Utility of Routine Chest Radiographs in Kenya

ABSTRACT

Background: Many otherwise healthy Kenyans are required to obtain chest radiographs as part of routine medical examination to exclude pulmonary TB; a condition of significant public health concern. Many of these people are required to have these radiographs taken yearly as part of routine check-up. No local data is available to support this practice. Though a quick procedure to perform and readily available throughout the country; chest radiograph exposes the individual to a dose of ionising radiation. Ionising radiation is associated with increased risk of malignancy. The cost is also substantial. Objective: To determine the prevalence of radiological findings consistent with PTB among routine medical examination chest radiographs. Design: A cross-sectional descriptive study. Settings Department of Radiology Kenyatta National Hospital;Department of Imaging and Radiation Medicine; University of Nairobi; Plaza Imaging Solutions; a private radiology practice in Nairobi and Department of Radiology; the Nairobi Hospital. Subjects: Four hundred and two chest radiographs of patients presenting for routine medical examinations were analysed. Results: Sixty three radiographs had abnormal but clinically insignificant findings (16). Only one radiograph (0.25). Only one radiograph (0.25) had radiological features of PTB. The rest were reported as normal (84). Conclusion: In this study; the diagnostic yield for the intended purpose (to include/ exclude PTB) was extremely low (0.25). It is recommended that routine chest radiographs as screening tools for active pulmonary tuberculosis be reconsidered due to poor diagnostic yield. The authors propose a bigger nation wide study before a policy decision can be proposed