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Tackling Tuberculosis in Ghana
February 28th, 2024
By combining ultra-portable X-ray systems and innovative AI software, Canon Medical subsidiary, Oldelft Benelux, and leading solutions provider, Delft Imaging, have created a health system strengthening program in Ghana, Africa, to screen for tuberculosis.
Tuberculosis (TB) is a highly infectious bacterial disease that most often affects the lungs. It spreads through the air when infected people cough, sneeze or spit. It is the 13th leading cause of death and the second leading infectious killer after COVID-19 globally. In 2021, an estimated 10.6 million people contracted TB worldwide1. While it can be fatal if untreated, TB can be prevented and cured. The World Health Organization (WHO) and other global health bodies are striving to eradicate the disease by 2030. Early detection of TB improves treatment outcomes and prevents the spread of the disease. Chest X-ray is one of the most effective screening methods for TB, but in developing countries such as Ghana, with minimal resources and often challenging access to the large and ever-increasing population, this has previously been difficult to implement.
Tuberculosis (TB) is a highly infectious bacterial disease that most often affects the lungs. It spreads through the air when infected people cough, sneeze or spit. It is the 13th leading cause of death and the second leading infectious killer after COVID-19 globally. In 2021, an estimated 10.6 million people contracted TB worldwide1. While it can be fatal if untreated, TB can be prevented and cured. The World Health Organization (WHO) and other global health bodies are striving to eradicate the disease by 2030. Early detection of TB improves treatment outcomes and prevents the spread of the disease. Chest X-ray is one of the most effective screening methods for TB, but in developing countries such as Ghana, with minimal resources and often challenging access to the large and ever-increasing population, this has previously been difficult to implement.
Solutions for screening
To tackle this issue, Delft Imaging developed an AI-based software, called CAD4TB (Computer-Aided Detection for Tuberculosis) to operate on the Easy DR mobile X-ray system.
“At the moment, the population of Africa is 1.2 billion people. It will be 2.4 billion people in 2050. And it will be four billion people at the end of the century,” said Guido Geerts, CEO of Delft Imaging.
“As well as being large, Africa’s population is extremely young and they don't have many highly skilled healthcare workers at the moment. So, how do you solve that? We believe that the combination of hardware and AI will be the solution for a lot of healthcare issues in Africa.”
“Delft Imaging’s main activity is screening for TB. Our biggest innovation is in using Artificial Intelligence to recognize TB on an X-ray with a software solution called CAD4TB,” he continued. “We have invested more than 10 years in its development. With the first prototype introduced in 2012, we are now recognized by the World Health Organization (WHO) as not only the inventor, but they have endorsed our AI as the way to go forward for screening of TB.”
EasyDR was our X-ray solution,” he said. “We deliberately chose EasyDR because it's a multifunctional system. It’s perfect to use for screening tuberculosis, but you can also use it as a multifunctional system. We can turn it to do abdominal, extremities and all kind of other issues. It has potential as a health system strengthening program. In a lot of the African countries there are too few X-ray systems. With the X-ray in place for TB screening, it could potentially be used for exploring other conditions.”
Screening for TB has previously always involved an X-ray and a doctor. Now it has become X-ray and AI.
“This shows the impact,” he added. “All the years that we invested in CAD4TB, we simply believed in this product and that it should become available. We focused on Tuberculosis and eradicating this before 2030. That is also the WHO’s aim, and we are trying to support that.”
Ghana 1
Ghana 1 is a government-to-government project between the Dutch Government and Ghanian Government that has enabled the screening to be implemented in Ghana. To date 52 ‘screening units’ – containers equipped with an EasyDR running CAD4TB – have been successfully installed in the country.
“Preparations for the project began in 2010 and we were able to start with the project in 2016,” said Guido. “You have to plan for years ahead to be effective in an environment that is very complex and difficult. And you have to be extremely flexible and, in your planning, and how you execute the plan. I think that's the biggest challenge. I think this is only possible for a certain size of company.”
CAD4TB automatically analyses the images from the X-ray with the aim to make the screening process as simple as possible.
“We installed approximately 52 X-rays all over Ghana in containers with solar panels in areas where they didn’t have any X-ray at all. We could screen for tuberculosis but also all kinds of other diseases. The Royal Institute for Tropical Diseases (Katholieke Instituut voor de Tropen (KIT) in Dutch – the Royal Institute for Tropical Diseases in English) here, in The Netherlands analyzed the project and there was definitely an impact on reduction of TB cases at the start of the program.” said Guido.
“Unfortunately during the COVID-19 pandemic the program stood still for two years and a lot of the benefits of the TB screening that we began with were lost. However, what they found out, which was for them also remarkable, is that it was not only a TB project, but very much a health system strengthening project. Within three months we taught the CAD4TB AI solution to recognize COVID-19 as well and installed this for free to provide support during the pandemic. The KIT were very positive about the end result and we are now fully up to speed again with the screening program. So, we are talking about a potential second project, Ghana 2, with the Ghanian Government again.”
“Our solutions not only support TB & COVID-19 response, but also support resilient and sustainable systems for health (RSSH). Additionally, they contribute towards achieving universal health coverage (UHC).” – Impact Analysis 2022.
To tackle this issue, Delft Imaging developed an AI-based software, called CAD4TB (Computer-Aided Detection for Tuberculosis) to operate on the Easy DR mobile X-ray system.
“At the moment, the population of Africa is 1.2 billion people. It will be 2.4 billion people in 2050. And it will be four billion people at the end of the century,” said Guido Geerts, CEO of Delft Imaging.
“As well as being large, Africa’s population is extremely young and they don't have many highly skilled healthcare workers at the moment. So, how do you solve that? We believe that the combination of hardware and AI will be the solution for a lot of healthcare issues in Africa.”
“Delft Imaging’s main activity is screening for TB. Our biggest innovation is in using Artificial Intelligence to recognize TB on an X-ray with a software solution called CAD4TB,” he continued. “We have invested more than 10 years in its development. With the first prototype introduced in 2012, we are now recognized by the World Health Organization (WHO) as not only the inventor, but they have endorsed our AI as the way to go forward for screening of TB.”
EasyDR was our X-ray solution,” he said. “We deliberately chose EasyDR because it's a multifunctional system. It’s perfect to use for screening tuberculosis, but you can also use it as a multifunctional system. We can turn it to do abdominal, extremities and all kind of other issues. It has potential as a health system strengthening program. In a lot of the African countries there are too few X-ray systems. With the X-ray in place for TB screening, it could potentially be used for exploring other conditions.”
Screening for TB has previously always involved an X-ray and a doctor. Now it has become X-ray and AI.
“This shows the impact,” he added. “All the years that we invested in CAD4TB, we simply believed in this product and that it should become available. We focused on Tuberculosis and eradicating this before 2030. That is also the WHO’s aim, and we are trying to support that.”
Ghana 1
Ghana 1 is a government-to-government project between the Dutch Government and Ghanian Government that has enabled the screening to be implemented in Ghana. To date 52 ‘screening units’ – containers equipped with an EasyDR running CAD4TB – have been successfully installed in the country.
“Preparations for the project began in 2010 and we were able to start with the project in 2016,” said Guido. “You have to plan for years ahead to be effective in an environment that is very complex and difficult. And you have to be extremely flexible and, in your planning, and how you execute the plan. I think that's the biggest challenge. I think this is only possible for a certain size of company.”
CAD4TB automatically analyses the images from the X-ray with the aim to make the screening process as simple as possible.
“We installed approximately 52 X-rays all over Ghana in containers with solar panels in areas where they didn’t have any X-ray at all. We could screen for tuberculosis but also all kinds of other diseases. The Royal Institute for Tropical Diseases (Katholieke Instituut voor de Tropen (KIT) in Dutch – the Royal Institute for Tropical Diseases in English) here, in The Netherlands analyzed the project and there was definitely an impact on reduction of TB cases at the start of the program.” said Guido.
“Unfortunately during the COVID-19 pandemic the program stood still for two years and a lot of the benefits of the TB screening that we began with were lost. However, what they found out, which was for them also remarkable, is that it was not only a TB project, but very much a health system strengthening project. Within three months we taught the CAD4TB AI solution to recognize COVID-19 as well and installed this for free to provide support during the pandemic. The KIT were very positive about the end result and we are now fully up to speed again with the screening program. So, we are talking about a potential second project, Ghana 2, with the Ghanian Government again.”
“Our solutions not only support TB & COVID-19 response, but also support resilient and sustainable systems for health (RSSH). Additionally, they contribute towards achieving universal health coverage (UHC).” – Impact Analysis 2022.
“The Easy DR is integrated into the container with solar panels and the CAD4TB box with its main purpose to provide a solution which in all circumstances is adapted to the country its specific needs. With this we aim to provide a sustainable impact on United Nations’ TB reduction targets.”
Luc Wijnhoven, Managing Director – Oldelft Benelux
(Oldelft Benelux is a subsidiary of Canon Medical Systems Europe specialized in diagnostic x-ray solutions).
Screening in remote villages
Together with Oldelft Benelux, Delft Imaging have also developed a solution to enable TB screening smaller, more remote villages with difficult access.
“Delft Light is a backpack X-ray. It’s a very small machine with Canon detectors inside,” explained Guido. “Everything is carried on your back. So you can go by scooter or by canoe if it’s near a river to the village and you can completely screen the whole population and then go back to the city to analyze the results. That’s something that wasn’t possible with the EasyDR as its stationary and quite big but now we have other solutions like Delft Light so you simply carry it on your back.”
Maintenance plan
One of the longer-term issues in the project was to address maintenance and service.
“Whatever you deliver, it is essential that it is easy to maintain, stable, and easy-to-use,” said Guido. “The EasyDR is an extremely robust system that was developed with the main objectives of being simple but high quality. The first EasyDRs delivered around 15 years ago are still functioning. That is what we did with all the solutions that we are delivering. Easy to maintain, very high quality, but not too complex, if it isn’t necessary, and where possible, we add AI.”
“Before we started, there was no maintenance or service infrastructure for the X-ray systems in Ghana. So, from the very beginning, we included this and after many years all the systems are still perfectly up and running,” he also remarked. “Initially, all the installations were carried out by Oldelft Benelux. Then gradually, we started developing a local organization with local people who could take over the support. We now have a team of 30 people in Ghana. Our Ghanian colleagues are now trained on the EasyDR, but in one or two years the local Ghanian health service will take over the maintenance.”
A great deal of flexibility and practical entrepreneurship is required to be effective under these conditions,
“That's exactly what the staff of Oldelft Benelux provide,” said Guido. “They are used to the fact that every situation is different and have a certain mindset and skill set that enables them to succeed and remain extremely positive. For Ghana 2, we will also collaborate with Oldelft Benelux.”
Together with Oldelft Benelux, Delft Imaging have also developed a solution to enable TB screening smaller, more remote villages with difficult access.
“Delft Light is a backpack X-ray. It’s a very small machine with Canon detectors inside,” explained Guido. “Everything is carried on your back. So you can go by scooter or by canoe if it’s near a river to the village and you can completely screen the whole population and then go back to the city to analyze the results. That’s something that wasn’t possible with the EasyDR as its stationary and quite big but now we have other solutions like Delft Light so you simply carry it on your back.”
Maintenance plan
One of the longer-term issues in the project was to address maintenance and service.
“Whatever you deliver, it is essential that it is easy to maintain, stable, and easy-to-use,” said Guido. “The EasyDR is an extremely robust system that was developed with the main objectives of being simple but high quality. The first EasyDRs delivered around 15 years ago are still functioning. That is what we did with all the solutions that we are delivering. Easy to maintain, very high quality, but not too complex, if it isn’t necessary, and where possible, we add AI.”
“Before we started, there was no maintenance or service infrastructure for the X-ray systems in Ghana. So, from the very beginning, we included this and after many years all the systems are still perfectly up and running,” he also remarked. “Initially, all the installations were carried out by Oldelft Benelux. Then gradually, we started developing a local organization with local people who could take over the support. We now have a team of 30 people in Ghana. Our Ghanian colleagues are now trained on the EasyDR, but in one or two years the local Ghanian health service will take over the maintenance.”
A great deal of flexibility and practical entrepreneurship is required to be effective under these conditions,
“That's exactly what the staff of Oldelft Benelux provide,” said Guido. “They are used to the fact that every situation is different and have a certain mindset and skill set that enables them to succeed and remain extremely positive. For Ghana 2, we will also collaborate with Oldelft Benelux.”
“ We are delighted that our solution has been able to ease the situation for district hospitals, provide some stability to existing systems by dealing with the screening in small villages, spread resources, and take pressure off the doctors that are there.”
Guido Geerts,
CEO of Delft Imaging,
the Netherlands.
Dynamic potential
With the EasyDR in a truck, it is possible to move around the field a bit with a complete clinic in one truck creating possibilities for other roles in healthcare.
“We have also in Ghana and other countries, complete trucks with EasyDR inside as well as a small lab, so we could screen on multi diseases,” said Guido. “We often screen for HIV AIDS, but there are a lot of other possibilities. That is what we are trying to stimulate. It goes slowly, but it is possible.”
Making healthcare a work of art
As they are, the containers used for screening are somewhat ugly and resemble sea containers. Delft Imaging organized an art project around the project to improve their appearance and improve the perception of screening within local populations.
“Some people have a stigma about TB screening, were scared of the containers and did not want to go inside,” said Guido. “So, we came up with the idea to invite local artists to paint the containers. There are 50 containers that are completely painted by local artists. We funded the artists and paint, and we made a small booklet showcasing all the different containers that are painted with promotion of the local artist, It's a perfect art project. It is so beautiful.”
Ghana 2
With the Royal Tropical Institute positive about the health system strengthening of the project, Delft Imaging is already planning a second version of the scheme, Ghana 2, with an even wider reach.
“We are delighted that our solution has been able to ease the situation for district hospitals, provide some stability to existing systems by dealing with the screening in small villages, spread resources, and take pressure off the doctors that are there,” remarked Guido. “Africa is still very remote in places in every area, because the continent is so extremely huge and it’s difficult to keep up with the pace of the population growth. Africa continues to require a huge amount of investment in care.”
With the EasyDR in a truck, it is possible to move around the field a bit with a complete clinic in one truck creating possibilities for other roles in healthcare.
“We have also in Ghana and other countries, complete trucks with EasyDR inside as well as a small lab, so we could screen on multi diseases,” said Guido. “We often screen for HIV AIDS, but there are a lot of other possibilities. That is what we are trying to stimulate. It goes slowly, but it is possible.”
Making healthcare a work of art
As they are, the containers used for screening are somewhat ugly and resemble sea containers. Delft Imaging organized an art project around the project to improve their appearance and improve the perception of screening within local populations.
“Some people have a stigma about TB screening, were scared of the containers and did not want to go inside,” said Guido. “So, we came up with the idea to invite local artists to paint the containers. There are 50 containers that are completely painted by local artists. We funded the artists and paint, and we made a small booklet showcasing all the different containers that are painted with promotion of the local artist, It's a perfect art project. It is so beautiful.”
Ghana 2
With the Royal Tropical Institute positive about the health system strengthening of the project, Delft Imaging is already planning a second version of the scheme, Ghana 2, with an even wider reach.
“We are delighted that our solution has been able to ease the situation for district hospitals, provide some stability to existing systems by dealing with the screening in small villages, spread resources, and take pressure off the doctors that are there,” remarked Guido. “Africa is still very remote in places in every area, because the continent is so extremely huge and it’s difficult to keep up with the pace of the population growth. Africa continues to require a huge amount of investment in care.”
Partners in innovation
Oldelft Benelux
Oldelft Benelux is a Systems Integrator and Service Provider specialized in the installation, commissioning, and maintenance of analog and digital medical equipment and innovative Healthcare ICT systems in hospitals and care centers. Oldelft Benelux BV is a subsidiary of Canon Medical Systems Europe. Oldelft Benelux supports Delft Imaging with several TB screening projects such as the Ghana 1 project. As an organization they want to make an impact and create value for the healthcare of communities in developing countries. Oldelft Benelux together with Delft Imaging Systems want to create fully adapted solutions to specific needs.
Click HERE to find out more.
Delft Imaging
Delft Imaging is a leading total solutions provider. It is the global leader in TB screenings with more than 1,200 installations in over 75 countries worldwide.
Click HERE to find out more.
Delft Light - The Backpack X-ray
The Delft Light is an easy-to-set-up, portable X-ray system featuring Canon flat panel detectors that is packed in a backpack for easy transport by car, motorcycle, or boat. It is especially suited for tuberculosis screening projects at remote locations. The Delft Light is specifically designed for use in areas with high ambient temperatures and elevated humidity.
Click HERE to find out more.
Easy DR
The Easy DR system combines the advantages of a compact, easy to install system with proven Canon digital imaging technology. This extremely robust system can be installed in a mobile vehicle or in container which can be a major benefit for field deployable requirements. The versatile Easy DR is ideal for chest imaging but also suited for general radiography.
Canon Flat Panel Detectors have been well-proven for many years and are renowned for their quality and reliability in both mainstream and in highly challenging environments. Canon FPD’s provide extremely high-resolution images, require very low patient X-ray dose and provide a long operational life.
Easy DR uses Canon’s intuitive ‘CXDI-NE’ Graphical User Interface (GUI) which is common to all DelftDI digital radiography modalities. This commonality of Canon GUI across the DR product range is a major advantage when it comes to speed of operator training and user familiarity and convenience. The configuration options ensure a GUI that is right for you; comprehensive image processing choices guarantee optimized image quality every time and the industry standard DICOM interface ensures multi-vendor and cross-platform connectivity in any situation.
Click HERE to find out more.
CAD4TB: Computer-Aided Detection for Tuberculosis
CAD4TB is a Class IIb medical software which quickly analyses a digital chest X-ray image and gives an indication if the subject on the image has abnormalities that may be related to pulmonary TB. The software has been trained in the detection of TB-related abnormalities by applying deep learning. CAD4TB has also received expert feedback from lung specialists, making it extremely accurate and reliable.
Click HERE to find out more.
Oldelft Benelux is a Systems Integrator and Service Provider specialized in the installation, commissioning, and maintenance of analog and digital medical equipment and innovative Healthcare ICT systems in hospitals and care centers. Oldelft Benelux BV is a subsidiary of Canon Medical Systems Europe. Oldelft Benelux supports Delft Imaging with several TB screening projects such as the Ghana 1 project. As an organization they want to make an impact and create value for the healthcare of communities in developing countries. Oldelft Benelux together with Delft Imaging Systems want to create fully adapted solutions to specific needs.
Click HERE to find out more.
Delft Imaging
Delft Imaging is a leading total solutions provider. It is the global leader in TB screenings with more than 1,200 installations in over 75 countries worldwide.
Click HERE to find out more.
Delft Light - The Backpack X-ray
The Delft Light is an easy-to-set-up, portable X-ray system featuring Canon flat panel detectors that is packed in a backpack for easy transport by car, motorcycle, or boat. It is especially suited for tuberculosis screening projects at remote locations. The Delft Light is specifically designed for use in areas with high ambient temperatures and elevated humidity.
Click HERE to find out more.
Easy DR
The Easy DR system combines the advantages of a compact, easy to install system with proven Canon digital imaging technology. This extremely robust system can be installed in a mobile vehicle or in container which can be a major benefit for field deployable requirements. The versatile Easy DR is ideal for chest imaging but also suited for general radiography.
Canon Flat Panel Detectors have been well-proven for many years and are renowned for their quality and reliability in both mainstream and in highly challenging environments. Canon FPD’s provide extremely high-resolution images, require very low patient X-ray dose and provide a long operational life.
Easy DR uses Canon’s intuitive ‘CXDI-NE’ Graphical User Interface (GUI) which is common to all DelftDI digital radiography modalities. This commonality of Canon GUI across the DR product range is a major advantage when it comes to speed of operator training and user familiarity and convenience. The configuration options ensure a GUI that is right for you; comprehensive image processing choices guarantee optimized image quality every time and the industry standard DICOM interface ensures multi-vendor and cross-platform connectivity in any situation.
Click HERE to find out more.
CAD4TB: Computer-Aided Detection for Tuberculosis
CAD4TB is a Class IIb medical software which quickly analyses a digital chest X-ray image and gives an indication if the subject on the image has abnormalities that may be related to pulmonary TB. The software has been trained in the detection of TB-related abnormalities by applying deep learning. CAD4TB has also received expert feedback from lung specialists, making it extremely accurate and reliable.
Click HERE to find out more.
Other blogs that may interest you
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References
1
https://www.who.int/news-room/fact-sheets/detail/tuberculosis
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