Submission ID 131919
| Issue/Objective | Nigeria is among the countries with the highest TB burden globally and contributes a substantial proportion of TB cases in Africa. Chest X-ray (CXR) plays an important role in TB screening and triage, particularly in active case-finding programs. However, the effective use of radiography is often limited by shortages of trained radiologists, delayed interpretation, and inconsistent reporting across health facilities. Teleradiology offers an opportunity to address these gaps by enabling remote expert interpretation of radiographic images. |
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| Methodology/Approach | The Instant Health Services X-ray Medical Analysis Platform (XMAP) was deployed as a digital teleradiology solution to support TB screening programs across multiple sites in Nigeria for remote review, interpretation and reporting. Images were transmitted via secure digital connectivity and reviewed by a network of trained radiologists using standardized TB reporting templates. Radiological findings were classified as suggestive or non-suggestive of pulmonary TB. Computer-aided detection using CAD4TB scoring was also integrated to support triage. Individuals with CXR findings suggestive of TB were referred for confirmatory bacteriological testing in accordance with national TB diagnostic algorithms. |
| Results | Between January and December 2025, 115,176 chest X-ray images from TB screening activities were uploaded and interpreted through the XMAP platform. Of these, 29,308 (25.4%) were classified as suggestive of TB, while 83,622 (72.6%) were non-suggestive. CAD4TB scores >40 were observed in 94,020 (81.6%) cases, among which 27,614 (29.4%) were interpreted as suggestive of TB by radiologists. In contrast, among 20,750 images with CAD4TB scores ≤40, only 1,694 (8.2%) were suggestive of TB. The platform enabled centralized interpretation of radiographic images from geographically dispersed screening sites, facilitating timely identification and referral of individuals with presumptive TB for confirmatory testing. |
| Discussion/Conclusion | The implementation of the XMAP teleradiology platform demonstrates the feasibility and effectiveness of scaling digital radiology services to support TB screening in high-burden settings. By improving access to expert CXR interpretation and enabling rapid identification of presumptive TB cases, teleradiology can significantly strengthen diagnostic pathways and support national efforts to close the TB detection gap. |
| Presenters and Affiliations | Kehinde Jimoh Agbaiyero Instant Health Services Odume Bethrand KNCV Nigeria Clement Adesigbin National TB and Leprosy Control Program Emperor Ubochioma National TB and Leprosy Control Program |
