DOI: 10.5061/dryad.280gb5n3f
title: Bridging the analog divide: A comparison of printed X-ray films and digital images when using computer-aided detection software for tuberculosis screening

description: Computer-aided detection (CAD) software provides scalable, standardized
 chest X-ray (CXR) interpretation, helping address the global shortage of
 radiologists and inter-reader variability. Printed X-ray films remain
 common in many low-resource settings, yet most CAD software can only
 process Digital Imaging and Communications in Medicine (DICOM)
 files. Genki software (DeepTek, India) is one of the few World
 Health Organization (WHO)-recommended CAD software capable of interpreting
 both DICOM files and photographs of printed X-ray films (Joint
 Photographic Experts Group [JPEG] files), but its performance using JPEG
 files has not been independently evaluated. We evaluated Genki software
 using a test library of 1,466 CXR images of adults collected during mobile
 CXR screening for tuberculosis (TB) in Ho Chi Minh City, Viet Nam. Each
 test library participant’s TB status was determined using a composite
 reference standard, based on radiological findings and Xpert MTB/RIF Ultra
 testing. Each CXR image was blindly re-read by 10 human readers and
 processed by Genki software using both DICOM and JPEG files. Genki
 software performance was evaluated using median abnormality scores, area
 under the receiver operating characteristic curves (AUC), and
 sensitivity/specificity comparisons at different abnormality score
 thresholds. Genki software abnormality scores were significantly higher
 when using JPEG files, but this did not translate into significant
 differences in AUCs between the file types (DICOM AUC=0.94 vs JPEG
 AUC=0.92, p=0.190). When abnormality score thresholds were calibrated to
 match average human reader sensitivity (79.0%), Genki achieved
 significantly higher specificity with both DICOM (95.2% vs 84.8%,
 p&lt;0.001) and JPEG (92.1% vs 94.8%, p&lt;0.001) files. When the
 software’s abnormality score thresholds were calibrated to achieve 90%
 sensitivity, Genki maintained high specificity with both DICOM (89.3%) and
 JPEG (81.1%) file types, exceeding the minimum Target Product Profile
 (TPP) criteria for a community-based TB referral test. Genki software
 performs comparably when interpreting DICOM files and photographs of
 printed X-ray films, outperforming human readers and meeting TPP criteria
 with both file types. This capability enhances its usability in
 resource-limited settings where digital infrastructure is lacking,
 supporting its broader deployment for TB screening. Further research is
 needed to assess real-world implementation and performance in diverse
 populations and clinical environments.
description: # Bridging the analog divide: A comparison of printed X-ray films and
 digital images when using computer-aided detection software for
 tuberculosis screening Dataset DOI:
 [10.5061/dryad.280gb5n3f](https://doi.org/10.5061/dryad.280gb5n3f) ##
 Description of the data and file structure This dataset was generated to
 support an independent evaluation of the Genki computer-aided detection
 (CAD) software (DeepTek, India) for chest X-ray (CXR) interpretation
 during tuberculosis (TB) screening. Data were collected during 133 mobile
 CXR screening events conducted across five districts in Ho Chi Minh City,
 Viet Nam, between July 2022 and March 2023. The de-identified dataset
 includes records from 1,466 adult participants. Each participant’s TB
 status was determined using a composite reference standard that combined
 radiological interpretations with Xpert MTB/RIF Ultra assay results. Each
 participant’s CXR image was blindly re-read by 10 TB clinicians and
 processed twice using the Genki CAD software: first using Digital Imaging
 and Communications in Medicine (DICOM) files, and then using photographs
 of printed X-ray films (JPEG files). The dataset also includes
 demographic, symptom, and clinical data extracted from the electronic data
 capture system used during the mobile screening activities. ### Files and
 variables #### File: Genki_CAD_Evaluation_-_Dryad_Data.xlsx #####
 Variables * \[study_id] * \[sex] - 1 or 2 * \[age_group] - 1: 18-54 years
 2: ≥55 years * \[shi] - Social health insurance - 0: No 1: Yes * \[c] -
 Cough - 0: No 1: Yes * \[f] - Fever - 0: No 1: Yes * \[wl] - Weight loss -
 0: No 1: Yes * \[ns] - Night sweats - 0: No 1: Yes * \[c_f_wl_ns] - WHO
 4-symptom screen - 0: No reported symptoms 1: At least one of the above
 four symptoms * \[contact] - Self-reported household contact - 0: No 1:
 Yes * \[dm] - Self-reported diabetes - 0: No 1: Yes * \[hiv] -
 Self-reported HIV - 0: No 1: Yes * \[history_tb] - Self-reported past TB
 treatment - 0: No 1: Yes * \[xray_type] - Type of radiography equipment
 used for CXR image capture - 1: Fujifilm Xair 2: DRTECH * \[radiologist01]
 - Field radiologist result - 0: Normal 1: Abnormal * \[qxr01] - qXR CAD
 software result - 0: &lt;0.50 1: &gt;=0.50 * \[xpert01] - Xpert MTB/RIF
 Ultra assay result - 0: MTB Negative 1: MTB Positive (including Trace
 semi-quantitative grade) * \[tb_status] - Did the participant have TB?
 - 0: No 1: Yes * \[genki_dicom] - Genki score from DICOM file processing *
 \[genki_jpeg_prepro] - Genki score from JPEG file processing * \[r01 to
 r10] - Readers 1-10 CXR interpretation - 1: TB-related abnormality in the
 lungs 2: Other abnormality in the lungs 3: Abnormality outside the lungs
 4: Normal ## Code/software Data are provided in a Microsoft Excel workbook
 and can be processed using any statistical software package (e.g., Stata,
 R, SPSS, SAS, etc.). ## Access information Other publicly accessible
 locations of the data: * N/A Data was derived from the following sources:
 * N/A ## Human subjects data The mobile CXR screening implementation was
 approved by the Ho Chi Minh City People’s Committee (Decision No.
 2681/QĐ-UBND). Since this activity is within the Vietnamese Ministry of
 Health’s TB screening and treatment guidelines (Decision No. 1314/QĐ-BYT),
 only verbal consent was obtained from participants. The Pham Ngoc Thach
 Hospital Institutional Review Board reviewed and approved the protocol for
 this de-identified, retrospective CAD software evaluation (Decision No.
 1688/HĐĐĐ-PNT).