South Africa has one of the biggest tuberculosis (TB) epidemics in the world. Social conditions, poor health, migrating labour and the HIV epidemic have all lead to us having the third highest number of new infections, after China and India.
The novel introduction of mobile x-ray identification and diagnostic trucks is letting us address these challenges.
Mobile X-ray Truck
At the end of 2014 Right Health designed and outfitted its first x-ray truck. The initial lead lined truck was self-supporting and clinically sound. Towing its own generator for power and housing internal water tanks for clean potable water it could operate independently in any environment.
The truck was outfitted with a state of the art clean air system, automated germicide spray and ultraviolet lights to reduce the spread of tuberculosis to staff and patients.
In two separate compartments, we housed a generous space for day to day operations and a secure area for the x-ray equipment. The radiographer and assistance go about their work in a safe environment while patient’s x-ray were taken by fully digital Samsung GU60A equipment.
The truck was certified under the Radiation Protection and Control board and went into operation in early 2015.
Automated Diagnostic capabilities
To increase TB identification we need to transform the process
Radiologists are a scarce skill in South Africa and to review each digital x-ray would have been time-consuming and costly. Right to Care looked into available technologies that were being used aboard to see if this challenge could be overcome.
We settled on Computer-aided detection for Tuberculosis (CAD4TB™) developed by Delft Imaging Systems which designed to help (non) expert readers in the diagnosis of TB. Within minutes of exposure, the software automatically analyses chest x-rays, detects abnormalities and indicates the likelihood of active TB.
This technology empowered us to have x-rays with an above threshold score to be reviewed by a qualified radiologist who reports back findings.
Transfer and storage of digital x-rays
Overcoming the geographical challenges
As important as automating the diagnostic process was empowering small local teams (one to two people) to work in geographically diverse areas without compromising patient care. To do this we needed to be able to send, receive and review digital x-rays from anywhere our trucks travelled to.
From the local truck Picture Archiving Communication System (PACS) we compress and transfer the digital x-ray to a central PACS system. Each x-ray is reviewed by the principal CAD4TB system. Irregular x-rays are spontaneously routed to the off-site Radiologist for review where predefined template reporting is used to help diagnosis the abnormality or irregularity. The radiologist reports are also centrally stored on the Right Health PACS systems. The mobile trucks routinely print and disseminate x-rays, CAD4TB™ and radiologist reports as needed.
Revolution of the public sector pharmacy
After the success of the first truck, two more were built and rolled out. External suppliers with similar trucks were contracted and the digital x-rays routed into the same central PACS for review and reporting.
This innovation has empowered Right to Care, in partnership with RightHealth, to x-ray 57 290 Department of Correctional staff and inmates.