Lung Ultrasound in Pulmonary Tuberculosis: Evaluating Image Acquisition Protocol and Probe Accuracy in Zambia

Tuberculosis (TB) is a major global health issue and the leading infectious killer worldwide. Efficient disease screening pathways, minimizing missed cases, and timely treatment of new cases are pivotal to ending TB. These measures rely on efficient and accurate diagnostics. However, current diagnostic tools are costly and often require specialized expertise to operate, impairing their implementation in TB-burdened settings.

Point-of-care (POC) lung ultrasound (LUS) has the potential to address these challenges by offering a less expensive, prompt, safe, non-invasive TB screening tool that can be performed by non-specialist operators.

Previous studies have demonstrated the utility of LUS in pulmonary TB (PTB) diagnosis. Yet, two critical questions remain unanswered: What constitutes the optimal method of scanning the chest (protocol), and which type of LUS probe is ideal for obtaining images of the lungs? In settings where non-technical staff manage healthcare facilities, adopting a simplified LUS protocol would be advantageous. If it met the World Health Organization’s (WHO) criteria for an effective screening tool, it could pave the way for the development of LUS computer-aided diagnosis for remote image interpretation.

Our research aims to find the best LUS protocol and probe for accurate PTB diagnosis. We will conduct a randomized study with 2600 suspected PTB patients at Kanyama Level one Hospital in Lusaka, Zambia. Patients will be randomly assigned to either a simplified or comprehensive LUS protocol and to use either a curved or linear LUS probe.

By comparing these combinations, we hope to identify the most effective LUS approach for PTB diagnosis and pave the way for the future application of AI tools for LUS image-reading. This is a potential game-changer in PTB screening in high-burden but understaffed remote areas in LIMCs.

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