Diagnosing Tuberculosis: The Limitations of Common Procedures, and How Reveal™ 35C Can Help

Tuberculosis (TB) is an infectious disease that occurs in every part of the world. It is spread through airborne bacteria from one person to the next without physical contact.
  

Although cases are relatively low in Canada and the US, in 2019 alone, 1.4 million people died from TB worldwide5. Tuberculosis is latent in most cases, but approximately 5% of people who are exposed end up with active infections that could be fatal5.
  

Since TB is preventable and curable, the World Health Organization aims to eliminate it by 2030. They estimate that 60 million lives have been saved globally through TB diagnosis and treatment between 2000 and 20195.
  

It is critical that tuberculosis be reported and treated in a timely fashion to prevent the spread of infection. Initial diagnosis is made by reviewing case history, blood and skin tests, with chest X-ray and computed tomography (CT) used to follow up, if accessible. Treatment begins with antibiotic medication that can span many months. 

According to a study published in 2015, chest radiography plays a major role in diagnosing and monitoring TB3. Recently, the World Health Organization (WHO) also issued guidance recommending the use of chest X-ray to initially screen for TB7.

Here are 3 issues to consider when using X-ray imaging:
 

Problem 1: Quality
 

X-ray is not effective in finding consolidation and cavitation, which are key signs of TB infection in the chest. Conventional X-ray imaging technology is thus inaccurate and unreliable for screening TB. Computed tomography scans are much more accurate, but these are not accessible in the parts of the world suffering from TB. 

How Reveal™ 35C can help:
  

Reveal 35C, a dual-energy subtraction X-ray, enables bone and tissue differentiation without motion artifacts in a single shot. It provides radiologists with three images, a high–quality X-ray, a bone-subtracted one, and a tissue-subtracted image. The bone-subtracted image in particular has been demonstrated in a clinical study3 to find more consolidation and cavitation than a standard digital X-ray and also to have a large negative predictive value. This allows more accurate detection of tuberculosis especially for screening.

Problem 2: Availability/Cost 

While X-ray technology is widely accessible in countries with a high prevalence of TB, there is almost always a challenge in accessing CT especially in remote locations. There are fewer machines and fewer hospitals and clinics that have them and CT is not portable.
  

In many areas of the world, CT technology is not an option at all. There are a limited number, if any, scanners available. This is mainly due to lack of funding. Although X-ray technology cannot replace CT, a more advanced X-ray can aid in diagnosis and portability provides the much–needed accessibility for remote locations.
 

How Reveal 35C can help:
  

Reveal 35C dual-energy X-ray detector is easily retrofittable into most portable and fixed X-ray systems. Reveal 35C is portable and can be taken right to a patient’s bedside or alternately, to the village. Reveal 35C provides a standard chest X-ray alongside bone and tissue images in just one shot, saving time and X-ray dose. It allows for faster reading and aids radiologists especially with difficult cases involving consolidation and cavitation.
  

Not only is Reveal 35C portable, it is available at less than a quarter of the price of other fixed dual-energy systems and can be used with any existing X-ray system reducing the need for large capital expenditures.
  

Problem 3: Radiation Dose
 

X-ray is the preferred method of diagnostic imaging for diagnosing TB, especially as a first step, due the lower dose of radiation used. Chest X-rays typically produce about 0.1 mSv of radiation1 which is well within the recommended public dose limit per year of 1 mSv1. CT scans require anywhere from 20-50X the radiation of a chest X-ray and thus, cannot be used as a screening tool for patients.
  

How Reveal 35C can help: 

Reveal 35C provides very high DQE digital radiography images, differentiates bone and soft tissue while maintaining the same exposure to radiation as a chest X-ray. 
  

Reveal 35C and TB:

KA Imaging was featured in a report about digital chest radiography and computer-aided detection solutions by the Foundation for Innovative New Diagnostics (FIND)6. They explored the market of radiology solutions for screening TB in order to help readers understand the different options and recognized the many benefits of using Reveal 35C in a TB screening application. 

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