Tuberculosis (TB) remains a leading cause of death worldwide, with children accounting for a significant proportion of cases and deaths. 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, play a crucial role in diagnosing TB in children, but the capacity to perform such diagnoses 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 in different economic settings, providing valuable information to improve health care practices and policies.
A new multinational research project aims to address the challenge of pediatric tuberculosis (TB) diagnosis by comprehensively assessing radiology capacity and use. This research will compare the effectiveness of radiological diagnostics in three countries: Mozambique, South Africa and Spain, each representing different economic and healthcare environments. The study is led by Dr Isabelle Thierry-Chef from the Barcelona Institute for Global Health, in collaboration with researchers from several institutions. The results 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 the diagnosis of paediatric tuberculosis in these countries. Researchers will collect data on the number of X-ray and CT scan units per million people and assess the geographic distribution of these resources within each country. This quantitative mapping will highlight regional variations and provide insight into potential infrastructure differences between the three nations.
The project will also focus on assessing the human resources available for radiological diagnosis, examining the training and qualifications of radiological personnel, and documenting typical protocols used for the diagnosis of paediatric tuberculosis. This aspect of the research is crucial as it will identify the challenges and barriers faced by healthcare professionals in using radiological diagnosis effectively.
One of the important components of this research is the analysis of radiation dose exposure in children diagnosed and treated for tuberculosis. The researchers will perform a retrospective analysis of dosimetry data from tuberculosis and radiology registries 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 repeat imaging, such as those with HIV who are at increased risk of recurrent tuberculosis.
According to Dr. Thierry-Chef, “This project is the first of its kind to provide a comprehensive assessment of the capacity and use of radiology in the diagnosis of pediatric tuberculosis in different economic contexts. Our findings will inform policy makers, clinicians and radiologists on best practices and means to optimize the use of radiological technology in the management of pediatric tuberculosis.”
The methodology involves several approaches. At the national level, the team will conduct a retrospective audit of licensed X-ray and CT units using official records. At the health facility level, they will conduct standardized surveys targeting site operational managers and radiology staff to collect data on existing equipment, human resources, and radiology protocols. In addition, they will administer a survey to physicians involved in the detection, diagnosis, and treatment of pediatric tuberculosis 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 communication system (PACS). In South Africa and Spain, dosimetry will be calculated using data extracted from the PACS, ensuring accurate and comparable results across the three countries. Cumulative radiation exposure will be calculated using computational tools from the National Cancer Institute.
This research addresses a critical gap in current knowledge about the capacity and use of radiology in the diagnosis of pediatric tuberculosis, particularly in low- and middle-income countries. By providing a detailed assessment of existing resources and practices, Dr. Isabelle Thierry-Chef and colleagues aim to optimize the use of radiology technology, ultimately improving the diagnosis and treatment of pediatric tuberculosis.
Journal reference
Munyangaju, I., José, B., Esmail, R., Palmer, M., Santiago, B., Hernanz-Lobo, A., et al. “Evaluation of radiological capacity and its use in the diagnosis of pediatric tuberculosis: 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, she leads radiation activities within ISGlobal’s Environment and Life-Course Health programme. With a primary background in environmental sciences and radiation protection, she obtained her PhD in 2000 for organ dose reconstruction she conducted for the 15-Country Study on Cancer Risk among Radiation Workers in the Nuclear Industry. Over the past 20 years, she has been dedicated to studying the potential health impacts (mainly cancer, but also non-cancer effects and societal impact) of exposure to ionizing radiation, with a particular focus on children. She has extensive experience coordinating activities in large international research projects such as: HARMONIC, EPI-CT, MEDIRAD, e-QuoL and IMAGEOMICS and contributed to several expert group – IARC and NCI monographs on cancer risk associated with exposure to low doses of ionizing radiation. Since 2021, Dr. Thierry-Chef has been a member of Committee 3 of the International Commission on Radiological Protection, where she leads a working group dedicated to the protection of human subjects involved in biomedical research.
Elisa López-Varela, MD, PhD, Pediatrician (joint PhD supervisor); has over a decade of experience leading research projects in pediatric HIV and tuberculosis, half of which has been based in Mozambique and South Africa, where she has combined pediatric clinical care with research activities. She is a board-certified pediatrician with a Masters in Public Health from Harvard University and a PhD from the University of Barcelona. From 2018 to 2020, she was a postdoctoral fellow at the Desmond Tutu TB Center at Stellenbosch University, Cape Town, South Africa, where she focused on pediatric tuberculosis treatment optimization, including new drugs for prevention of multidrug-resistant tuberculosis and pharmacokinetic/dynamic studies. In 2020, she was awarded a RESPIRE4 Marie Sklodowska-Curie Fellowship (European Respiratory Society), to focus on improving the management of pediatric respiratory infections, including tuberculosis, with a particular interest in evaluating novel diagnostic strategies focused on high HIV-burden settings. Since May 2023, she has served as Director of Global Medical Affairs at ViiV Healthcare.
Isabelle Munyangaju, MD (Predoctoral Fellow); is a physician and public health professional based in Mozambique 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 holds a degree in medicine from the University of the Witwatersrand (South Africa) and a Masters in Infectious Diseases (LSHTM), Vaccinology (Universita de Siena, Italy) and a Global MBA (University of London). Having been awarded a PhD scholarship from the “la Caixa” Foundation in 2021 (ID 100010434), she is currently pursuing a PhD with ISGlobal Barcelona and the University of Barcelona researching the optimization of pediatric tuberculosis diagnosis using imaging techniques and the assessment of radiation exposure of children diagnosed and treated for tuberculosis.
You have successfully subscribed!
