The state-wide TB prevalence survey in Tamil Nadu was conducted in 2021- 2022. The Chest X-rays (CXR) used for screening were read by independently field level medical officers deputed from primary health centres (PHCs) and by a central panel of pulmonologists at the each district. The survey showed a very good agreement between the field medical officers and the expert panel in terms of reporting the CXR. The adjusted kappa (95% CI) was 83.4% (83.0 - 83.7) Medical officers from the PHCs can be trained to read and report survey/ ACF survey CXRs to get earlier and reliable results for further action at field level, considering the availability of resources especially in remote areas.