Radiological Findings of Chest X-Rays During the Hajj Seasons 1444–1445 H/2023–2024 G: Diagnostic Quality and Gender Differences in Interpretation Concordance

Background: Mass gatherings like the Hajj pilgrimage present unique challenges for radiological services, with high patient volumes and increased respiratory disease risks necessitating reliable chest X-ray interpretation. Objectives: The objective of this study is to assess the diagnostic quality, abnormality rates, and peer-review concordance of chest X-rays in patients transferred during the Hajj seasons of 1444–1445 H/2023–2024 G, with an additional focus on gender-based differences in radiological interpretation. Methods and Materials: A cross-sectional analysis of 2093 chest X-rays from Hajj healthcare facilities was conducted. Two blinded radiologists independently reinterpreted images using standardized criteria. Data included demographic variables, radiographic findings (quality, opacities, nodules, cardiomegaly, effusions), and tuberculosis likelihood. Results: Among interpretable films (89.7% acceptable quality), 69.2% showed abnormalities, primarily opacities (56.4%) and cardiomegaly (27.0%). Tuberculosis was considered probable by radiographic appearance in 21.0% of cases. Peer review demonstrated 94.2% overall concordance. Regression analysis identified the presence of any abnormality (OR = 10.67, p < 0.001) and female gender (OR = 2.97, p = 0.003) as significant independent predictors of interpretive discordance. A trend towards higher discordance was noted for pulmonary nodules, though it was not statistically significant (9.4% vs. 5.6%, p = 0.062). Conclusions: While chest X-rays proved reliable for Hajj screening, gender disparities in interpretation and challenges in certain assessments, such as nodule evaluation, highlight opportunities to refine radiological protocols in mass gatherings.