CAD4TB+
CAD4TB+ is AI software that reads chest X-rays for tuberculosis and lung disease, returning a 0-100 score, a heatmap and a cardiothoracic ratio in under five seconds. It runs fully offline at the point of care.
What is CAD4TB+?
CAD4TB+ is computer-aided detection software that applies artificial intelligence to chest radiographs in order to find tuberculosis and other lung disease. It is built by Delft Imaging, a Dutch social enterprise headquartered in 's-Hertogenbosch with regional offices in Africa and Asia, and it is aimed squarely at settings where radiologists are scarce or absent.
The software accepts chest X-ray images in DICOM, PNG or JPEG from any digital X-ray machine made by a major manufacturer, whether stationary, mobile or ultra-portable, and works on the frontal PA view. For each examination it returns four outputs: a tuberculosis probability score from 0 to 100 based on a bacteriological reference, an abnormality score from 0 to 100 based on a radiological reference, a coloured heatmap overlaid on the original image, and the cardiothoracic ratio, which points to an enlarged heart. Beyond tuberculosis it detects silicosis and ten further abnormalities, among them pleural effusion, consolidation, pleural thickening, lung opacity, emphysema, nodule or mass, fibrosis, atelectasis, infiltration and pneumothorax. Results arrive in under five seconds.
Deployment comes in three shapes. Offline, a mini-computer called the CAD4TBbox carries the algorithm, an SQL database acting as a PACS and a local web server, so results can be read in a browser on the supplied tablet, on the X-ray console or on any laptop or smartphone joined to the local network, with no special viewing software. Online, images are processed on the CAD4TBcloud. Hybrid mode combines the two, synchronising the box to the cloud whenever a connection appears. A workflow platform for monitoring and evaluation ships with the software at no extra cost.
The plus in the name marks the 2025 union of the established CAD4TB engine with EPCON's Epi-control platform, which adds national surveillance and predictive analytics: screening data feeds hotspot mapping and forecasting rather than stopping at the individual result. The software carries CE Class IIa certification under CE 0044, though only for version 8, and the World Health Organization counted CAD4TB among six products meeting its performance standards in 2025. Delft Imaging reports 55 million people screened across more than 90 countries, supported by over 120 publications.
What it does
- Read a chest X-ray and return a tuberculosis probability score from 0 to 100
- Highlight suspect areas as a colour heatmap laid over the original radiograph
- Flag silicosis and ten further lung abnormalities alongside tuberculosis
- Deliver every result in under five seconds, with no internet connection required
- Calculate the cardiothoracic ratio as an indicator of an enlarged heart
- Track screening coverage, probable cases and vulnerable areas in real time
- Map and anticipate tuberculosis hotspots to target outreach
When to use CAD4TB+ / When not to
A quick filter to help you decide if CAD4TB+ is the right fit.
When to use CAD4TB+
- National tuberculosis programmes and health ministries scaling screening across a country
- NGOs and health providers running active case-finding in communities, prisons and refugee camps
- Clinics and screening sites that have a digital X-ray machine but no radiologist on hand
- Occupational health programmes screening mining and industrial workforces for silicosis
- Field teams working where the internet is unreliable or simply absent
When not to use CAD4TB+
- Clinicians looking for a standalone diagnosis: CAD4TB+ produces a probability score for triage, not a verdict
- Anyone without a digital X-ray system, since the software reads images rather than producing them
- Services needing modalities other than the frontal (PA) chest radiograph
- Buyers outside the public and not-for-profit sector of the 138 eligible low- and middle-income countries, for whom no price is published
- Teams after ultrasound screening, which belongs to the publisher's separate BabyChecker and LUS4TB products
How to use CAD4TB+
A typical end-to-end flow, from setup to results.
- Connect the CAD4TBbox to a digital X-ray unit over a DICOM link on the local WiFi network
- Unpack the all-in-one case, in which the cables arrive already connected, and plug the box in
- Power the unit from mains electricity or from the solar pack supplied with a Delft Light X-ray system
- Have installation, commissioning and staff training carried out by Delft Imaging or one of its 47 local partners
- Acquire a frontal chest radiograph as usual; analysis then runs on site
- Read the score and heatmap on the pre-configured tablet, the X-ray console, or any browser on the local network
- Set the score threshold your programme will act on, then refer patients above it for confirmatory testing
- Export results as CSV offline, or to the cloud, a PACS or RIS system, or through the API
- Share reports by QR code across approved communication channels
- Synchronise the box to the cloud once back in range so central programme managers can review the data
Pros & Cons
Pros
- Works with no internet connection at all, which is precisely where radiologists are missing
- Backed by more than 120 scientific publications and named by the WHO among six products meeting its performance standards
- CE Class IIa certified as a medical device under notified body 0044
- Cost cut by up to 65 percent under the July 2026 Unitaid and CHAI agreement
- Unlimited scans per connected X-ray unit, with software, installation, training, updates and maintenance included
- Reads output from any major manufacturer's digital X-ray machine over standard DICOM
- Eleven interface languages, including Bengali, Tagalog, Thai, Urdu and Vietnamese
Cons
- No pricing page exists: the only public price sits inside a press article on the site
- The published price is reserved for public and not-for-profit buyers in 138 eligible countries; nothing is published for anyone else
- CE certification covers version 8 of CAD4TB only, a restriction carried in a footnote
- No terms and conditions, legal notice or security page exist on the site
- Instructions for use are not public and are released only on request through a secure channel
- The privacy statement is out of date, naming a different domain and an older company address
- Requires a CAD4TBbox and a digital X-ray system, so this is not software you can simply subscribe to
Pricing & Plans
There is no free plan and no free trial. Under the agreement announced with Unitaid and the Clinton Health Access Initiative on 17 July 2026, the entry point is a single annual fee of USD 2,500 to USD 2,850 per connected X-ray unit, down from a previous USD 7,000 to USD 12,000 per unit per year. That fee covers unlimited CAD scans on the unit together with the software, installation, training, updates and maintenance, with no additional charges. It applies to public sector and not-for-profit buyers across the 138 low-, lower-middle- and upper-middle-income countries defined by the World Bank. No price is published for buyers outside that scope, and an earlier whitepaper describes a different arrangement based on a perpetual licence or per-use billing.
- USD 2
- 500 to USD 2
- 850 per connected X-ray unit
- unlimited scans included
- USD 7
- 500 per connected X-ray unit
- cardiomegaly
- silicosis and lung cancer
- No free plan
Data, GDPR & hosting
A consolidated view of how CAD4TB+ handles your data.
GDPR overview
GDPR compliance is claimed explicitly and in two places: the privacy statement says personal data is processed in conformity with the regulation, and the product whitepaper states that Delft Imaging, being based in the Netherlands, complies with EU data protection law including the GDPR. Concrete mechanisms are named. The full set of data-subject rights is listed, including access, rectification, erasure, restriction, portability, objection and objection to automated processing and profiling. Requests go to privacy@delft.care, require proof of identity, and are answered within five working days. Complaints are routed to the chief executive and handled within two weeks. The lawful bases are named: contract for business relationships, consent for enquiries. A register of processing activities is maintained. One caveat: the privacy statement is visibly out of date, describing a different domain and an older address.
Who owns the data?
The publisher states plainly that any data processed by CAD4TB remains the property of the client. Delft Imaging positions itself as a processor working on the customer's behalf rather than as an owner of the screening data. In offline deployments the point is close to self-evident: patient details, symptoms, the radiograph, the heatmap, the score and the laboratory result all stay on the CAD4TBbox or on a local external hard drive, and never leave the site. Where images do travel, DICOM data is de-identified and pseudonymised before being sent to a server. Note that no separate terms and conditions are published; this commitment comes from the product whitepaper.
Reuse rights
The whitepaper sets one explicit limit: data are used for purposes beyond delivering CAD4TB results to the client only where explicit written permission has been given. In practice the customer therefore keeps the initiative over any secondary use, and nothing is repurposed by default. Customers may export and reuse their own data freely through the available channels: a CSV download from the CAD4TBbox in offline mode, cloud backup online, a DICOM secondary capture pushed to a third-party PACS, or the API. Website and business-contact data are handled separately, with Mailchimp used for the newsletter and Google Analytics kept for sixty days. Model training is never mentioned anywhere, in either direction.
Data retention & training
Hosting summary
Where data lives depends on how the software is deployed. Offline, everything stays on site: patient details, symptoms, the X-ray image, the heatmap and score, and laboratory results are held on the CAD4TBbox or an attached external hard drive, and can be viewed only there. Online, a dedicated cloud server holds the data so that programme managers in several locations can review it on dashboards, and hosting of data and images on an in-country server is offered as an option; on-premises servers can be discussed on request. In hybrid mode the box synchronises to the cloud when a connection is available. Wherever images travel, DICOM data is de-identified and pseudonymised first, so that no personal information crosses the internet. The publisher is established in the Netherlands and presents itself as bound by EU data protection law. For the website and business contacts specifically, the privacy statement states that data is held in the Netherlands on a protected and encrypted server and that no personal data is stored outside Europe.
Things to keep in mind
Risks and trade-offs to weigh before adopting CAD4TB+.
- The score is a probability, not a diagnosis: treating a number as a verdict risks both missed cases and needless confirmatory testing
- Deskilling is a real hazard where the AI becomes the only reader, since local radiographic interpretation skills may quietly erode
- The threshold chosen by a programme silently sets its sensitivity and specificity, and moving it changes who gets tested
- The privacy statement is out of date, naming a different domain and an older address, so any contractual fact drawn from it should be re-checked
- No published position exists on whether customer data is used to train the models, and no opt-out is documented
- Chest radiographs are identifiable clinical data; offline convenience means an unencrypted local drive can leave a site with the box
- The legal entity dates from 2002 but this unified product only from 2025, so published track record and current release are not the same thing
Setup & Integrations
Technical difficulty
Low for the customer, because the vendor does the work. The offline kit arrives pre-assembled in a case with its cables already connected and is described as a plug-in installation; the online mode needs no installation at all. Delft Imaging and 47 local partners handle commissioning and training, with annual remote refresher sessions and e-learning covering setup, operation and troubleshooting. Reading results needs nothing more than a browser. The real prerequisites are physical rather than technical: a digital X-ray machine to connect to over DICOM, and a power supply, which can be a solar pack.
Deployment
Integrations
Supported languages
Behind CAD4TB+
Social
Resources
All the official URLs gathered for verification and reference.
Alternatives
Tools that compete with or complement CAD4TB+.
Frequently asked questions
What does CAD4TB+ actually do?
Does it need a radiologist?
Does it work without an internet connection?
What does it cost?
Is there a free trial or a free plan?
Is the software certified?
Which patients can be screened?
Which X-ray machines does it work with?
Is there an API?
Where is the data stored?
Should you pick CAD4TB+?
CAD4TB+ is an unusually well-documented product for an annotated directory, and an unusually specific one. It does a single thing, reading a frontal chest radiograph and scoring it for tuberculosis and other lung disease, and it does that thing in the place where the problem actually bites: clinics, trucks and outreach camps with a digital X-ray machine, no radiologist and often no internet. The offline design is not a marketing flourish but the core engineering decision, and it is what separates this from general medical imaging AI.
The evidence behind it is substantial. More than 120 publications, CE Class IIa certification, and a place among the six products the World Health Organization identified as meeting its performance standards in 2025 put it on firmer ground than most tools of its kind. The July 2026 agreement with Unitaid and CHAI matters just as much, turning an opaque and often prohibitive licence into a published annual fee with unlimited scans included.
The reservations are about transparency rather than capability. There is no pricing page, no terms and conditions, no legal notice; the privacy statement still describes a domain and an address the company has left behind; the instructions for use are released only on request. The published price, generous as it is, covers only public and not-for-profit buyers in eligible countries, and anyone outside that perimeter is left without a figure. Buyers should also note that the certification applies to version 8 alone, and that part of the surveillance capability comes from a partner, EPCON, rather than from the publisher. None of this undermines the product; it simply means the paperwork lags well behind the engineering.
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