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Tuberculosis (TB), despite being a preventable and treatable disease, continues to pose a significant global health challenge. Each year, over 10.5 million people are afflicted, and 1.3 million lose their lives to this devastating disease.
Tragically, children are disproportionately affected, with a significant number dying from TB due to undiagnosed and untreated disease.
Recognising the urgent need for improved diagnostic solutions, we are proud to announce our involvement in the Start4All project, an initiative aimed at enhancing TB diagnosis and treatment across the globe.
The vision behind Start4All
Start4All, funded by a $15 million grant from UNITAID, is a four-year research programme led by the Liverpool School of Tropical Medicine (LSTM) and the Stop TB Partnership.
The initiative collaborates with local partners in Bangladesh, Brazil, Cameroon, Kenya, Malawi, Nigeria, and Vietnam, focusing on tailoring TB diagnostic tests to various populations.
Phase one of Start4All specifically targets the evaluation of the efficacy of different diagnostic tools, including computer-aided detection (CAD) of TB in chest X-rays of children.
The role of Worldwide Radiology
At Worldwide Radiology, we will be contributing to the development of a new repository of high-quality, labelled paediatric chest X-rays, held by Start4All at LSTM, starting with 1,000 X-rays from two study sites in Cameroon and Vietnam.
Repositories like these are essential for the evaluation and training of CAD software, which can then be used to assist in the detection of suspected TB on Chest X-rays..
Challenges and innovations
Diagnosing suspected TB on Chest X-rays in children remains a challenge due to the more complex appearances of the disease on X-ray and the technical challenges in obtaining high-quality chest X-rays. Challenges with accurate interpretation of the images are posed by a lack of expert readers, including radiologists and TB clinicians.
Chest X-ray, combined with Computer aided detection software, is one of the solutions endorsed by the WHO, to scale up the diagnosis of adults with suspected TB. For children, the accuracy and role of CAD is still under investigation and in urgent need of further evaluation.
Our contribution will involve recruiting a team of expert paediatric radiologists, with experience in TB, to provide a 'gold standard' interpretation of the X-rays, which will also be compared to microbiological TB tests and clinical information.
Furthermore, we will recruit 'real-world' readers, such as non-specialist radiologists and other health workers caring for TB patients, who more often handle this task in resource-limited settings.
By assessing the performance difference between expert and real-world interpretations, we aim to contribute to a growing evidence base on the potential benefits of the deployment of CAD technology as a supporting diagnostic tool in these challenging environments.
Project activities and goals
Activities planned under our Start4All project include:
Consulting with AI/CAD development experts and other Paediatric TB research groups to finalise technical specifications for the X-ray dataset and annotation methods.
Working with our partner Collective Minds Radiology, to set up a platform for viewing and annotating paediatric Chest X-rays from Cameroon and Vietnam..
Recruiting and preparing a team of five expert pediatric radiologists from high-burden TB countries to annotate the X-rays.
Participating in discussions for fair and ethical access to the X-ray repository after completion.
Conducting a comparative study between expert and ‘real-world’ X-ray readings, to inform paediatric CAD evaluation studies.
Disseminating research study findings in scientific journals and at international conferences.
Why Worldwide Radiology?
With our expanding radiology community network in countries with a high burden of TB and our extensive experience in contributing to CAD for TB evaluation studies, we are uniquely positioned to lead this aspect of the Start4All project.
Our commitment to advancing global health and to fair, ethical development of AI driven imaging solutions, aligns perfectly with the project’s objectives.
By leveraging our expertise and fostering new partnerships, we aim to contribute significantly to the global fight against TB.
Stay tuned
Start4All represents an important step forward in the battle against TB, particularly in improving diagnosis among vulnerable populations like children.
Through strategic partnerships and contributing to the robust evaluation of new technologies, we are set to make a substantial impact on TB care worldwide. We look forward to sharing our progress and successes as we move forward with this vital work.
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