Why is x ray insufficient to make a positive diagnosis of tuberculosis?

X-rays can show signs of tuberculosis (TB), such as lung nodules or cavities, but they are not definitive for diagnosis because these findings can also resemble other diseases. Additionally, early-stage TB may not produce visible changes on an X-ray, leading to false negatives. A positive diagnosis typically requires microbiological confirmation through sputum tests or tissue biopsies to identify the bacteria directly. Thus, while X-rays can indicate the possibility of TB, they cannot confirm it without further testing.