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UltraPortable X-ray / UPX for outreach screening

"Portable” radiographic systems are a subset of “mobile” radiographic equipment, which mainly impact the system portability, management and clinical applications. Designed to be used mainly when the planned diagnostic and/or screening activities are located far from health structures for e.g. outreach interventions. Various new ultra-portable X-ray systems called UPX are available on the market to reach out to key and vulnerable populations, and to perform diagnostic imaging for not only chest, but also pelvis, extremities and trauma. Solar-powered battery packs and offline CAD allow for environmentally friendly, rapid and accurate screening for active TB also in resource constrained setting.

Examples of Ultra-Portable X-ray Transportation

Community-based screening efforts with mobile/portable digital X-ray have the potential to identify people very early in their disease course and to substantially increase TB notification rates. In addition ultra-portable X-ray / UPX systems remove from the patients the burden (cost and time) of transportation by taking screening services to the people. Facilitated by CAD/AI to instantly and accurately read chest radiographs, ultra-portable X-ray contributes to infection control and is transforms screening for active TB worldwide including for childhood TB.

According to WHO, the use of portable X-ray (UPX) in combination with compatible AI (Artificial Intelligence)-powered Computer-Aided Detection (CAD) software solutions could significantly increase the diagnostic capacities of the system, efficacy and efficiency, and its appropriateness and advantages of use [1]. These digital and AI-powered innovations support the WHO plan to End the Global TB Epidemic by 2035, by finding the missing people with TB early, including key and vulnerable populations living in remote areas.

Ultraportable X-ray (UPX) training at Hospital Provincial de Gaza

Outreach Backpack UPX/CAD4TB screening in Nepal by StC/NTCC

Tajikistan GDF: user training completed by Ghana Delft team for portable X-ray (UPX) and CAD

March 2022: DRC PNLT user training for portable X-ray (UPX) completed

Ultra-portable X-ray/UPX: 29.5 kg Backpack UPX system

At the UNION Conference in The Hague in 2018, the innovative Delft Light Backpack X-ray for safe and shock-resitant transporation was introduced as the next generation portable digital X-ray system. At the UNION Conference in Bali in 2024, the next generation ofDelft Light with better portability and doubled battery capacity was presented.

Based on extensive operational since 2018 experience Worldwide, this further optimized system comes with an ultra-portable X-ray unit now allowing for about 400 high quality X-ray images per day. All required components can be powered with a portable (6kg) solar/powerpack. The solar power panel and internal battery recharge the X-ray and detector batteries and power the laptop and CAD4TB tablet during a full day of operation. Spare batteries or external power can further extend the outreach operations. The foamed Backpack - designed for easy and safe transportation - typically includes a high resolution flat panel CANON detector, notebook, protection apron and lightweight X-ray system.

Key technical specifications

  • The complete UPX system is fully battery-powered and now weighs about 29.5 kg.
  • The energy-efficient 90 kV generator allows for up to 400 exposures @90kV per day on (fully charged) batteries only.
  • Batteries are solar panel rechargeable for off grid use in the field
  • Ultra-portable: can be taken anywhere in a car on motorbike or by walking.
  • The UPX can also be used to diagnose other body parts like fractures in extremities.
  • Fit for easy & safe transport on foot, motorbike, SUV and kano; no bulky cases to carry.
  • Operable in any remote setting designed for use in areas with high ambient temperatures and elevated humidity.
  • Electrical power 1.35 kW @ 90 kV, 15 mA (high power mode 30 mA)
  • Tube voltage 40-90 kV (2 kV steps)
  • Exposure time range 0.01-1.0 sec (0.01 sec steps)
  • Duty cycle 1:60 (one 0.2 sec exposure every 12 seconds)
  • Dual laser positioning pointer: Class III-a laser diode
  • Battery charging time (empty to full) 4 hours. 'Low battery’ indicator / alarm on display panel
  • Foldable, twistable and rotatable stand
  • Large wheels for easy movement
  • Vertical travel range 36 – 213 cm
  • Purpose: general radiography; Scintillator: CsI
  • Detector effective imaging area 35x43 cm
  • Detector Image display time < 5 seconds; gray scale 4096
  • Detector image matrix size: 2496 x 3040 pixels; scatter correction software (no need for GRID)
  • Detector battery-type Lithium ion

2023 ultra-portable X-ray introduction: 90 kV Delft Ultra compact UPX

This addition to the ultra-portable X-ray (UPX) landscape solution portfolio was announced at the 2023 UNION Conference in Paris and aims to provide access to truly ultra-portable digital X-ray with fully integrated CAD compatibility. This next generation UPX system is compact, ultra-portable and allows the operator to take low cost digital X-ray images almost everywhere. It acquires images and wirelessly transmits these to an archive (PACS) via the on-board workstation, hosted within the camera. By combining this UPX with CAD software, rapid and accurate TB screening is possible in the most remote and resource-constrained areas to reach 90% of the most vulnerable, underserved and at-risk populations. Its capital investment cost is significantly below other ultra-portable systems (UPX) used for higher daily throughput TB screening.

Images from Delft Ultra pilot project in Ghana
Images from XACT-19 community-based active case finding research in South Africa.
Delft Ultra and CAD4TB v7 used for “Detecting active TB, sub-clinical TB, and probably infectious TB in the community; providing vital information to screening strategies and national TB programmes to improve policy and practice by e.g. locating contacts and TB hotspots”

Key technical specifications

  • Wireless and ultra-portable AI empowered X-ray screening for TB disease in key populations and difficult to reach areas.
  • Package consists off; Xray tube with integrated mini PC, detector, holder and tripod stand.
  • Xray technique; fixed 90kV, 2-5 mA, expose time 0,05-1,3 seconds.
  • Weight < 10 kg for complete system (excluding accessories).
  • Integrated easy to use solution for rapid set-up in the field; easy to assemble, setup takes around 5 minutes.
  • CAD4TB can be integrated in the compact X-ray camera, so no need for the CAD4TB box.
  • Use case: household screening and outreach programs accessible by motor, canoe or walking.
  • Accessories: integrated powerpack and solar panel, tube and detector stands.
  • Maximizes productivity in the field with long-lasting battery performance and solar panel recharging; up to ~100 images per working day.
  • FDA 510(k) cleared system guarantees the safety of X-ray operations.
  • Low cost state-of-the-art fully digital X-ray system for affordable active TB case findings.

Delft Ultra/CAD4TB used by University of Cape Town for research

Delft Ultra with CAD4TB allow for a rapid and reliable offline abnormality heatmap scoring within 1 minute

UPX for facility and outreach TB screening in Kenya

The Goal: Active TB case finding in hard-to-reach communities in Kenya with free services.

Introducing New Tools Project (iNTP): Kenya, June 2022. “One major benefit of the machines is portability hence improving access to TB screening and diagnosis at lower-level health facilities and at the community level. These portable radiology devices are characterized with reduced exposure to radiation and cost-effectiveness thus being user friendly. This patient-centred provision of free services is likely to reduce the time to diagnosis, reduce the number of tests needed to diagnose a TB patient as well as reducing the catastrophic cost incurred due to diagnosis.”


Improving TB Case Finding through the use of UPX and CAD4TB in Siaya County, Kenya:

Source: 2024 UNION World Lung Health Conference, iNTP Kenya presentation:

Backpack ultra-portable X-ray

“It is a good screening tool for TB because of its high accuracy for detecting TB disease, especially before the unset of symptoms. A high TB positivity rate among individuals with high CAD scores highlights the effectiveness of community-based screening. Battery life X-ray long lasting 2-5 days and shigh-quality images, but multiple detachable parts”.
2024
TIBULUMS

is the Information Management System in Kenya whereby UPX/CAD4TB data are seamlessly integrated through an API gateway for digital screening data on LMIS for TB surveillance. The API takes data from CAD4TB Boxes to the CAD cloud and then to TIBULMIS that provides a real time dashboard on device usage, CAD score, age lab results and radiologist reports.
2024

Source: Division of National Tuberculosis, Leprosy and Lung Disease program - June 2023:
Introducing New Tools Project (iNTP) accelerated efforts to find the missing cases by rolling out CAD4TB for Chest X-ray at amongst others Madiany sub-county Hospital.

Regional officer USAID TB ARC II Nyanza

recommends the scale-up of CAD4TB and X-ray to every GeneXpert site as per WHO guidelines to ensure targeted testing and reduction in cartridge wastage. “If a patient scores above 60 (CAD4TB) then they are referred to clinicians for sputum testing to confirm TB. Data shows that at least 2 out of 10 people sent to the lab for testing will turn out positive for TB, hence with targeted testing a reduction in cartridge wastage”.
June 2023
Facility radiographer

praises the efficiency, effectiveness and user-friendly nature of the portable machine which involves taking the X-ray images and utilizing the built-in AI for interpretation. “This machine is superior to other, providing satisfaction when diagnosing patients, initiating treatment and witnessing their health improvement”.
June 2023
Medical super-intendent Madiany sub-county:

“In a day we serve an average of 200-300 clients of which 10 are likely to be TB patients. Compared to last year our TB diagnosis increased by 50% meaning we were missing cases as a result of the absence of the machine”.
June 2023
TB/HIV officer:

Previously we had to refer clients to distant hospitals which posed challenges due to transportation cost and patient X-ray fees resulting in delayed diagnosis. However, with CAD4TB and CXR we now screen clients on-site and accompany those who require further testing free of charge. If TB is detected they initiate treatment. .
June 2023

Ultra-Portable X-Ray (UPX) for outreach TB screening in Nigeria

The Goal: To increase active TB case finding in hard-to-reach communities in Nigeria within the TB LON Regions.

KNCV applied the below algorithm whereby the Delft Light (UPX) was used to identify presumptive TB cases based on the CAD4TB abnormality score. Any subject with a CAD abnormality score > 60 was eligible for Xpert MTB/RIF testing.

Flow Algorithm
Nigeria NTP user experience, sharing for Delft Light

With DL we screen in the field up to 250 people/day, with a fully charged battery, which is a game changer for finding the missing people with TB in hard to reach areas.
May 2022
StopTB Partnership on Nigeria

The 10 backpack Delft Light X-ray systems with CAD4TB software perpetual licenses will allow Nigeria to improve TB screening in hard-to-reach places, and the 38 Truenat systems will make it easier for people in Nigeria to receive rapid molecular testing for TB where they seek care.
May 2022
The Global Fund ordered 200 ultra-portable X-ray machines

The 200 back-pack UPX devices - with a solar-battery packs - will be deployed across Nigeria in support of the END TB strategy and will facilitate intensifying early TB case detection in key populations including among children.
June 2024
USAID Global Health Assistant Administrator

In Nigeria screening with a combination of ultra-portable, AI-assisted X-ray equipment and fast-turnaround molecular tests helped boost TB case detection by almost 40% in a single year.
August 2024

Outreach screening with Wellness on Keke in Nigeria

Screening in a remote village in Kano by KNCV Nigeria Radiographer

Nigeria KNCV/IHVN user experience sharing for Delft Light on May 5th 2022
Webinar of StopTB Focus Group on AI based imaging for TB

Implementing CAD and Ultra-Portable X-ray in Nigeria

  • With DL backpack X-ray we see no issue to screen up to 250 per day with fully charged battery.
  • Being able to operate both offline and online allows for DL to be deployed in hard to reach areas without mobile phone or internet connectivity.
  • Image quality is comparable to the WoW Truck and other stationary X-ray systems.
  • Delft Light image resolution at its best.
  • Detector and hanger / frame is highly adoptable and easy to use.
  • Operational presumptive TB threshold is CAD4TB score 50+ based on prior experience..
  • Local technical service center plus local equipment parts needed.

Pictures from the KNCV outreach TB screening program in Nigeria

Ultra-Portable X-ray in Bangladesh

Source: Rahman, M. (2023, November 15-18). Ultra-portable X-ray with artificial intelligence for TB screening and facilitating TB preventive therapy in Bangladesh [Conference session]. The Union World Conference on Lung Health 2023, Paris, France

“Ultra-portable X-rays with CAD4TB can be a game-changer in detecting TB cases early, including asymptomatic cases. They also help save cartridges and ensure equitable access to quality care. NTP can scale up this technology to diagnose missing TB cases in remote locations and for nationwide TPT roll-out.”