key":"ref_11","unstructured":"World Health Organization (2016). Chest Radiography in Tuberculosis Detection\u2014Summary of Current WHO Recommendations and Guidance on Programmatic Approaches, World Health Organization. WHO\/HTM\/TB\/2016.20."},{"key":"ref_12","unstructured":"World Health Organization (2014). High-Priority Target Product Profiles for New Tuberculosis Diagnostics: Report of a Consensus Meeting, 28\u201329 April 2014, Geneva, Switzerland, World Health Organization."},{"key":"ref_13","unstructured":"World Health Organization (2021). WHO Consolidated Guidelines on Tuberculosis. Module 2: Screening\u2014Systematic Screening for Tuberculosis Disease, World Health Organization. Licence: CC BY-NC-SA 3.0 IGO."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.5588\/ijtld.15.0926","article-title":"Computer-aided detection of pulmonary TB on digital chest radiographs: A systematic review","volume":"20","author":"Pande","year":"2016","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Harris, M., Qi, A., Jeagal, L., Torabi, N., Menzies, D., Korobitsyn, A., Pai, M., Nathavitharana, R.R., and Ahmad Khan, F. (2019). A systematic review of the diagnostic accuracy of artificial intelligence-based computer programs to analyze chest X-rays for pulmonary tuberculosis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0221339"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Breuninger, M., van Ginneken, B., Philipsen, R.H., Mhimbira, F., Hella, J.J., Lwilla, F., van den Hombergh, J., Ross, A., Jugheli, L., and Wagner, D. (2014). Diagnostic accuracy of computer-aided detection of pulmonary TB in chest radiographs: A validation study from sub-Saharan Africa. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0106381"},{"key":"ref_17","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":"Khan","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1136\/oemed-2019-106386","article-title":"Potential of deep learning in assessing pneumoconiosis depicted on digital chest radiography","volume":"77","author":"Wang","year":"2020","journal-title":"Occup. Environ. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1038\/s41598-020-77924-z","article-title":"A deep learning-based mode for screening and staging pneumoconiosis","volume":"11","author":"Zhang","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1002\/ajim.20602","article-title":"The burden of silicosis, pulmonary tuberculosis and COPD among former Basotho goldminers","volume":"51","author":"White","year":"2008","journal-title":"Am. J. Ind. Med."},{"key":"ref_21","first-page":"145","article-title":"Burden of disease among Basotho ex-miners in a large out-reach medical assessment programme","volume":"26","author":"Maboso","year":"2020","journal-title":"Occup. Health South. Afr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1179\/oeh.2000.6.3.215","article-title":"A proposed radiographic classification of TB to accompany the ILO International Classification of Radiographs of Pneumoconiosis","volume":"6","author":"Solomon","year":"2000","journal-title":"Int. J. Occup. Environ. Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1179\/oeh.2001.7.1.54","article-title":"Part 2\u2014A radiographic presentation of nodular TB and silicosis","volume":"7","author":"Solomon","year":"2001","journal-title":"Int. J. Occup. Environ. Health"},{"key":"ref_24","first-page":"25","article-title":"Back to Basics-the chest radiograph in silica associated tuberculosis","volume":"16","author":"Solomon","year":"2010","journal-title":"Occup. Health South. Afr."},{"key":"ref_25","first-page":"381","article-title":"Silicosis and tuberculosis","volume":"33","author":"Schepers","year":"1964","journal-title":"Ind. Med. Surg."},{"key":"ref_26","unstructured":"World Health Organization (2021). Determining the Local Calibration of Computer-Assisted Detection (CAD) Thresholds and Other Parameters: A Toolkit to Support the Effective Use of CAD for TB Screening, World Health Organization. Licence: CC BY-NC-SA 3.0 IGOWHO Handbook."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"444","DOI":"10.5588\/ijtld.19.0624","article-title":"Computer-aided Detection for TB and silicosis in chest radiographs of Southern African gold miners","volume":"24","author":"Young","year":"2020","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_28","unstructured":"Zhou, X. (2019). Receiver Operating Characteristic (ROC) Area under the Curve (AUC): A Diagnostic Measure for Evaluating the Accuracy of Predictors of Education Outcomes, Teachers College Columbia University. Available online: https:\/\/www.tc.columbia.edu\/elda\/blog\/content\/receiver-operating-characteristic-roc-area-under-the-curve-auc\/."},{"key":"ref_29","unstructured":"International Labour Organization (2022, July 07). ILO International Classification of Radiographs of Pneumoconioses (Digital Format). Available online: https:\/\/www.ilo.org\/global\/publications\/books\/WCMS_168337\/lang--en\/index.htm."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"h5527","DOI":"10.1136\/bmj.h5527","article-title":"STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies","volume":"351","author":"Bossuyt","year":"2015","journal-title":"BMJ"},{"key":"ref_31","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":"Qin","year":"2021","journal-title":"Lancet Digit. Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1002\/ajim.4700240408","article-title":"Correlation between radiological and pathological diagnosis of silicosis: An autopsy population based study","volume":"24","author":"Hnizdo","year":"1993","journal-title":"Am. J. Ind. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1002\/ajim.22803","article-title":"Comparison of digital and film chest radiography for detection and medical surveillance of silicosis and pulmonary tuberculosis","volume":"61","author":"Franzblau","year":"2018","journal-title":"Am. J. Ind. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1164\/rccm.200806-846OC","article-title":"HIV Infection does not affect active case finding of TB in South African gold miners","volume":"180","author":"Lewis","year":"2009","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_37","first-page":"523","article-title":"Screening for TB prior to isoniazid preventive therapy among HIV-infected gold miners in South Africa","volume":"10","author":"Day","year":"2006","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1007\/s00420-021-01805-9","article-title":"Reforming the workers\u2019 compensation process for occupational lung disease among miners in South Africa\u2014An efficiency study of claims assessment","volume":"95","author":"Barker","year":"2022","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"58","DOI":"10.5334\/aogh.3206","article-title":"Using artificial intelligence for high-volume identification of silicosis and tuberculosis: A bio-ethics approach","volume":"87","author":"Spiegel","year":"2021","journal-title":"Ann. Glob. Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/12402\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:41:44Z","timestamp":1760143304000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/12402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,29]]},"references-count":39,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph191912402"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191912402","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,29]]}}}