Evaluation of a short training course of chest X-ray interpretation for the diagnosis of paediatric TB

The SCIEPR checklist: A tool for standardizing chest X-ray interpretation in resource-constrained settings - A pilot study

INTRODUCTION

Checklists improve performance in specialized fields such as radiology. The SCIEPR (Standardization, Communication, Image Evaluation, and Pattern Recognition) checklist was developed to aid nonradiologists in interpreting chest radiographs in district hospitals with no radiologists onsite. This study aims to investigate the clinical utility of the SCIEPR checklist.

METHODS

A descriptive cross-sectional pilot study included 103 participants, including 40 radiographers and 63 doctors from four district hospitals. Radiographers completed sections A and B regarding imaging protocols for chest radiographs, while doctors filled out section C for systematically searching for abnormalities. After four weeks of using the checklist, the participants completed a survey comprising 23 closed-ended and seven open-ended questions. Key measures included compliance in completing the checklist and evaluating the end-user's perceptions of the checklist.

RESULTS

Seventy-four SCIEPR checklists were adequately completed. Sections A and B had 100 % compliance. Two items were omitted from Section C. Forty-one participants completed the survey tool (22 doctors and 19 radiographers). Participants had mixed opinions on the checklist's impact on time and workload. No item changes were suggested. Participants reported that the checklist enhanced patient care, improved service quality, reduced interpretation time, and reduced patient waiting time.

CONCLUSION

Following the pilot study, we refined section C of the SCIEPR checklist, improving content and face validity. The SCIEPR checklist promotes interprofessional collaboration and may reduce omission errors by standardizing imaging protocols.

IMPLICATIONS FOR PRACTICE

The SCIEPR checklist is designed to enhance collaboration between radiographers and medical doctors in chest imaging and interpretation. Its main goal is to improve the consistency and accuracy of chest X-ray interpretations, particularly in resource-limited settings with no radiologist onsite.

Implementation of digital chest radiography for childhood tuberculosis diagnosis at district hospital level in six high tuberculosis burden and resources limited countries

OBJECTIVES

Chest x-ray (CXR) plays an important role in childhood tuberculosis (TB) diagnosis, but access to quality CXR remains a major challenge in resource-limited settings. Digital CXR (d-CXR) can solve some image quality issues and facilitate their transfer for quality control. We assess the implementation of introducing d-CXR in 12 district hospitals (DHs) in 2021-2022 across Cambodia, Cameroon, Ivory Coast, Mozambique, Sierra Leone and Uganda as part of the TB-speed decentralisation study on childhood TB diagnosis.

METHODS

For digitisation of CXR, digital radiography (DR) plates were setup on existing analogue radiography devices. d-CXR were transferred to an international server at Bordeaux University and downloaded by sites' clinicians for interpretation. We assessed the uptake and performance of CXR services and health care workers' (HCW) perceptions of d-CXR implementation. We used a convergent mixed method approach utilising process data, individual interviews with 113 HCWs involved in performing or interpreting d-CXRs and site support supervision reports.

RESULTS

Of 3104 children with presumptive TB, 1642 (52.9%) had at least one d-CXR, including 1505, 136 and 1 children with one, two and three d-CXRs, respectively, resulting in a total of 1780 d-CXR. Of them, 1773 (99.6%) were of good quality and 1772/1773 (99.9%) were interpreted by sites' clinicians. One hundred and sixty-four children had no d-CXR performed despite attending the radiography department: 126, 37 and 1 with one, two and three attempts, respectively. d-CXRs were not performed in 21.6% (44/203) due to connectivity problem between the DR plate captor and the computer. HCW reported good perceptions of d-CXR and of the DR plates provided. The main challenge was the upload to and download from the server of d-CXRs due to limited internet access.

CONCLUSION

d-CXR using DR plates was feasible at DH level and provided good quality images but required overcoming operational challenges.