Tackling Tuberculosis in Ghana: 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.

Tackling Tuberculosis in Ghana

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 worldwide. 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 Canon Medical’s 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.”

“Canon’s 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.”

Look at our screening solutions here: https://oldelftbenelux.nl/product-categorie/screening/

Ghana 1
Ghana 1 (Tackling Tuberculosis in Ghana) 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.

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 Medical 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.