Tuberculosis (TB) is a highly contagious disease spread through airborne bacteria. Seniors are particularly susceptible to tuberculosis due to their deteriorating health, which heavily impacts the body’s ability to fight off TB bacteria. For long term care homes housing various senior residents, TB screening is essential to combat the risks of spreading infection to a vulnerable population. Traditional X-ray can detect lung abnormalities, but dual-energy X-ray has been shown to improve detection compared to traditional methods. This article explores the use of traditional X-ray for TB screening and how DE has potential to provide more accurate X-ray results for long term care residents at risk of tuberculosis.
Traditional Chest X-ray (CXR) for Tuberculosis (TB) Screening
Tuberculosis can be located in multiple areas of the body, including the brain, heart, bones, and kidneys. However, it is most often found in the lungs. This is known as pulmonary tuberculosis.
The World Health Organization does not recommend traditional CXR as a diagnosis method for TB. However, it is still considered a useful screening method, especially when pulmonary TB cannot be diagnosed through bacteriological methods. Traditional CXR is highly sensitive to lung abnormalities consistent with TB. A large portion of people infected with TB, especially early into the disease, are asymptomatic. In most TB screening cases, traditional CXR is a tool that provides clarity when bacteriological examination results are unclear.
How Dual Energy CXR Increases Sensitivity for TB Screening
Dual energy subtraction (DES) imaging is not standard for TB screening. That being said, compared to traditional CXR, studies show that DE-CXR performs better than DR in detection of nodules, consolidation, and cavitation in pulmonary TB. DES historically has not been widely used for tuberculosis detection due to higher costs, lack of portability and higher radiation, although a newer single exposure DES detector – the Reveal 35C – is promising because it maintains CXR radiation dose and clinical technique. We look forward to conducting further studies and tests to evaluate its value in TB screening in LTCH.
The First Portable Dual Energy X-Ray: Reveal 35C
KA Imaging developed a portable dual energy X-ray detector, Reveal 35C, built to overcome challenges typically seen with dual energy X-ray solutions. It is proven to improve the appearance of pulmonary lesions by up to 43%, and compared to traditional X-ray, increases confidence in ICU cases by 57% without any additional radiologist reading time. Let’s explore some of the ways that using Reveal 35C can add value in TB management:
Portability
Reveal 35C is the first commercial X-ray to offer dual-energy capabilities in a portable format. Reveal 35C’s SpectralDR technology enables high visibility with dual energy capabilities that separate bone from soft tissue. The ability to be portable while not sacrificing effectiveness is crucial. While fixed applications present concerns with patient comfort and mobility, Reveal 35C can screen for tuberculosis from the bed-side.
Moving patients around a clinical space should be avoided when possible because some patients struggle with mobility issues, especially in long-term care homes. The spread of infection through patient movement is also a pressing concern. For this reason, the portability of clinical tools like an x-ray is extremely impactful to patient comfort and safety.
Quick Workflow
Reveal 35C can be used without any changes to current TB screening workflows. The Reveal 35C processes images in 20-second cycle time, producing three distinct images: a traditional DR image, a bone image, and a soft tissue image. This quick dual energy technique is able to subtract the presence of obstructions that can conceal vital diagnostic information. The three images are produced with only one exposure and a standard radiation dose, reducing the health risks associated with radiation overexposure.
In 2021, the World Health Organization included Reveal 35C as part of its compendium of innovative health technologies for low-resource settings. While Reveal 35C has advanced dual-energy capabilities, it is available at a comparable price to other traditional fixed CXR systems.
Ready to learn more? Contact us today for more details on Reveal 35C’s imaging capabilities.
The State of Tuberculosis (TB) Screening for Long Term Care Homes in 2025
Ontario’s Long Term Care Home Act mandates that all incoming residents must go through a tuberculosis screening before being admitted to a long term care home. TB screening must take place within 14 days of admission. If a potential resident has already been screened for TB 90 days prior to admission, another screening will not be needed as long as there is documentation available that proves a negative diagnosis. Ideally, long term care homes should screen for TB routinely.
There is no specific TB screening method that Ontario mandates. Common methods for TB screening in Ontario include:
- TB Blood Test: Acquires a blood sample and then analyzes how the immune system reacts when your blood is mixed with TB bacteria.
- TB Skin Test: A small needle injects tuberculin into your arm. A follow-up visit takes place a few days after to assess your body’s reaction to the tuberculin, which will determine whether you’re infected.
- Chest X-ray: An X-ray image captures the internal bones and tissue of the chest. A technician then analyzes this image for radiographic abnormalities consistent with tuberculosis. Dual energy X-rays are capable of material separation, which can separate the bone (ribs) from soft tissue (lungs) for better detection of abnormalities.
- Sputum Smear Test: Sputum is a mucus found in the lungs. This test acquires a sample of that mucus and analyzes the sample for TB germs and bacteria.
- Nucleic Acid Amplification Tests: NAAT tests take a blood sample and amplify the genetic material to detect the presence of viruses like tuberculosis.