With nearly 686,000 people developing tuberculosis and 49,000 TB-related deaths in 2023, Pakistan continues to face a significant public health challenge. Despite progress, over 210,000 people with TB were missed, and the country also reported high burdens of drug-resistant TB and TB-HIV co-infection.
Delft Imaging has been actively involved in Pakistan’s TB response for over a decade. In 2013, we provided 9 EasyDR X-ray systems equipped with CAD4TB to Interactive Research and Development (IRD), as well as partners in Bangladesh and South Africa, through TB Reach Wave 3. By 2016, that project had screened over one million people.
That same year, our partnership with IRD scaled up dramatically to become the world’s largest deployment of AI for TB screening. At least 76 CAD4TB systems were installed in hospitals and mobile clinics throughout the country, enabling the rapid identification of suspected TB cases and facilitating same-day diagnosis and treatment. The rollout included installation, training, and ongoing support.
Between 2017 and 2019, we delivered an additional 18 CAD4TB systems — nine to the National Tuberculosis Program and nine to Mercy Corps. In 2021, the National TB Program further expanded its use of AI diagnostics with the procurement of 40 additional CAD4TB.
Pakistan’s digital X-ray infrastructure grew significantly over the next two years. In 2022, 12 Delft MAC systems with CAD4TB were deployed, each delivered with full installation and user training. In 2023, 3 major national projects were launched: 25 portable Delft Light systems, 57 additional Delft MAC units, and 79 additional Delft Light systems. Each of the 104 Delft Lights and 57 Delft MAC units was paired with CAD4TB, along with comprehensive training and maintenance services.
Today, over 80,000 people are screened for TB each month with CAD4TB installations in Pakistan. More than five million individuals have been screened using CAD4TB, making it the largest AI-supported TB screening initiative worldwide. We continue to provide technical support and service through our local in-country partner.
In 2024, we delivered 13 CAD4TB systems to Pakistan’s Ministry of Health. Later that year, 5 Delft Light systems and 8 CAD4TB were supplied to further strengthen TB screening. Additionally, Médecins Sans Frontières deployed a Delft Light system and 2 CAD4TB, and Nutramed FZCO acquired 20 CAD4TB systems to support ongoing TB control efforts.
Making a Difference
Research paper
Over the years, local stakeholders in Pakistan have published regarding the impact of CAD4TB in the nation. The most extensive TB screening program with CAD4TB in the world, its implementation has garnered much attention.
According to a 2020 paper, CAD4TB performed on par with expert human readers. While the cost per screened subject using the CAD4TB 6 is almost half compared to screening without, the daily throughput is nearly 2.5 times higher. They concluded that CAD4TB offers good diagnostic accuracy as a triage for TB screening among diabetes patients. A previous 2018 research paper, followed by another paper in 2020, proved that CAD4TB could save molecular tests like the Xpert tests.
In a 2021 study, researchers concluded that in low-income, high-burden TB settings, triage using AI-based CXR interpretation (incl. CAD4TB) could be cost-effective when compared to the standard practice among persons with suspected TB. Similarly, according to a study conducted in the same year, community-based screening with innovative activities, which comprises sensitive screening and diagnostic tools like digital X-ray and CAD4TB, effectively improves TB case detection.
Another study in Pakistan featuring the Zero TB initiative concluded that CAD4TB is a valuable tool for mass screening TB in high-burden developing countries. The results also suggest combining CAD and symptomatology to screen a symptomatic population is a more cost-effective and reasonably effective algorithm. In Pakistan, researchers realised that CAD4TB as a triage tool could minimise the use of expensive molecular tests in low-resource settings.
Webinar insights
For more information on how CAD4TB is extensively used throughout Pakistan, please view the story of ‘Using CAD in a High Throughput Settings,’ presented by Dr. Adeel Tahir, Senior Program Manger at MercyCorps in Pakistan. The story was presented during the 2022 Delft Imaging webinar. During the webinar, Dr. Tahir noted: “Pakistan is a big country, and the Mercy Coprs works in almost two-thirds of the nation. Many areas have issues with internet connectivity. In those settings, the CAD4TB boxes are helpful. It helps chest scan physicians even when radiologists are not present. Not only does it reduce human resources, but also reduces the cost of X-ray film printing. We only get scans printed once we get the score. We don’t print scans for people with lower scores, saving the costs. It also rationalises the use of Xpert testing. With CAD4TB software, we identify certain presumptions, and based on those presumptions, we go for Xpert testing.”
Later, in 2024 webinar “Digital X-rays & CAD in action: The real-world impact on TB program,” Dr. Adeel Tahir, Director of the TB Program at Mercy Corps Pakistan, and Mr. Sohail Siddiqui, Country Head of OmniTech, discussed the impact of deploying Delft Light portable X-ray systems with CAD4TB. Dr. Tahir highlighted, “The best thing that CAD4TB has done is that the accuracy of diagnosis has increased. Our physicians are quite comfortable and confident in ordering the sputum sample for these patients.” Siddiqui noted the challenges of implementation in remote areas, stating, “In countries like Pakistan, there are a lot of challenges, especially in remote areas where there is no light, water, or basic necessities.” With over 79 Delft Light systems deployed and hundreds of healthcare workers trained, this initiative is transforming TB detection in hard-to-reach regions.
Case studies
Active case finding at prison with CAD4TB in 2021: In a prison setting, systematic screening using CAD4TB and portable X-ray systems screened over 20,000 inmates, identifying a TB prevalence 1.8 times higher than the national average. Discover how this approach underscores the importance of regular TB screening in prisons, utilizing technology to facilitate mass screening and reduce transmission.
Active case finding using OneStopTB Clinic with CAD4TB in 2021: At community outreach camps, a massive active case-finding initiative screened over 62,000 individuals, identifying and diagnosing a significant number of TB cases, including drug-resistant strains. Learn how this approach is effectively uncovering missed TB cases, facilitating early diagnosis and treatment in challenging areas.
Press coverage
In 2024, PFSCM detailed Delft’s collaboration with Pakistan to enhance its TB program through the procurement and delivery of advanced medical imaging equipment. This partnership aims to strengthen TB diagnosis and treatment capabilities in the country. Read the full report here.
In 2025, The Express Tribune reported that Qatar Hospital in Orangi Town, Karachi, became the first healthcare center in Sindh to deploy an AI-equipped X-ray machine (MAC) for TB diagnosis. The CAD4TB can deliver an initial TB diagnosis within five minutes, a significant improvement over traditional methods. Dr. Rashid Siraj Khanzada explained, “The grayscale will change to red, indicating the presence of TB or chest infections, with the diagnosis completed within five minutes.” This innovation aims to enable immediate treatment and reduce transmission in high-burden settings.
