CAD4TB

With the CAD4TB software, computers can automatically analyze chest radiographs for signs of tuberculosis.

We introduce the project with three movies.

The first movie reports on a big health care project in Ghana, where a large number of hospitals are equipped with digital x-ray and our CAD4TB software:


The second movie, from Delft Imaging Systems, our industrial partner, describes TB screening in Bangladesh, and shows how CAD4TB is used there:

Finally, a short video (mostly in Dutch) about the use of CAD4TB in Zambia is available by clicking on the picture below or by following this link

Videocad4tb.png

Chest radiography has always been widely used to find TB. Digital chest radiography has made x-ray cheaper and easier to use. No films, chemicals and water are needed to produce a digital radiograph and automatic exposure control ensures high image quality, and images are instanly available. The cost per exam, once a digital unit is operational, is near zero. Digital chest radiography therefore has a large potential to be used in TB case finding and prevalence surveys, as an adjunct test, next to molecular testing. Molecular diagnostics for TB, such as the GeneXpert MTB/RIF test are an exciting new development; they can make a definitive diagnosis of TB in two hours. However, these tests are still much more expensive and time consuming than radiography. Radiography can therefore act as a filter: TB suspects undergo symptom screening and chest radiography, and those with symptoms and/or abnormalities in the chest radiograph undergo further testing.

This is illustrated below in an animation from Delft Imaging Systems:


One issue remains: the lack of human expert readers in countries with a high burden of TB. CAD4TB eliminates this problem by automating the reading process.

The CAD4TB project

Our work in developing software to detect signs of tuberculosis started in 1996 when digital x-ray machines were first entering the market. We work with Delft Imaging Systems, famous as the inventor of the Odelca camera from the 1960s, one of the most widely used systems in x-ray TB screening in the world. Our project resulted in a prototype computer-aided detection system for TB in 2001. At that time however, digital x-ray was not yet widely adopted for TB case finding. In 2007, we attracted a research grant and established the CAD4TB project with partners in South Africa, the University of Cape Town Lung Institute, and in Zambia, the NGO Zambart.

Xrayunits.png
Left: one of the first digital units that is currently operational for the CAD4TB project, installed in Kanyama Clinic, in Lusaka, Zambia. In this clinic more than 10,000 TB suspects are seen every year. Right: mobile digital X-ray unit used in the Gambia for its TB prevalence survey.

The CAD4TB software

The first CAD4TB beta prototype (CAD4TB v0.01) was delivered in January 2010, and field tested in 2010. In 2011, the first official prototype version was released (CAD4TB v1.08), notably improved by training the system with a much larger number of images. Every year a new prototype version of the software has been released: in 2012 v2.09, in 2013 v3.07 and in 2014 v4.10. Version v4.10 has received a CE label. In 2016 version 5 was released. The algorithm developement behind CAD4TB is now done by Thirona, a spin-off company from the Diagnostic Image Analysis Group.

CAD4TB is commercially available via Delft Imaging Systems and operational in 12 countries worldwide. Our current research focuses on extending the capabilities of the software to do more than outputting a single number related to the preobability the subject has TB. We expect that in tyhe near future, the software can recognize and differetiate different types of abnormalities in the chest radiographs.

Researchers

Clinical publications

  • J. Melendez, C.I. Sanchez, R.H.H.M. Philipsen, P. Maduskar, R. Dawson, G. Theron, K. Dheda and B. van Ginneken. "An automated tuberculosis screening strategy combining X-ray-based computer-aided detection and clinical information", Nature Scientific Reports 2016;6:25265. Abstract/PDF DOI PMID

  • A. Steiner, C. Mangu, J. van den Hombergh, H. van Deutekom, B. van Ginneken, P. Clowes, F. Mhimbira, S. Mfinanga, A. Rachow, K. Reither and M. Hoelscher. "Screening for pulmonary tuberculosis in a Tanzanian prison and computer-aided interpretation of chest X-rays", Public Health Action 2015;5(4):249-254. Abstract/PDF DOI PMID

  • R. Philipsen, C.I. Sánchez, P. Maduskar, J. Melendez, L. Peters-Bax, J. Peter, R. Dawson, G. Theron, K. Dheda and B. van Ginneken. "Automated chest-radiography as a triage for Xpert testing in resource-constrained settings: a prospective study of diagnostic accuracy and costs", Nature Scientific Reports 2015;5. Abstract/PDF DOI PMID

  • P. Maduskar, I. Adetifa, J. van den Hombergh, E. Leroy-Terquem, A. Fasan-Odunsi, C.I. Sánchez, U. d'Alessandro and B. van Ginneken. "Computerized Reading of Chest Radiographs in The Gambia National Tuberculosis Prevalence Survey: Retrospective Comparison with Human Experts", in: Union World Conference on Lung Health, 2015. Abstract

  • R.H. Philipsen, C.I. Sánchez, P. Maduskar, J. Melendez, B. van Ginneken and W. Lew. "Objective Computerized Chest Radiography Screening to Detect Tuberculosis in the Philippines", in: Union World Conference on Lung Health, 2015. Abstract

  • M. Breuninger, B. van Ginneken, R.H.H.M. Philipsen, F. Mhimbira, J.J. Hella, F. Lwilla, J. van den Hombergh, A. Ross, L. Jugheli, D. Wagner and K. Reither. "Diagnostic accuracy of computer-aided detection of pulmonary tuberculosis in chest radiographs: a validation study from sub-saharan Africa", PLoS One 2014;9:e106381. Abstract/PDF DOI PMID

  • M. Muyoyeta, P. Maduskar, M. Moyo, N. Kasese, D. Milimo, R. Spooner, N. Kapata, L. Hogeweg, B. van Ginneken and H. Ayles. "The Sensitivity and Specificity of Using a Computer Aided Diagnosis Program for Automatically Scoring Chest X-Rays of Presumptive TB Patients Compared with Xpert MTB/RIF in Lusaka Zambia", PLoS One 2014;9(4):e93757. Abstract/PDF DOI PMID Citations found: 17

  • A. Khan, A. Zaidi, R. Philipsen, S. Khowaja, B. van Ginneken, A. Khan and T. Dossul. "Detection of Chest X-ray abnormalities and tuberculosis using computer-aided detection vs interpretation by radiologists and a clinical officer", in: 45th World Conference on Lung Health, 2014. Abstract

  • A. Steiner, F. Mhimbira, J. van den Hombergh, P. Clowes, C. Mangu, B. van Ginneken, M. Hoelscher and K. Reither. "Computer-aided diagnosis of X-rays in a screening for pulmonary tuberculosis of a prison population in Tanzania", in: 45th World Conference on Lung Health, 2014. Abstract

  • A. Zaidi, N. Khalid, R. Philipsen, B. van Ginneken, S. Khowaja and A. Khan. "Symptomatic screening and computer-aided radiography for active-case finding of tuberculosis: a prediction model for TB case detection", in: 45th World Conference on Lung Health, 2014. Abstract

  • P. Maduskar, M. Muyoyeta, H. Ayles, L. Hogeweg, L. Peters-Bax and B. van Ginneken. "Detection of tuberculosis with digital chest radiography: automatic reading versus interpretation by clinical officers", International Journal of Tuberculosis and Lung Disease 2013;17:1613-1620. Abstract/PDF DOI PMID Citations found: 2

  • B. van Ginneken, L. Hogeweg, P. Maduskar, L. Peters-Bax, R. Dawson, K. Dheda, H. Ayles, J. Melendez and C.I. Sánchez. "Performance of inexperienced and experienced observers in detection of active tuberculosis on digital chest radiographs with and without the use of computer-aided diagnosis", in: Annual Meeting of the Radiological Society of North America, 2012. Abstract

  • L. Hogeweg, A. Story, A. Hayward, R. Aldridge, I. Abubakar, P. Maduskar and B. van Ginneken. "Computer-aided detection of tuberculosis among high risk groups: potential for automated triage", in: Annual Meeting of the Radiological Society of North America, 2011. Abstract


Technical publications

  • P. Maduskar, R.H.M.M. Philipsen, J. Melendez, E. Scholten, D. Chanda, H. Ayles, C.I. Sánchez and B. van Ginneken. "Automatic detection of pleural effusion in chest radiographs", Medical Image Analysis 2016;28:22-32. Abstract/PDF DOI PMID

  • J. Melendez, B. van Ginneken, P. Maduskar, R. Philipsen, H. Ayles and C.I. Sánchez. "On Combining Multiple-Instance Learning and Active Learning for Computer-Aided Detection of Tuberculosis", IEEE Transactions on Medical Imaging 2016;35(4):1013-1024. Abstract/PDF DOI PMID

  • L. Hogeweg, C.I. Sánchez, P. Maduskar, R. Philipsen, A. Story, R. Dawson, G. Theron, K. Dheda, L. Peters-Bax and B. van Ginneken. "Automatic detection of tuberculosis in chest radiographs using a combination of textural, focal, and shape abnormality analysis", IEEE Transactions on Medical Imaging 2015;34(12):2429-2442. Abstract/PDF DOI PMID

  • J. Melendez, B. van Ginneken, P. Maduskar, R.H.H.M. Philipsen, K. Reither, M. Breuninger, I.M.O. Adetifa, R. Maane, H. Ayles and C.I. Sánchez. "A Novel Multiple-Instance Learning-Based Approach to Computer-Aided Detection of Tuberculosis on Chest X-Rays", IEEE Transactions on Medical Imaging 2015;34:179-192. Abstract/PDF DOI PMID

  • P. Maduskar, L. Hogeweg, P.A. de Jong, L. Peters-Bax, R. Dawson, H. Ayles, C.I. Sánchez and B. van Ginneken. "Cavity contour segmentation in chest radiographs using supervised learning and dynamic programming", Medical Physics 2014;41:071912-1 - 071912-15. Abstract/PDF DOI PMID

  • J. Melendez, C.I. Sánchez, R.H.H.M. Philipsen, P. Maduskar and B. van Ginneken. "Multiple-instance learning for computer-aided detection of tuberculosis", in: Medical Imaging, volume 9035 of Proceedings of the SPIE, 2014, page 90351J. Abstract/PDF DOI Citations found: 1

  • L. Hogeweg, C.I. Sánchez and B. van Ginneken. "Suppression of translucent elongated structures: applications in chest radiography", IEEE Transactions on Medical Imaging 2013;32:2099-2113. Abstract/PDF DOI PMID Citations found: 1

  • L. Hogeweg, C.I. Sánchez, J. Melendez, P. Maduskar, A. Story, A. Hayward and B. van Ginneken. "Foreign object detection and removal to improve automated analysis of chest radiographs", Medical Physics 2013;40:071901. Abstract/PDF DOI PMID Citations found: 1

  • B. van Ginneken, R.H.H.M. Philipsen, L. Hogeweg, P. Maduskar, J.C. Melendez, C.I. Sánchez, R. Maane, B. dei Alorse, U. d'Alessandro and I.M.O. Adetifa. "Automated Scoring of Chest Radiographs for Tuberculosis Prevalence Surveys: A Combined Approach", in: The Fifth International Workshop on Pulmonary Image Analysis, 2013, pages 9-19. Abstract/PDF

  • R. Philipsen, P. Maduskar, L. Hogeweg and B. van Ginneken. "Normalization of Chest Radiographs", in: Medical Imaging, volume 8670 of Proceedings of the SPIE, 2013, page 86700G. Abstract/PDF DOI Citations found: 3

  • P. Maduskar, L. Hogeweg, R. Philipsen and B. van Ginneken. "Automated localization of costophrenic recesses and costophrenic angle measurement on frontal chest radiographs", in: Medical Imaging, volume 8670 of Proceedings of the SPIE, 2013, page 867038. Abstract/PDF DOI Citations found: 2

  • P. Maduskar, L. Hogeweg, R. Philipsen, S. Schalekamp and B. van Ginneken. "Improved texture analysis for automatic detection of Tuberculosis (TB) on Chest Radiographs with Bone Suppression images", in: Medical Imaging, volume 8670 of Proceedings of the SPIE, 2013, page 86700H. Abstract/PDF DOI Citations found: 3

  • L. Hogeweg, C.I. Sánchez, P.A. de Jong, P. Maduskar and B. van Ginneken. "Clavicle segmentation in chest radiographs", Medical Image Analysis 2012;16:1490 - 1502. Abstract/PDF DOI PMID Citations found: 14

  • L. Hogeweg, C. Mol, P.A. de Jong, R. Dawson, H. Ayles and B. van Ginneken. "Fusion of local and global detection systems to detect tuberculosis in chest radiographs", in: Medical Image Computing and Computer-Assisted Intervention, volume 6363 of Lecture Notes in Computer Science, 2010, pages 650-657. Abstract/PDF DOI PMID Citations found: 32

  • L. Hogeweg, C. Mol, P.A. de Jong and B. van Ginneken. "Rib suppression in chest radiographs to improve classification of textural abnormalities", in: Medical Imaging, volume 7624 of Proceedings of the SPIE, 2010, pages 76240Y1-76240Y6. Abstract/PDF DOI Citations found: 3

  • Y. Arzhaeva, D.M.J. Tax and B. van Ginneken. "Dissimilarity-based classification in the absence of local ground truth: application to the diagnostic interpretation of chest radiographs", Pattern Recognition 2009;42:1768-1776. Abstract/PDF DOI Citations found: 23

  • Y. Arzhaeva, M. Prokop, D.M.J. Tax, P.A. de Jong, C.M. Schaefer-Prokop and B. van Ginneken. "Computer-aided detection of interstitial abnormalities in chest radiographs using a reference standard based on computed tomography", Medical Physics 2007;34:4798-4809. Abstract/PDF DOI PMID Citations found: 28

  • B. van Ginneken, M.B. Stegmann and M. Loog. "Segmentation of anatomical structures in chest radiographs using supervised methods: a comparative study on a public database", Medical Image Analysis 2006;10:19-40. Abstract/PDF DOI PMID Citations found: 221

  • B. van Ginneken, S. Katsuragawa, B.M. ter Haar Romeny, K. Doi and M.A. Viergever. "Automatic detection of abnormalities in chest radiographs using local texture analysis", IEEE Transactions on Medical Imaging 2002;21:139-149. Abstract/PDF DOI PMID Citations found: 162


Theses

  • P. Maduskar. "Automated analysis of tuberculosis in chest radiographs", PhD thesis, Radboud Universiteit Nijmegen, 2015. Abstract/PDF URL

  • J. Melendez. "Improving computer-aided detection systems through advanced pattern recognition techniques", PhD thesis, Radboud Universiteit Nijmegen, 2015. Abstract/PDF URL

  • L.E. Hogeweg. "Automatic detection of tuberculosis in chest radiographs", PhD thesis, Radboud Universiteit Nijmegen, 2013. Abstract/PDF URL

  • B. van Ginneken. "Computer-aided diagnosis in chest radiography", PhD thesis, Utrecht University, The Netherlands, 2001. Abstract/PDF URL