Drug-resistant TB story illustrates global challenge for radiology

Ours is a global economy, and personal mobility is part of the equation. Immigration rates are up everywhere, and with this movement come new trends and developments in disease that strain the healthcare system, including imaging.

Part of this is evident in an Overread article in this issue ("Chest x-ray remains crucial for evaluating drug-resistant TB," page 9). Deputy editor Shalmali Pal reports that the San Francisco Bay Area has seen a 20% uptick in tuberculosis cases in just one year-at a time when budgets to control the disease are being cut and multi­drug-resistant disease and coinfection with human immunodeficiency virus are complicating the prevention picture.

For radiologists, it means that they may be seeing more cases of TB on x-rays and the diagnosis may be more difficult to spot, particularly if it's combined with HIV. In the U.S., at least, other tests-such as purified protein derivative, sputum smear microscopy, and nucleic acid amplification-can reveal active TB. But elsewhere in the world, these tests may not be available. And even in the U.S., routine x-ray referrals for TB will continue.

In the San Francisco Bay Area, most recent cases of TB were documented in immigrant workers, many of whom live together in close quarters. That won't always be the case with infectious diseases, but it is a signal that radiologists could be challenged by new variations in pathology as global work and migration patterns shift.

-John C. Hayes is editor of Diagnostic Imaging.