Publisher Correction: Computer-aided interpretation of chest radiography reveals the spectrum of tuberculosis in rural South Africa

Computer-aided digital chest radiograph interpretation (CAD) can facilitate high-throughput screening for tuberculosis (TB), but its use in population-based active case finding programs has been limited. In an HIV-endemic area in rural South Africa, we used a CAD-algorithm (CAD4TBv5) to interpret digital chest x-rays (CXR) as part of a mobile health screening effort. Participants with TB symptoms or CAD4TBv5 score above the triaging threshold were referred for microbiological sputum assessment. During an initial pilot phase, a low CAD4TBv5 triaging threshold of 25 was selected to maximize TB case finding. We report the performance of CAD4TBv5 in screening 9,914 participants, 99 (1.0%) of whom were found to have microbiologically proven TB. CAD4TBv5 was able to identify TB cases at the same sensitivity but lower specificity as a blinded radiologist, whereas the next generation of the algorithm (CAD4TBv6) achieved comparable sensitivity and specificity to the radiologist. The CXRs of people with microbiologically-confirmed TB spanned a range of lung field abnormality, including 19 (19.2%) cases deemed normal by the radiologist. HIV-serostatus did not impact CAD4TB’s performance. Notably, 78.8% of the TB cases identified during this population-based survey were asymptomatic and therefore triaged for sputum collection on the basis of CAD4TBv5 score alone. While CAD4TBv6 has the potential to replace radiologists for triaging CXRs in TB prevalence surveys, population-specific piloting is necessary to set the appropriate triaging thresholds. Further work on image analysis strategies is needed to identify radiologically-subtle active TB. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement The community-screening program Vukuzazi is funded by the Africa Health Research Institute, the Wellcome Trust (201433/Z/16/Z), and the Bill and Melinda Gates Foundation (OPP1175182). Additional funders include NIAID (K08AI118538) and FIC (TW011687), National Institutes of Health, and Cascade IMPAc-TB Center (Contract # 75N93019C00070). The funders had no role in study design, data analysis and interpretation, or writing of the report. The mobile CXR unit including the real-time use of the CAD4TBv5 software was leased from Aurum Innova in partnership with Delft. The retrospective calculation of CAD4TBv6 scores was provided by Delft free of charge. Delft provided no funding and had no other role in this study. TN is supported through the South Africa Research Chairs Initiative (grant # 64809) and the Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE), a DELTAS Africa Initiative [grant # DEL-15-006]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS) Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africas Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [grant # 107752/Z/15/Z] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval was obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee (BE560/17), the London School of Hygiene & Tropical Medicine Ethics Committee (14722), and the Partners Institutional Review Board (2018P001802). All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The Vukuzazi screening protocol and anonymized data can be requested at .