Is chest x-ray screening for pulmonary tuberculosis by mass radiography--a cost-effective tool in a military population?

279 cases of pulmonary tuberculosis were diagnosed during a 10 year period from 1969 to 1978. 60% as a result of self-referral and 40% from mass miniature radiography of the chest. For every case of pulmonary tuberculosis picked up, the number of MMRs required has been steadily rising from 1 in 1900 to 1 in 6700. Using South Korea study figures, it costs US$42600 for a case of pulmonary tuberculosis detected by MMR. Besides being not cost effective, there is little advantage in early detection with regard to prognosis, in preventing subsequent cases and in picking up other lung or cardiac abnormalities. Unnecessary radiation results from frequent MMR whose dosage is 10 or more times greater than standard chest X-rays. MMR should be limited to. contact tracing, prior to overseas courses and on termination of service.
Study site: medical boards submitted to Medical Directorate, Ministry of Defence, Malaysia