Chest X-rays on prison arrival: what a pilot study found

Tuberculosis (TB) is a concern in prison settings, and the World Health Organization recommends chest X-ray (CXR) screening on admission. To test how this would work in practice, Stephanie E. Perrett and colleagues ran a pilot service evaluation between 1 September 2023 and 31 March 2024. The team offered CXRs to people arriving at a prison to learn three things: whether residents would accept the offer, whether the X-rays could be completed within 48 hours of admission, and what the results would tell them about TB in this population. The study was set up as a cross-sectional evaluation, recording how many people said yes, how many actually received a CXR, and the findings on the images. For everyone who accepted, the team also assessed clinical and social risks for TB and measured how long it took to carry out the X-ray and to get the results back. The approach was practical and intended to reflect routine service delivery rather than a tightly controlled research trial.

Over the seven-month pilot, 61% (n=310) of new prison admissions accepted the offer of a CXR. Of those who accepted, 226 people (73%) went on to receive a CXR, which represents 44% of all new arrivals during the pilot period. About a quarter of those who accepted did not attend their first appointment and needed further offers; the study team observed that as the number of rearranged appointments increased, fewer men attended. The median time from arrival to completion of a CXR was 17 days (interquartile range 13–20 days), so the 48-hour target was not met under the existing service model. The screening did not identify any respiratory TB cases, but nine CXRs (4% of those done) were reported as abnormal, highlighting other respiratory health issues. The researchers captured both the uptake statistics and the logistical challenges of delivering CXR screening in this setting.

The pilot shows that offering a CXR at prison entry is acceptable to residents but is hard to deliver quickly with current radiography services. Because the median time to complete a CXR was 17 days, meeting the World Health Organization recommendation of screening within 48 hours would require a bespoke service model added to existing provision. The finding that nine CXRs were abnormal, even though no TB was diagnosed, suggests CXR screening could serve as a broader respiratory health check that picks up other lung problems as well as TB. The study also highlights practical barriers: missed first appointments, the drop in attendance with repeated rescheduling, and the frequent movement of people through the criminal justice system, which disrupts continuity of care. These realities mean that policy decisions about CXR screening should consider using it as part of a wider respiratory health strategy and plan for additional resources and tailored service models to deliver timely screening.