The effect of a tuberculosis chest X-ray image reference set on non-expert reader performance.

Objectives: In low-resource settings, limitations in diagnostic accuracy of chest X-rays (CXR) for pulmonary tuberculosis (PTB) relate partly to non-expert interpretation. We piloted a TB CXR Image Reference Set (TIRS) to improve non-expert performance in an operational setting in Malawi.

Methods: Nineteen doctors and clinical officers read 60 CXR of patients with suspected PTB, at baseline and using TIRS.