These algorithms can eliminate the risk of tuberculosis

In some of the world’s most remote and deteriorated corners, where respiratory illnesses spread and trained medical professionals are feared, the diagnosis is driven by artificial intelligence and the Internet.

In less than a minute, a new app on a phone or computer can scan X-rays to indicate tuberculosis, Kovid-19 and 27 other conditions.

TB, the deadliest infectious disease in the world, claimed about 1.4 million lives last year. The app, called qXR, is one of several AI-based tools that have emerged in the last few years to test and diagnose TB.

The equipment quickly hopes to mark the disease and cut costs of unnecessary laboratory tests. Used extensively, they can also refer to emerging groups of the disease.

“Of all the applications of AI, I think it is probably wrong to interpret an image using an algorithm rather than a human radiologist,” said Madhukar Pai, director of the McGill International TB Center in Montreal.

Artificial Intelligence Physicians, Drs. Cannot alert Pai and other experts. But the combination of AI and clinical expertise is proving powerful.

“Machine Plus is better than physician medicine, and it is even better than machine,” said Dr., director of the Scripps Research Translational Institute in San Diego and author of a book on the use of AI in medicine. Eric Topol said. .

In India, where about one-quarter of the world’s TB cases occur, an app that can flag the disease in remote locations is urgently needed.

Chinchpada Christian Hospital in Nandurbar, a small town in northwest India, serves members of the Bhil tribal community, some of whom travel 125 miles to travel to the center. The 50-bed hospital has eight doctors, and only the most underdeveloped medical equipment.

Explicit across the country, Simdega, one of the 20 poorest districts in India, is isolated from the nearest city, Rourkela, by about five hours of bumpy roads. The tribal population in the district lives in small villages surrounded by dense, evergreen forests. Simdega’s medical center, which has 60 beds and three doctors, is in the clearing of the jungle – “literally in the middle of nowhere,” Dr. Said George Matthews, director.

Dr. Mathew said younger employees have to manage everything from “malaria to myocardial infections to head injuries.” Over the years he has taught himself to read X-rays, and when he is stumped he appeals to radiologists among his distant friends and former colleagues.

Although Nandurbar and Simdega are more than 800 miles apart, they have a similar population. Malaria, sickle cell disease and TB prevail among them, compounded by poverty, dependence on spiritual healers and alcoholism – even among children.

“TB gets neglected and diagnosis is often delayed,” head of medicine at Nandurbar Hospital, Dr. Ashita Singh said. By the time people arrive at these medical centers, they are often “very ill and are never evaluated anywhere else,” she said.

But in some patients, X-rays carry signals that are too subtle to detect a nonexpert. Dr. “It is in that group of patients where AI technology can be of great benefit,” Singh said.

The arrival of coronaviruses – and subsequent lockdowns – cut off these remote hospitals from the nearest cities, and also from radiologists. This led to further delays and the diagnosis of complex TB as both diseases affect the lungs.

A few months ago, the two hospitals began using qXR, an app created by the Indian company Qure.ai and subsidized by the Indian government. The app allows the user to perform X-ray scans. If it finds evidence of TB, it confers risk points on the patient. Doctors can then perform confirmation tests on patients at highest risk.

Dr. Singh said that at the hospital in Nandurbar, the app helped detect TB in 20 patients in October.

Experts said that applications such as tuberculosis can also be useful in places with low prevalence of TB, and for routine screening of people with HIV who are at high risk of contracting TB, as well as those with There are other conditions nearby.

A TB specialist at Johns Hopkins University, Dr. Richard E. “For those suspected of having tuberculosis, most chest X-rays are read by people who are not remotely specialist,” Chisson said. “If there was an AI package that could read X-rays and CT scans for you in some remote emergency room, it would be a huge advance.”

qXR is one of the more promising AI-based apps for TB detection. The company that made the app did not realize that potential until a doctor at an Indian hospital suggested it a few years ago.

In studies Comparing different AI applications These stops were operated by TB Partnership, which was all AI apps Fared better than experienced human readers, And qXR seemed to fare best.

According to Qure.ai Chief Executive Officer Prashant Warrier the app identifies TB with an accuracy of 95%. But that level of accuracy is not based on real-world conditions, which Dr. Topol has called for “a common problem” with AI-based apps. Dr. Topol stated that a TB program may be less accurate in the United States or Western Europe than in India, because the prevalence of the disease is low.

The application has only been tested in adults, but is now being used in children 6 and older. Chest X-rays are particularly useful for pediatric TB because about 70 percent of cases in children cannot be confirmed by lab tests, Drs. Sylvia S. Chiang said Brown University has pediatric TB specialists.

“There is an acute shortage of trained professionals who feel comfortable interpreting pediatric X-rays,” she said, “Developing and validating computer-aided X-ray reading techniques in children will go a long way . “

Qure.ai said that it was testing its app in children in Bangladesh, and that it would publish the data early next year. Meanwhile, QXR and other apps will continue to improve as they learn on the go.

“The more X-rays you feed the animal, the better it is,” Dr. Pa said.

Experts were optimistic at all that AI-based apps could heavily impact the control of TB, especially in countries like India that lack adequate resources.

“I am dreaming of a time when there will be something available in all small primary and secondary health care centers in the government sector that hesitate to do X-rays because they lack the confidence to read,” Dr. Singh said. “If it were to be made available to every X-ray center in rural India, I think we could beat TB.”

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