WORLD TUBERCULOSIS DAY 2018 Bernard F. Laya, MD, DO, FPCR
LOWER RESPIRATORY INFECTIONS } Most common cause of illness in children and is a significant cause of morbidity and mortality } 156 million cases of pneumonia yearly in children < 5 years of age } Mortality is low in developed countries but a main cause of mortality in developing countries } 1/5 of deaths in children < 5 years of age } 70% occur in Africa and Southeast Asia } 1.9 million deaths in children per year
CHILDHOOD TUBERCULOSIS } 9 th leading cause of death worldwide and leading cause from single infectious agent } 10.4 million people fell ill with TB in 2016 } TB in children } 1 milllion (10% - 11%) are children } South Asia, East Asia, and Pacific (63%), Africa (30%) } 250,000 children died with TB } More than 25,000 develop MDRTB
MEDICAL IMAGING } Important in diagnosis, assessment of complications, follow-up, intervention } 2/3 to 3/4 of population lacks access to imaging } Scarcity of resource } Inadequate quality } Challenges in imaging interpretation: } Variations in terminology } Classification } Approach to interpretation, among others
WORLD TB DAY 2018 PROJECT } Proposed to WFPI in March 2017 } Summit on Imaging Thoracic TB & Other Lung Infections } Educate } Establish standards } Identify concerns & propose solutions } Establish a global network } Avenue to meet and conceptualize projects pertaining to childhood pulmonary infections } Venue: Manila, Philippines on March 24, 2018
COOPERATING AGENCIES } Philippine College of Radiology } Philippine Society for Pediatric Radiology } CT/MRI Society of the Philippines } Ultrasound Society of the Philippines } World Federation of Pediatric Imaging } International Society for Pediatric Thoracic Imaging } Industrial Partners
SPEAKERS } Wendy Lam Hong Kong } Zaleha Abdul Manaf Malaysia } Paras Lakhani USA } Kushaljit Singh Sodhi India } Jaishree Naidoo South Africa } Savvas Andronikou United Kingdom } Pilar Garcia Peña Spain } Omolola Mojisola Atalabi Nigeria } Nathan Concepcion Philippines } Bernard F. Laya Philippines } Ma. Isabel M. Atienza Philippines
PRE-CONGRESS: MARCH 23, 2018 } Technical issues in imaging thoracic infections } The need for lateral view } When is ultrasound, CT, or MRI appropriate? } Quality concerns } Standardized terminologies in Thoracic Imaging } Are all items in Fleischner s glossary of terminology appropriate in children? } Lung opacities, infiltrate, & consolidation: which is appropriate? } Viral disease vs. bronchiolitis vs. peripheral airways disease
PRE-CONGRESS: MARCH 23, 2018 } Artificial Intelligence for Detection of Pulmonary TB } Resource Building and International Collaboration } Financial, non-financial, human resource availability and generation } Global networking } Plans, strategies, & future endeavors
Precongress: March 23, 2018. Manila Hotel, Philippines
CONGRESS PROPER: MARCH 24, 2018 } State of Childhood Tuberculosis: Global Perspective } Current TB Imaging Trends and Future Directions } Controversies and Issues in Pulmonary TB Imaging } Imaging of HIV and TB-HIV Co-infection } Mediastinal lymph node detection: Multimodality Imaging } Detection of Complications of Pulmonary Infections } Pulmonary Infections in the Immunocompromized } Standardized Radiographic Interpretation of Childhood Thoracic Tuberculosis } } Precongress Discussion Output Pediatric Thoracic Ultrasound Workshop
INVITED FACULTY Andronikou Sodhi Garcia-Peña Concepcion Laya Naidoo Atalabi Lakhani Manaf Lam Atienza
Congress Proper: March 24, 2018. Manila Hotel, Philippines
IMAGING TECHNIQUE } Consider ionising radiation exposure, cost, availability } Resource availability: I. Low resource centre CXR, US II. Middle resource centre CXR, US, CT III. High resource centre CXR, US, CT, MRI } To define clinical scenario eg: Group A suspected lung infection / non TB suspect Group B high clinical suspicion of TB, screening or contact tracing (asymptomatic patient) for TB, immunocompromised children
CHEST RADIOGRAPH } CXR is still the initial imaging technique in evaluation of lung infections despite low sensitivity and specificity and high inter-observer variability } Frontal CXR in child with no clinical suspicion of PTB. No follow up CXR if patient respond well to treatment } Frontal and lateral CXR in child with high clinical suspicion of PTB, screening and contact tracing for PTB. Radiologic hallmark of PTB in children ~ mediastinal & hilar lymphadenopathy } CXR may be the only imaging required in smear +ve cases for diagnosis and follow-up
CHEST ULTRASOUND } US maybe the only imaging modality in resource limited center } Useful in detection & characterization of pleural effusion, guiding aspiration and drainage } Able to assess the underlying lung parenchyma } useful in differentiating effusion from residual pleural thickening. } US of mediastinum detects mediastinal lymph nodes } US of abdomen to evaluate hepatosplenomegaly, liver nodules, ascites, and lymphadenopathy
COMPUTED TOMOGRAPHY } Problem solving modality for low and middle resource facilities } CT is more sensitive than chest radiographs } Detection of mediastinal lymphadenopathy and pleural & parenchymal disease } Assessment of complications } Indications for CT scan } Smear negative child } Equivocal CXR } Immunocompromised child } Low dose CT
MAGNETIC RESONANCE IMAGING } Problem solving modality for low and middle resource facilities } Highly sensitive & specific in detecting mediastinal lymph nodes in PTB } Sequences } T1 and T2W images without contrast } DWI and contrast-enhanced study for disease activity } Follow-up of mediastinal nodal disease } As good as CT in assessing parenchymal diseases
TERMINOLOGIES } Abandon the terms Pneumonitis and Infiltrate } Promote the use of consolidation and opacity } Use small airways disease describing peripheral airways interstitial thickening / opacities } Bronchiolitis is a specific form of small airways disease } Reassess definitions of lymphadenopathy, nodules, and masses in children } Propose standardized reporting for Pediatric lung infections
THORACIC TB IN CHILDREN
Concepcion ND, Laya BF, Andronikou S, et al. Standardized Radoigraphic Evaluation of Thoracic TB in Children. Pediatric Radiology Journal 2017
ARTIFICIAL INTELLIGENCE } Shows promise in adult lung TB infection/disease } Explore its utility in children } Chest radiograph } Variable patient size, technique } Lymph node detection } Chest CT } More feasible
RESOURCE & NETWORKING } WFPI provides platform for international collaboration } Telereading: TB hotline } Research funding is available, you have to search } WFPI educational resource } Articles, lectures, video tutorials } Free online access
WFPI EDUCATIONAL TOOLS Savvas 7-min snippets * Link to important TB literature
COLLABORATION WITH ISR Open access, online education module on Imaging of Tuberculosis. March 2014 Dr. Eric Stern, the TB Steering Committee's Chair
SUMMARY } World TB Day 2018 Celebration in Manila was an overwhelming successful event } White Paper will be written by the Speakers } Proposals during the Precongress } Topics covered in the Congress Proper } Aim for Free Access publication for wider reach } Plan for another Pediatric Thoracic Imaging Summit in the future