National Guide for use of digital x-ray with AI in camp settings

Overview

The National Tuberculosis Control Center endorses the National Guide for using Digital X-rays with AI in Camp Settings. This guide aims to provide step by step process to Health workers, social mobilizers, officers, implementers, and planners engaged in ACF activities to support the effective deployment of digital X-ray technology, enhanced by artificial intelligence, for tuberculosis screening in camp settings across Nepal.

This guide is the first of its kind, providing standardized procedures and operational guidelines to ensure accurate and timely TB diagnosis, especially in remote and high-risk populations. By integrating digital X-rays with AI into our TB control efforts, we aim to enhance early detection and improve outcomes, contributing to our goal of eliminating TB in Nepal.

Target population

The target population for TB screening using X-ray aims to prioritize those most vulnerable to TB infection and least likely to access regular, or existing healthcare services, ensuring that TB control efforts reach those who need them most, which are mostly vulnerable populations, mapped as detailed below.

• Higher Prevalence of TB: Those within populations with an increased likelihood of TB transmission and infection.
• Limited Access to Healthcare: Individuals facing difficulties accessing healthcare services due to geographical constraints, cultural barriers, socioeconomic challenges, or political barriers.
• Congregate Settings: Individuals living in communal environments such as urban slums, monasteries, prisons, and other congregate settings where TB transmission rates may be elevated.
• Hard-to-Reach Areas: Individuals residing in secluded or geographically isolated areas where access to healthcare services is particularly challenging.
• Secluded Indigenous Population: Indigenous communities living in remote or isolated areas where healthcare resources may be scarce and TB prevalence may be higher.

Inclusion criteria

• Population in target sites: 15 years and older, regardless of symptoms.
• Contacts of bacteriologically confirmed TB: 5 years and older, regardless of symptoms.
• Children aged 5-14 with prolonged cough (more than two weeks, on and off) and or malnutrition

Exclusion criteria CXR screening

• Pregnant women.
• TB patients under treatment
• Children under 5 years old.

Assure radiation safety

Setting up of chest x-ray screening procedure:

• Preferably conduct X-ray procedures in enclosed areas with a 2-meter safety zone.
• If conducted in open air, maintain a minimum distance of 2 meters between individuals and the X-ray tube.
• Use lead curtains to shield personnel from scattered X-rays and post appropriate radiation warning signs.

Worker’s safety:

• Install lead curtains or barriers between the X-ray machine and personnel.
• Ensure radiographers wear lead protectors as per the manufacturer’s instructions.
• Monitor radiation exposure levels regularly using dosimeters.

Participant safety:

• Obtain informed consent from all participants before X-ray examination.
• Inform female participants about the risks of chest X-ray during pregnancy and exclude pregnant women from screening.
• Educate participants on the minimal health risks associated with chest X-ray radiation exposure.

Infection control:

• Staff should wear N95 masks/surgical masks when working close to participants.
• Encourage hand hygiene practices among staff and participants.
• Minimize contact between participants during ACF activities.

Reporting: All program data should be reported monthly in the HMIS 9.3 and NTPMIS (NTP Service Tracker – SR Reporting) and regularly updated in the eTB register.

Recommended readings

• National Tuberculosis Programme Annual Report 2018
• National Tuberculosis Program Update in Nepal #WorldTBDay #EndTB
• National TB Prevalence Survey, 2018-19 Key findings
• World Tuberculosis Day 2020! It’s time to End TB!
• National Guideline on Drug Resistant TB Management 2019, Nepal
• National Tuberculosis Management Guideline 2019, Nepal
• Global Tuberculosis Report 2019: Latest status of the tuberculosis epidemic
• National TB Prevalence Survey, 2018-19 Key findings
• New WHO recommendations to prevent tuberculosis aim to save millions of lives
• World Health Organization (WHO) Information Note Tuberculosis and COVID-19
• World Tuberculosis Day 2020! It’s time to End TB!
• People-centred framework for tuberculosis programme planning and prioritization, User guide
• Global Tuberculosis Report 2019: Latest status of the tuberculosis epidemic
• Dissemination of Findings and Recommendations of Joint External Monitoring Mission(JEMM) of Nepal National Tuberculosis Program
• National Tuberculosis Programme Annual Report 2018
• National Strategic Plan for Tuberculosis Prevention, Care and Control 2016 – 2021
• NTP, Nepal: New TB Treatment Algorithm & Regimen (Updated)
• WHO announces landmark changes in MDR-TB treatment regimens
• TB Vaccine results announce a promising step towards ending the emergency
• 7 million people receive record levels of lifesaving TB treatment but 3 million still miss out

Related reports

• Global Tuberculosis Report 2024
• Global tuberculosis report 2023
• Global Tuberculosis Report 2022
• Global Tuberculosis Report 2021
• Global Tuberculosis Report 2020
• National Strategic Plan to End Tuberculosis in Nepal
• Global Tuberculosis Report 2019: Latest status of the tuberculosis epidemic
• Global Tuberculosis Report 2018
• WHO Global Tuberculosis report 2015
• Global tuberculosis report 2014: Improved data reveals higher global burden of tuberculosis