Portable X-ray machines, AI take TB diagnosis to remote areas Dr Lucica Ditiu

Rumbidzayi Zinyuke-Health Buzz

On May 16, the Stop TB Partnership participated in an attempt to break the Guinness World Record of operating an X-ray machine at the highest altitude ever.

The attempt took place at 5 644m in Kala Pattar, on Mt Everest to raise awareness and demonstrate the effectiveness of ultra-portable digital X-ray technology combined with artificial intelligence (AI) in diagnosing TB in remote and underserved areas.

Most people may wonder, what the purpose of climbing thousands of kilometres up the dangerous Mt Kilimanjaro just to perform an X-ray was?

Of course the procedure could have been done on the ground, but why not up that mountain?

For centuries, tuberculosis has been around and X-rays have been the game changer in the diagnosis of the disease.

But the coming in of Artificial Intelligence is what makes this different.

It is why they had to scale the tallest mountain to prove that new technologies can indeed make a difference in the TB landscape.

This record attempt by the Stop TB Partnership, which is now awaiting validation, underscores the potential of ultra-portable digital X-ray machines to operate in extreme conditions, highlighting their utility in regions with limited access to healthcare.

The portable X-ray machines, capable of operating without direct electricity and enhanced with AI for rapid TB and pulmonary condition analysis, are a game-changer.

This technology promises early detection and comprehensive healthcare in isolated areas.

According to Dr Lucica Ditiu, the Stop TB Partnership executive director: “This achievement symbolises our commitment to ensuring no region is beyond the reach of life-saving health services. With this technology, we can reach the unreached and provide essential healthcare to vulnerable communities.”

TB remains a significant global health challenge, affecting over 10 million people annually, with three million cases going undiagnosed.

Zimbabwe is among the most affected countries in the world with an estimated TB incidence of 204 per 100 000 population in 2022.

Although the country has been moved from the world’s top 30 list of countries heavily burdened by TB, it still has a double burden of TB/HIV and Multi-Drug Resistant TB.

An estimated 11 778 cases of TB were missed in 2022 alone, meaning the country needs to scale up efforts to identify all TB cases if it is to attain the goals to end the disease as a public health challenge by 2030, in line with the Global TB strategy.

And new technologies could be the answer to this challenge.

Worldwide, Artificial Intelligence and battery-powered portable X-ray machines are helping to expand access to tuberculosis testing and treatment.

Chest X-rays are a common method of screening and triaging people for TB and assessing their lung damage.

With artificial intelligence, results become more precise and ready in a shorter time, allowing health workers to quickly determine the next steps for TB care.

In the most remote parts of any country, where shortage of equipment and health personnel is common, not everyone can read and interpret an X-ray report.

AI comes in to help in highlighting potential TB screening in cases where there is no radiologist or doctor.

So the combined benefits of AI and the battery-powered X-ray machines, which are small and light enough to transport by hand, are bound to bring positive changes.

The challenge with traditional X-ray machines is that they are stationary and operate on local electricity grids. 

Like many low- and middle-income countries, where most TB cases are found, electricity is unavailable in some parts of rural Zimbabwe.

Zimbabwe has a total of 1 650 Government health facilities countrywide. 

However, the country has a total of 180 GeneXpert machines in the network of which 18 are GeneXpert XDR machines. 

To ensure that facilities in hard to reach areas where there is no access to electricity are catered for, the Government deployed 20 Truenat machines which are battery operated.

A total of 50 digital X-ray machines have also been deployed in the public sector with an additional 45 new machines awaiting installation.

Portability reduces the cost of travelling to health centres for rural patients, who may otherwise delay TB testing until their health worsens.

Deputy director AIDS and TB programmes in the Ministry of Health and Child Care Dr Fungai Kavenga recently said Government was taking the necessary steps to ensure increased case identifications in all parts of the country.

Dr Fungai Kavenga

Part of these efforts include the deployment of mobile x-ray trucks in communities which brings diagnosis closer to the people.

But above all this, the country has not been left far behind in using new technologies to fight TB.

The deployment of the ultra-portable x-ray machines is in the process and will definitely make an impact.

“These are very portable machines that can be moved further down in our communities to screen for TB. The country has adopted a new technology called computer-aided diagnosis artificial intelligence. So this innovation is a software that can be used in the field and it will help us interpret chest radiographs. And we believe this will result in an early diagnosis, early identification and diagnosis of TB in our communities. 

“We have already started piloting the computer aided diagnosis artificial intelligence in selected districts and soon we will be rolling this out to all our provinces,” said Dr Kavenga.

Not only will AI algorithms be able to analyse X-rays with a high degree of accuracy, comparable to that of radiologists.

This can significantly reduce misdiagnoses and ensure timely initiation of treatment.

It can also reduce the burden on healthcare workers, allowing them to focus on other issues and patient care.

Dr Kavenga said the technology would be the game changer that Zimbabwe needs to deal with the low case detection.

“The country is struggling with a case detection gap, meaning there are some people with TB out there, but they go about their business in communities undiagnosed and untreated. So we believe by bringing screening tools closer to them, and even faster screening tools, it will go a long way to find the missing people with TB. And ultimately we will achieve our goals of reducing the incidence of TB, and ultimately ending TB by 2030,” he said.

Zimbabwe has plans to increase the treatment coverage of drug susceptible TB from 83 percent in 2018 to 90 percent by 2026, to increase the treatment success rate of patients with drug susceptible TB from 83 percent in 2017 to 90 percent by 2026, to cumulatively detect 2 680 patients with MDR TB between 2021 and 2026 as well as to increase the treatment success rate of patients with RR/MDR TB from 57 percent (2016) to 75 percent by 2026.

With just six years left to achieve the 2030 Agenda, progress has already been made.

The country moved from 16 576 TB notifications in 2022 to 19 483 notifications in 2023, representing a 15 percent increase.

But more can still be done to expand TB prevention, testing and treatment, including equitable access to digital solutions and AI innovations across the country.

Dr Kavenga said the country should continue scaling up best practices, innovations and highly sensitive tools to achieve this.

“We need to have more innovation at implementation level to reduce stigma, create demand, reduce the proportion of missed cases and improve treatment outcomes. We already have political commitment so pulling together through joint multi-sectoral accountability and leaving no one behind, will END TB in Zimbabwe,” she said.

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