Tuberculosis (TB) remains a leading cause of death globally, with children accounting for a significant proportion of cases and fatalities. Diagnosing pediatric TB is particularly challenging due to the difficulty of using conventional laboratory tests. Radiological imaging, such as chest X-rays and CT scans, plays a crucial role in diagnosing TB in children, but the capacity for such diagnostics is often limited, especially in low- and middle-income countries. This new initiative aims to assess and optimize the use of radiological technology for diagnosing pediatric TB across different economic settings, providing valuable insights for improving healthcare practices and policies.
A new multinational research project aims to tackle the challenge of pediatric tuberculosis (TB) diagnosis through a comprehensive evaluation of radiological capacity and usage. This investigation will compare the effectiveness of radiological diagnostics across three countries: Mozambique, South Africa, and Spain, each representing different economic and healthcare settings. The study is led by Dr. Isabelle Thierry-Chef from the Barcelona Institute for Global Health, in collaboration with researchers from various institutions. The findings were published in the peer-reviewed journal PLOS ONE.
The primary objective of this research is to map and assess the radiological resources available for diagnosing pediatric TB in these countries. The researchers will collect data on the number of X-ray and CT scan units per million people and evaluate the geographical distribution of these resources within each country. This quantitative mapping will highlight regional variations and provide insights into potential infrastructure differences among the three nations.
The project will also focus on evaluating the human resources available for radiological diagnostics, examining the training and qualifications of radiological personnel, and documenting the typical protocols used for pediatric TB diagnosis. This aspect of the research is crucial as it will identify challenges and barriers faced by healthcare professionals in utilizing radiological diagnostics effectively.
One of the significant components of this research is the analysis of radiation dose exposure in children diagnosed and treated for TB. The researchers will conduct a retrospective analysis of dosimetry data from TB and radiology records to assess the potential for dose optimization, ensuring that radiation exposure is minimized while maintaining diagnostic efficacy. This is particularly important for children who may require repeated imaging, such as those with HIV who are at higher risk of recurrent TB.
According to Dr. Thierry-Chef, “This project is the first of its kind to provide a comprehensive evaluation of radiological capacity and usage in pediatric TB diagnosis across different economic settings. Our findings will inform policymakers, clinicians, and radiologists on best practices and means to optimize the use of radiological technology in managing pediatric TB.”
The methodology involves several approaches. At the national level, the team will perform a retrospective audit of licensed X-ray and CT units using official registries. At the health facility level, they will conduct standardized surveys targeting site operational managers and radiology staff to gather data on existing equipment, human resources, and radiological protocols. Additionally, they will administer a survey to clinicians involved in the screening, diagnosis, and management of pediatric TB to collect data on the clinical use of radiological diagnostics.
In Mozambique, the study will adapt its methodology to local privacy laws and the absence of a Picture Archiving and Communications System (PACS). In South Africa and Spain, dosimetry will be calculated using data extracted from PACS, ensuring accurate and comparable results across the three countries. The cumulative radiation exposure will be calculated using computational tools from the National Cancer Institute.
This research addresses a critical gap in the current understanding of radiological capacity and usage in pediatric TB diagnosis, particularly in low- and middle-income countries. By providing a detailed assessment of existing resources and practices, Dr. Isabelle Thierry-Chef and her colleagues aim to optimize the use of radiological technology, ultimately improving the diagnosis and management of pediatric TB.
Journal Reference
Munyangaju, I., José, B., Esmail, R., Palmer, M., Santiago, B., Hernanz-Lobo, A., et al. “Evaluation of radiological capacity and usage in paediatric TB diagnosis: A mixed-method protocol of a comparative study in Mozambique, South Africa and Spain.” PLOS ONE, 2024. DOI: https://doi.org/10.1371/journal.pone.0299293
About the Authors
Isabelle Thierry-Chef ,PhD (Principal investigator); as Head of the Medical Radiation Group, spearheads radiation activities within the Environment and Health over the Life course programme of ISGlobal. With a primary background in environmental sciences and radiation protection, she earned her PhD in 2000 for the reconstruction of organ doses she performed for the 15-Country Study on Cancer Risk among Radiation Workers in the Nuclear Industry. In the last 20 years, she has dedicated herself to studying the potential health impacts (mainly cancer but also non-cancer effects and social impact) of exposure to ionising radiation, with particular attention payed to children. She has extensive experience in coordinating activities in major international research projects such as : HARMONIC, EPI-CT, MEDIRAD, e-QuoL and IMAGEOMICS and she contributed to several expert groups: IARC and NCI monographs on cancer risk associated with exposure to low-doses of ionizing radiation. Since 2021, Dr Thierry-Chef is a member of Committee 3 of the International Commission on Radiological Protection where she is leading a task group devoted to protection of humans involved in biomedical research.
Elisa Lopez-Varela, MD, PhD, Paediatrician (co-PhD supervisor); has over a decade of of experience leading research projects in pediatric HIV and TB, half of which she has been based in Mozambique and South Africa where she has combined pediatric clinical care with research activities. She is a certified pediatrician with a Master’s in Public Health from Harvard University and a PhD from the University of Barcelona. From 2018-2020, she was postdoctoral fellowship at the Desmond Tutu TB Center University of Stellenbosch, Cape Town, South Africa, where she focused on the optimization of pediatric TB treatment, including new drugs for the prevention of multidrug-resistant TB and pharmacokinetic/dynamic studies. In 2020, she was awarded a RESPIRE4 Marie Sklodowska-Curie fellow (European Respiratory Society), to focus in improving the management of pediatric respiratory infections, including TB, with a particular interest in evaluating novel diagnostic strategies focused in high HIV burden settings. Since May 2023, she serves as Global Medical Affairs Director at ViiV Healthcare.
Isabelle Munyangaju, MD (Predoctoral fellow); is a Mozambique-based medical doctor and public health professional working in the field of Infectious Diseases (mainly Tuberculosis and TB/HIV co-infections) for the past 10 years in clinical and programmatic management, with previous work experience in South Africa and Eswatini. She is a medical graduate of Witwatersrand University (South Africa) and holds Masters degrees in Infectious Diseases (LSHTM), Vaccinology (Universita de Siena, Italy) and Global MBA (University of London). Having been awarded a “la Caixa” Foundation doctoral fellowship in 2021 (ID 100010434); she is currently pursuing a PhD with ISGlobal Barcelona and the University of Barcelona looking into the optimization of pediatric TB diagnosis using imaging techniques and evaluation of radiation exposure of children diagnosed and treated for TB.
