The Usefulness of Chest X-Ray Screening in Detecting Tuberculosis

Senior (College 4th year) ・Healthcare&Medicine ・APA ・2 Sources

The use of chest x-ray screening has become a vital diagnostic tool in checking conditions including lung cancer and tuberculosis. The effectiveness of the method in screening various condition has received different criticism with regard to accuracy. Numerous studies have been done, some of which refute the usefulness of the method while some confirm that it improves the treatment and management of conditions in question. The divergent opinion of authors establishes the need to select a particular article and critique it to determine the reliability of the paper. The present analysis critiques Weinrich et al. (2017) work on the determination of the yield of chest x-ray tuberculosis.

Summary of the Research

The researchers aimed at determining the prevalence of tuberculosis, the number required screening and the accuracy of chest X-ray to check the presence of active pulmonary TB among the 2015 European refugees. In the study, data of the refugees who had undergone chest x-ray screening in a section within the German metropolitan in the year 2015. In the study, the researchers checked for the prevalence of tuberculosis, the number needed for screening and accuracy of chest x-ray in the detection of active pulmonary TB. The utilized the existing cases which had been registered at Department of Public Health as a database. The total number of participants was 17487 immigrants who had undergone chest x-ray screening in the year 2015. The findings indicate that overall, the prevalence rate was 0.103%. The total number needed for screening was 1749, and the sensitivity of the chest x-ray was 55.6%. The researchers conclude that the technique had a low yield which was primarily associated with the minimal prevalence of the condition. Overall, the development of better strategies is critical to help in the screening of a large number of refugees.

Identification of the Problem

Tuberculosis remains to be a disease of global public health concern. Indeed, the treatment and management of the disease are dependent on how soon it is detected, followed by the adoption of relevant mitigation measures. Over the years, mass migration from low-income countries to Europe has seen an increase in TB prevalence, an issue that is both a national and global concern. For example, in the year 2015, many refugees migrated from poor countries which had a high rate of TB, to Germany. It is a requirement for refugees to undergo screening for TB through the use of chest x-ray. The measures are aimed at dealing with the condition before it progresses to life-threatening levels. The choice of a diagnostic tool to check TB should be guided by various factors including sensitivity, accuracy and the ability to detect a huge number of samples. In particular, the diagnostic tool should be able to screen a large proportion to help in preventing possible deaths. Studies have been conducted in the past to determine the usefulness of a various TB screening programs. Unfortunately, disparate results have been obtained with specific reference to chest x-ray screening (Van’t et al., 2013). The failure to determine the most appropriate screening tool significantly impedes efforts toward the management of the condition. Further, there is a high likelihood of mortality rates being realized because of the inability to detect the disease in time. Also, the considerable number of refugees migrating from countries having a high prevalence of TB affects efforts of treatment, if the screening program is not ascertained with regard to its effectiveness.

Critique of the Article

The article has been written with a focus on ensuring that it meets the established standards of scientific reporting. Indeed, significant efforts are evident with regard to the structure and flow of ideas from one section to the other. The aim of the research is clear, and the reader is able to comprehend the same from the beginning of the article. For example, it is evident that researchers are focusing on the determination of the accuracy of chest x-ray diagnosis of TB, the number required for screening and the prevalence of TB among migrant refugees. 
The methods used by the researchers to arrive at their results have been articulated in a clear and straightforward manner. The materials and methods that have been used by the researcher help in reaching the results which have been reported. The measures used by the researchers in performing statistical analysis after conducting the study have been provided. For example, the researchers resort to the use of R for statistical computations. It is critical to acknowledge that the method has been used by various researchers, hence providing reliability and validity to the study. The findings that have been reported in the article are in line with the objective that had been established by the authors. The ability to identify the aim of the study, and later link a discussion on the results which answer each of the individual objectives makes the article sufficient, as a tool for evidence-based practice. For example, in the discussion section, the researchers report;

“Our study revealed that routine CXR screening for pulmonary TB during the European refugee crisis in 2015 had a high specificity (98%). However, the prevalence of TB among the refuges is generally low (0.1%): only ten active cases were detected among the 17,487 refugees undergoing screening, resulting in a high NNS. In our study population, 1749 refugees had to undergo CXR to detect one case of active pulmonary TB. Overall, results of our study demonstrate that CXR screening for pulmonary TB during the 2015 European refugee crisis is of low yield”. (Weinrich et al. 2017).

Further, the article provides an in-depth discussion on the results which promotes the reader’s understanding of the subject matter. Scientific literature presents significant challenges for the readers to understand. However, in the present scenario, the information presented in the article is simple to comprehend, and readers are able to get a broader picture of the subject matter.

The article has incorporated information from the different scholarly literature. Indeed, the authenticity, reliability, and validity of a given article are measured by the kind of evidence it has and makes references to. In the current situation, the authors made significant efforts to ensure that they draw information from various sources which are current and relevant to the research in question. It is an attribute that provides strength to the article.

I agree with the information that has been provided by the authors. Indeed, the ability to adequately deal with the menace of TB infection especially among refugees is dependent on the kind of screening tools which have been adopted. The authors suggest the use of surveys, questionnaires to get an overview of the condition in the population of the refugees. However, they proceed to advise on the need to use other techniques including chest x-ray for the screening of TB. Indeed, the approach is essential since it will offer a broader picture of the prevalence of the disease amongst the refugee population. The authors further proceed to vouch for the development of an algorithm which will ensure that a significant number of refugees are screened for TB. The approach will help in the attainment of better results regarding the number of people who are possibly affected by the condition. I agree that indeed, there is need to develop improved techniques which will yield better results with regard to the diagnosis of TB.

The authors depict signs of biases with regard to the selection of the participants of the study. For example, despite the fact that refugees coming from poor countries may be harboring the TB disease, it is not logical to conclude that the original inhabitants may not be having the condition. It could be that the locals may be suffering from the disease as well. Therefore, in conducting the study, it could have been prudent to check the screening program not only on the refugees but the locals as well. However, the biases of the author could be due to the fact that they rely on studies which have been conducted in the past and they form the basis of the study.

Personal Opinion

All in all, I believe significant efforts have been put to ensure that the article attains the objective for which it was meant. I think the authors have done an impressive task with regard to the manner in which the study was performed. Overall, the article is excellent and has met the established standards of scientific and academic writing despite the minor variations identified including biases. 


Weinrich, J. M., Diel, R., Sauer, M., Henes, F. O., Meywald-Walter, K., Adam, G., ... & Bannas, P. (2017). Yield of chest X-ray tuberculosis screening of immigrants during the European refugee crisis of 2015: a single-centre experience. European radiology, 1-5.

Van’t Hoog, A. H., Langendam, M. W., Mitchell, E., Cobelens, F. G., Sinclair, D., Leeflang, M. M. G., & Lonnroth, K. (2013). A systematic review of the sensitivity and specificity of symptom-and chest-radiography screening for active pulmonary tuberculosis in HIV-negative persons and persons with unknown HIV status. REPORT-Version March 2013. World Health Organization, Geneva, Switzerland: WHO."

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