A report in Europe between 19 documented 35% non-TB pathology on mass miniature X-rays. However, studies describing non-TB pathology during mass radiography were few and mostly in the 20 th century. Our search yielded a number of studies using CXR screening in prevalence surveys as well as active case finding activities. The search strategy included MESH terms: “Chest Xray” or “Chest-Xray” or “Chest radiograph” or “Mass screening” or “Mass radiography” AND “Tuberculosis screening” or “Tuberculosis triaging” or “TB screening” or “TB triaging” AND “Non-tuberculous” or “Non-TB pathology” or “other pathology”. The WHO Stop TB Department website and reference lists from relevant reviews and studies were used to supplement the search. We systematically searched MEDLINE, CINHAL, Global Health and Google scholar databases from 1940–2019 to identify studies that described the prevalence of non-TB CXR findings during TB prevalence surveys or mass screening activities. However, the prevalence of diseases other than TB identified by CXR during TB mass screening or TB prevalence survey activities is unknown. In addition, CXR has an advantage of detecting conditions besides TB. Increased digital X-ray availability, coupled with the development of Computer Aided Detection (CAD) software for identification of TB, could enable widespread use of CXR in screening for TB in areas with limited access to radiologists. Mathematical modelling suggests that an algorithm incorporating a screening CXR to direct subsequent Xpert MTB/RIF testing is the optimal pathway with lowest number needed to test at acceptable programme costs in active case finding mass screening activities. The World Health Organization (WHO) recommends the use of chest X-ray (CXR) as a mass screening tool in TB prevalence surveys and active case finding activities to identify patients eligible for bacteriological investigation. Evidence before this study Tuberculosis (TB) remains the leading adult infectious killer in the world.
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