Streamlined Point-of-Care Ultrasound Examination for Pulmonary Tuberculosis
Year: 2026
Type: preprint
Abstract: Background: Point-of-care ultrasound (POCUS) is a low-cost, radiation-free triage tool but lacks standardized acquisition protocols for tuberculosis (TB). We developed and evaluated a streamlined symmetric POCUS protocol for pulmonary TB in a high-burden setting. Methods: Ugandan participants aged ≥13 years with confirmed pulmonary TB, household TB exposure, or a non-TB respiratory condition underwent an 18-position POCUS examination (12 lung zones and 6 pre-established extrapulmonary positions). Random Forest classifiers using prespecified pathologic features were developed in a fixed stratified 75/25 training/holdout split. All symmetric 2-, 4-, and 6-zone combinations were evaluated in training data. The best protocol of each size was locked and tested in the holdout set. Results: Among 318 analyzed participants, 118 (37.1%) had pulmonary TB and 200 were TB-negative, including 102 with other respiratory conditions (ORC). The model-selected 6-zone protocol comprised bilateral anterior-superior, lateral-superior, and posterior-superior lung zones. For TB versus all TB-negative participants, the AUCs for the 6-zone, 12-zone, and 18-position protocols were 0.82 (95% CI, 0.73-0.92), 0.81 (0.70—0.92), and 0.81 (0.71—0.91), respectively (all P > 0.76). For TB versus ORC, AUCs were 0.81 (0.70—0.91), 0.85 (0.76—0.93), and 0.85 (0.76—0.94), respectively (all P > 0.45). The 2-zone protocol had a lower AUC than the 6-zone protocol for TB versus all TB-negative participants (P = 0.004). Shred sign, consolidation, and B-lines with irregular pleura were the strongest TB-associated findings. Conclusions: A fixed 6-zone lung POCUS examination showed similar discrimination for TB to more comprehensive 12-lung-zone and 18-position protocols. This supports a simpler, scalable approach to TB triage
Source: medRxiv
Authors: Lydia Nakiyingi, Rohan Dhamdhere, Wycliff Nate, Keith Guevarra, Eva Nabawanuka, Elena Jovanovska Janeva, Raphael Shankman, Eria Lwanga, Elizabeth Nakabugo, Emmanuel Nasinghe, Sarah Nakayenga, Guadalupe Astorga, Thejaswini Anapakula Sridhar, Hyndavi Krishna Javvaji, Emily Clark, Deborah Handler, Padmini Salgame, David Alland, Moses Joloba, Jerrold Ellner, Anant Madabhushi, Yingda L. Xie
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225738905
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