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Welcome to Online course for interpretation of CXRs in children with presumptive TB
The course is based on the Union’s Diagnostic CXR Atlas for Tuberculosis in Children: a Guide to chest X-ray Interpretation (2nd edition, 2022) that provides pragmatic guidance to healthcare professionals working in child tuberculosis. We aim to narrow the detection-treatment gap in child tuberculosis and fill a training gap among health care workers on the topic of interpretation of chest X-rays in the context of high tuberculosis burden settings.
The course is available free-of-charge to all audiences, particularly those health care workers who are diagnosing and treating TB in children in high TB burden settings. It is as an asynchronous online learning, comprising of nine video presentations that last approximately 20 minutes each. Each video presents several chest X-ray images that are discussed. At the end of each presentation there is a quiz to reinforce the learning point.
Once you complete all the modules, you will be allowed to take the post-course test to assess your knowledge gain. The pass mark is 80% and you can take the test as many times as you wish. After the post-course test, there is a course evaluation for you to provide feedback on the course.
Estimated time to complete the course is approximately 5 hours. You can start the course at any time, pause and come back to it at a later stage, and continue at the same point where you had left it. You will receive a course completion certificate at the end of the course.
After completing this course, you may wish to have a look at more chest X-ray images of children with presumptive tuberculosis; you are welcome to visit: https://theunion.org/technical-publications/diagnostic-cxr-atlas-for-tuberculosis-in-children
This online course was supported by Cooperative Agreement Number NU2GGH002222 from the U.S. Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S Centers for Disease Control and Prevention, the U.S Department of Health and Human Services, or the U.S government.
Module 1. Introduction to the course
1. Topics:
1. Course learning objectives
2. Why is this course important
3. Course faculty
4. How to progress through the course
5. Overview of the role of CXR in the context of childhood TB
Module 2. The role of the CXR in childhood TB
1. Learning objectives: To understand the different roles of CXR in child TB. To understand how CXR can be used in treatment decision algorithms. To appreciate that decisions in child TB can be made without CXR
2. Topics:
1. Overview of the role of CXR in childhood TB
2. The role of CXR in child TB
3. Focus of this CXR interpretation course
4. The place of CXR in treatment decision algorithms for TB-exposed well children
5. Treatment decision algorithm without CXR
6. Quiz
7. Conclusion
Module 3. An approach to CXR interpretation and classifying technical quality
1. Learning objectives: Understand that a CXR is only part of the diagnostic process for TB in children Understand that a CXR is only part of the diagnostic process for TB in children, Identification of CXR, be able to assess the quality of a CXR
2. Topics:
1. Understand that a CXR is only part of the diagnostic process for TB in children
2. Identification of CXR
3. Technical quality of the CXR
4. Using a systematic approach
5. Exercise
6. Quiz
7. Conclusion
Module 4 Part 1. The algorithmic approach to CXR classification
1. Learning objectives: By the end of this lecture you should be able to understand: The concepts of sensitivity and specificity, which CXR features are very specific to TB
2. Topics:
1. Introducing the algorithmic approach to CXR classification
2. Understanding sensitivity and specificity
3. The CXR features that are very specific to TB
4. Quiz
7. Conclusion
Module 4 - Part 2. The algorithmic approach to CXR classification
1. Learning objectives: recap of Part 1 of this module. By the end of this module you should be able to: be able to identify and classify the CXR features that are abnormal but NOT very specific to TB, including the normal CXR
2. Topics:
1. Recap
2. The CXR features that are less specific to TB
3. Quiz
4. Conclusion
Module 5. Classifying radiological disease severity on CXR
1. Learning objectives: At the end of this lecture, you should be able: to recap of the algorithmic approach to CXR classification – where does disease severity fit in? To develop confidence in classifying disease severity on CXR. To facilitate access to shorter treatment regimens for children.
2. Topics:
1. Recap of the algorithmic approach to CXR
2. Examples
3. Quiz
4. Conclusion
*Optional Module:
Module 6. The use of advance imaging in the diagnosis of PTB
1. Learning Objectives: By the end of this presentation you should be able: To determine when advanced imaging is needed. To understand the value of advanced imaging in the diagnosis and management of childhood TB
2. Topics:
1. Chest CT scan
2. CT scan reconstructions
3. MRI
4. Ultrasound
5. Bronchoscopy including TBNA
6. Ultrasound-bronchoscopy (EBUS)
7. 3D visualizations
8. Virtual bronchoscopy
9. FDG/PET scan
10. Virtual bronchoscopy
11. Combination of imaging
12. Conclusion
Module 7. CXR as part of diagnostic decision making: practical cases
1. Learning Objective: by the end of this presentation, you should have been able to review the concepts presented in the previous modules.
2. Topics: six scenarios.
Module 8. Post-test and certificate
Pass rate of 80%
Certificate upon completion
Post-course test
When you complete all the modules, you will need to take a test with 20 questions. The passing mark is 80%. You can repeat the test as many times as you wish until you reach the passing mark.
Course evaluation
Once you pass the post-course test, you will be asked to complete a standard questionnaire to leave feedback about the platform and quality of the course.
Certificate of completion
Once you complete the course evaluation, you will be able to download a certificate of completion with your name, the title of the course, the date of completion. The certificate also includes the equivalent number of hours of the educational content (pre-recorded lectures only).
By the end of this course, participants should be able to:
- Understand how the CXR fits into the diagnostic decision-making process for paediatric TB
- Feel more confident in identifying when a paediatric CXR is technically unacceptable, normal and abnormal
- Know which CXR features are very helpful in diagnosing paediatric TB and which are not
FACULTY:
Dr Megan Palmer: A paediatrician and clinical researcher, with an interest in diagnostics and imaging for paediatric TB, based at the Desmond Tutu TB Centre at Stellenbosch University
Prof H Simon Schaaf: A paediatric infectious disease specialist and professor of paediatrics who has been working in the field of paediatric TB for over 30 years
Dr James Seddon: A child and adolescent TB researcher and paediatric infectious diseases clinician. He is a Reader in Global Child Health at Imperial College London and an Associate Professor at Stellenbosch University in Cape Town.
Dr Marieke van der Zalm: a paediatrician and clinical researcher based at the DTTC at SU with an interest in paediatric lung health, TB diagnostics and post-TB lung disease
Prof Pierre Goussard: A paediatric pulmonologist with a special interest in the use of advanced imaging (particularly bronchoscopy) to diagnose and manage paediatric TB; he is a Professor in the Department of Paediatrics and Child Health at Stellenbosch University.
Reviewers:
Dr Riitta Dlodlo - The Union: Has worked in both clinical and programmatic TB, TB-HIV and management of health services and projects for over 30 years in Zimbabwe and other sub-Saharan African countries. Having joined The Union in 2003, she has served as TB-HIV programme coordinator and Director of the Department of TB and HIV from 2015 to mid-2019 when she was appointed Senior Advisor. Riitta is a strong proponent of patient-centered decentralised and integrated services for people with TB and comorbidities. She coordinated the development of Union’s guide on Management of Tuberculosis: a Guide to Essential Practice, 7th edition and has published in TB, TB risk factors and mortality.
Dr Kobto Ghislain Koura- The Union: A medical epidemiologist. He has participated in the management of international projects and his work over these years has focused on diseases, including malaria and anaemia, in low-income countries. He also completed a post doctorate in epidemiology at Claude Bernard University in Lyon, France. Since joining The Union in 2013, his work has focused on technical assistance, operational research and education, addressing the challenges of tuberculosis in Francophone African countries. He also serves as faculty member in several courses in France and he is associated researcher to MERIT Laboratory, a laboratory of The IRD (Institut de Recherche pour le Développement), a French research organism.
Mrs Lara Garrido-Herrero – The Union: Has been part of the Training and Education Department since 2016, leading the design, development and delivery of face-to-face and online trainings. Prior to joining The Union, Lara advocated for better health policies in Europe and provided public relations advice to multinational organisations in South Africa.
The course content was developed by The Union.
Faculty and reviewers have no real or perceived, direct or indirect conflicts of interest that relate to this online course.
Dr Megan Palmer has no conflict of interest to declare.
Prof H Simon Schaaf has no conflict of interest to declare.
Dr James Seddon has no conflict of interest to declare.
Dr Marieke van der Zalm has no conflict of interest to declare.
This online course was supported by Cooperative Agreement Number NU2GGH002222 from the U.S. Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S Centers for Disease Control and Prevention, the U.S Department of Health and Human Services, or the U.S government.
Commercial names of medical devices/software/equipment may appear in this content because they are linked to specific medical procedures, which are the focus of this training material. Other products in the market can be used to perform the aforementioned medical procedures. The educational provider does not endorse any particular product.
Module 1: Introduction to the use of CXR in Paediatric TB
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Module 2: The role of CXR in diagnostic algorithms for paediatric TB
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Module 3: An approach to CXR interpretation and classifying technical quality
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Module 4: The specific and less specific CXR features of paediatric TB, and using an algorithmic approach
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Module 5: Classifying radiological disease severity on CXR
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OPTIONAL: Module 6: Other Imaging Modalities for Paediatric Intra-Thoracic TB
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Module 7. CXR as part of diagnostic decision making: Practical cases
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Assessment and Course Evaluation
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