Tuberculosis Screening


Screen detection of tuberculosis on chest radiograph, in asymptomatic adults





Define-AI ID



Eric J. Stern

Panel Chair

Eric J. Stern

Panel Reviewers

Thoracic Panel


Creative Commons 4.0



RadElement Set RDES79 

Clinical Implementation

Value Proposition

The value proposition is well stated by the World Health Organization publication: Chest radiography in tuberculosis detection – summary of current WHO recommendations and guidance on programmatic approaches:

“Systematic screening for active pulmonary TB is defined as the “systematic identification of people with suspected active TB in a predetermined target group, using tests, examinations or other procedures that can be applied rapidly”. Unlike the evaluation of those who actively seek care for respiratory symptoms (see Tuberculosis, Triage), the systematic screening of individuals for TB is typically initiated by a provider and offered in a systematic way to an apparently healthy target group that has been determined to have a high risk of TB.

Systematic screening outside health facilities – such as in the community or in special institutions such as prisons or shelters for homeless people – is often labelled active case finding, which refers to a provider initiated approach that actively reaches outside the health services. Such screening can help find prevalent cases of TB in the community that might otherwise go undiagnosed and untreated. It often requires screening a large number of people who do not have TB. Costs can be high, and the risk of a false positive diagnosis is high when TB prevalence in the screened group is low or moderate (4). Therefore, choosing an accurate screening algorithm is critical, and there are specific considerations involved, including how well the screening and diagnostic tools perform in the population to be screened, the tradeoff between risks and benefits to the person being screened, the ability of the screening algorithms to detect TB without risking overdiagnosis, and the feasibility and costs.” [1]

The chest radiography (CXR) has high sensitivity for pulmonary TB and thus is a valuable tool to identify TB as a differential diagnosis for patients, especially when the radiograph is interpreted to identify any abnormality that is consistent with TB. However, many CXR abnormalities that are consistent with pulmonary TB are seen also in several other lung diseases, often with significant intra- and interobserver variation in interpretations, which can lead to both overdiagnosis and underdiagnosis.


In the specific context of a TB prevalence survey to determine the population prevalence of TB, screening is applied to identify individuals who should undergo bacteriological examinations. CXR is the most sensitive screening tool for identifying those survey participants with a high probability of having TB. For diagnosis, combining CXR and symptom checklists for screening (with, typically, a positive result in either category being sufficient to warrant further testing) with culture or an alternative bacteriological test with high sensitivity (such as the Xpert MTB/RIF assay), will generate the most accurate prevalence estimate for bacteriologically positive TB (the objective of a TB prevalence survey). CXR should, therefore, be used for all participants in a survey, regardless of their symptoms or risk markers.

Workflow Description

Image obtained from modality and sent to PACS (or mini-PACS) and the AI engine. Image analyzed by engine. System detects and characterizes exam for suspected tuberculosis. An alert message is sent to PACS from the engine with the information, and identification, and graphic highlighting abnormalities. Cases in which AI has detected active TB are flagged and prioritized for expedited reading in worklist.

Considerations for Dataset Development


XRAY, Chest


primarily AP, PA only, PA/Lat (supplementary Apical Lordotic or decubitus views)

Sex at Birth:



asyale, mptomatic


pleural fluid (including air/fluid levels), other lung disease (eg. bullous emphysema, malignancy, left-sided congestive heart failure, pulmonary edema, prior chest surgery, prior lung injury)

Lung Tissue Involvement:

right, left, bilateral


upper, middle, lower, diffuse, segmental or lobar cavitary, micronodular, nodular, calcifications, linear scarring

Technical Specifications




XRAY, Chest


PA, AP, PA/Lat, apical lordotic, lateral decubitus

Data Type




Body Region


Anatomic Focus







Primary Outputs

Tuberculosis Detection

RadElement ID



Detection of tuberculosis in symptomatic adult patient

Data Type


Value Set


1-Tuberculosis present

2-Tuberculosis absent





1. Chest radiography in tuberculosis detection – summary of current WHO recommendations and guidance on programmatic approaches. I. World Health Organization. ISBN 978 92 4 151150 6

Related Datasets

No known related public datasets at this time,  please alert us if you know of any.