Project and participant characteristics.

Background
Recent technological and radiological advances have renewed interest in using X-rays to screen and triage people with tuberculosis (TB). The miniaturization of digital X-ray (DXR), combined with automatic interpretation using computer-aided detection (CAD) software can extend the reach of DXR screening interventions for TB. This qualitative study assessed early implementers’ experiences and lessons learned when using ultra-portable (UP) DXR systems integrated with CAD software to screen and triage TB.
Methods
Semi-structured interviews were conducted with project staff and healthcare workers at six pilot sites. Transcripts were coded and analyzed using a framework approach. The themes that emerged were subsequently organized and presented using the Consolidated Framework for Implementation Research (CFIR).
Results
There were 26 interviewees with varying roles: supervisory, clinicians, radiographers, and radiologists. Participants recognized the portability as the main advantage, but criticize that it involves several compromises on throughput, internet dependence, manoeuvrability, and stability, as well as suitability for patients with larger body sizes. Furthermore, compared to using hardware and software from the same supplier and without digital health information systems, complexity increases with interoperability between hardware and software, and between different electronic health information systems. Currently, there is a limited capacity to implement these technologies, especially due to the need for threshold selection, and lack of guidance on radiation protection suitable for UP DXR machines. Finally, the respondents stressed the importance of having protected means of sharing patient medical data, as well as comprehensive support and warranty plans.
Conclusion
Study findings suggest that UP DXR with CAD was overall well received to decentralize radiological assessment for TB, however, the improved portability involved programmatic compromises. The main barriers to uptake included insufficient capacity and lack of guidance on radiation protection suitable for UP DXR.

背景
近年来，技术与放射学领域的进展重新推动了X射线（X-rays）在结核病（tuberculosis, TB）患者筛查与分流中的应用研究。数字X射线（digital X-ray, DXR）的小型化，结合计算机辅助检测（computer-aided detection, CAD）软件实现的自动影像解读，可拓展结核病DXR筛查干预的覆盖范围。本定性研究评估了早期实施者在集成CAD软件的超便携（ultra-portable, UP）DXR系统用于结核病筛查与分流时的使用体验与经验教训。
方法
在六个试点站点对项目工作人员与医护人员开展半结构化访谈（semi-structured interviews）。采用框架分析法（framework approach）对访谈转录文本进行编码与分析。基于归纳出的主题，参照实施研究综合框架（Consolidated Framework for Implementation Research, CFIR）进行组织与呈现。
结果
本次研究共访谈26名职责各异的参与者，涵盖管理人员、临床医师、放射技师与放射科医师。参与者认为便携性是该系统的核心优势，但同时指出该系统存在诸多局限性：包括吞吐量受限、依赖网络、操控性与稳定性不足，以及不适用于体型较大的患者。此外，相较于使用同一供应商的软硬件且未接入数字健康信息系统的场景，软硬件间、不同电子健康信息系统间的互操作性会提升系统整体复杂度。当前，该类技术的落地应用能力有限，尤其体现在需进行阈值选择，且缺乏适配超便携DXR设备的辐射防护指南。最后，受访者强调需具备受保护的患者医疗数据共享渠道，以及完善的技术支持与保修方案的重要性。
结论
研究结果表明，集成CAD的超便携DXR系统在去中心化开展结核病放射评估方面整体认可度较高，但便携性的提升也伴随了项目实施层面的诸多权衡妥协。其推广应用的主要障碍包括落地能力不足，以及缺乏适配超便携DXR设备的辐射防护指南。