Mini portable x-ray machines and AI-powered software will enable access to TB screening and rapid treatment for people living in remote Pacific island communities
Significant strides have been made in the Western Pacific region in the battle against tuberculosis (TB). However, these achievements have not benefited everyone equally. People living in remote areas, where access to health care services is limited, are at risk of being left behind.
New health technologies may hold great promise to address this.
One such innovation is the mini portable x-ray machine, equipped with advanced artificial intelligence (AI)-powered software. These systems are particularly well suited for the challenging operating environments that are so common in the Pacific, where TB incidence is high, populations are disbursed across distant island communities with limited access to health care and there is a lack of health care professionals with advanced training.
Reaching remote areas
The United Nations Development Programme (UNDP), through the Multi-Country Western Pacific Integrated HIV/TB Programme, has procured mini portable x-ray systems for the Ministries of Health in the Federated States of Micronesia, Kiribati, Republic of Marshall Islands, Samoa, Tuvalu and Vanuatu, with additional machines on the way for Fiji and Tonga.
The compact devices can fit in a suitcase and be carried by a single technician to the most remote communities and produce rapid, accurate results, without the need for on-site radiologists or doctors.
“These x-ray systems will greatly assist with screening for TB in remote areas – which means more cases will be detected, treatment will be initiated rapidly and the burden of TB will be decreased,” says Ms. Gayane Tovmasyan, Programme Manager at UNDP Pacific Office in Fiji. “This will help to achieve the Sustainable Development Goals target of ending TB in the Pacific by 2030.”
Systematic screening, also known as active case-finding, is a TB control strategy that typically targets at-risk populations outside of health facilities. It plays an important role in reducing TB transmission within the community by identifying individuals with TB and shortening the duration of their infectiousness.
A recent four-day workshop in Nadi, Fiji provided hands-on training on the new x-ray systems for health workers from the eight countries.
Relieving pressure on health systems
“We have another type of mobile x-ray machine which we use for screening in the outer islands in Tuvalu, however it is still fairly bulky and requires a team of four to move it,” says Ms. Lafou Manatu Mosese, an x-ray technician from Tuvalu, who participated in the training. “This new technology is very portable.”
Chest x-rays are an essential and cost-effective screening tool for detecting TB disease in a person’s lungs. However, the devices are difficult to transport and require a full health care team to operate, including a technician who takes the radiographic images and a radiologist (typically a doctor) who interprets the images.
The new mini portable versions, on the other hand, can be operated in outreach screening campaigns by a trained technician and clinician. This is an especially important improvement given the shortages of radiologists and doctors across the region.
The accompanying AI-powered software is specifically designed for analyzing chest x-rays. In just one minute, it can accurately determine whether a patient is TB presumptive. In cases where a patient's screening yields a positive result and a clinician's assessment reveals corresponding signs and symptoms of TB, the patient can be put on treatment the same day.
The impact of this efficiency gain is not trivial. “In Tuvalu, we only have one TB doctor, who normally would have to split their time between the mainland and traveling to outer islands for TB screening campaigns,” explains Ms. Mosese. An outreach screening mission to the outer islands can last up to one month, due to infrequent ferries and inclement weather.
“The system will have a great impact on the treatment and management of TB, and make our work easier. The AI-powered software will be very useful in our setting and in remote areas with no radiologist available to interpret images,” adds Ms. Mosese.
Speeding up TB testing
Mr. Kun Kios, another x-ray technician from the Republic of the Marshall Islands – one of the higher burden TB countries in the region – shared further positive reflections.
“The new mini portable systems will help a lot with more quickly detecting TB cases and getting people on treatment, especially in our remote islands,” explains Mr. Kios.
Having a quicker workflow, the mini portable x-ray systems can increase the number of people that can be screened in a given day. The devices are battery-powered, with capacity to process about 70 x-rays per day on a single charge.
“The system can read the x-ray images and give a diagnosis within a minute. It really speeds up the turnaround time – which previously could be up to a week before a diagnosis is confirmed and a patient put on treatment,” he says.
When not being used in outer island active case finding campaigns, the systems will be put to work in TB clinics and hospitals as part of regular TB prevention efforts, boosting the diagnostic capacities and efficiencies of the national TB programmes.
Through hands-on training and the deployment of these devices, the national TB programmes in the Pacific are now better equipped to tackle the challenges posed by TB.