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Start4Kids
Start4Kids is a new multi-country research study running from 2026-2028. It is part of the second phase of the Start4All study, which Worldwide Radiology has supported since 2024.
Start4Kids expands on the work already done in Phase 1 to find better ways to diagnose children: the group of patients which are the hardest to diagnose.
This study will enroll 4,300 children aged 0 to 14 across six study sites in Kenya, Bangladesh, Cameroon and Vietnam and will evaluate the use of several new diagnostic tests, including Chest X-rays with AI-assisted interpretation (also known as computer aided detection or CAD).
As in Phase 1, Worldwide Radiology will again provide the paediatric radiology and radiography expertise for the study.
Expanding on the library of Chest X-rays that Worldwide Radiology’s team developed during Phase 1, a further 13,000 chest X-rays of children with suspected Tuberculosis will be interpreted by an even larger global team of twelve study radiologists.
Project goals and objectives
Expand the Pediatric Chest X-ray reference set developed in Phase 1 of Start4All
Creating an additional independently annotated library of paediatric chest X-rays - the standard against which AI interpretation software can be evaluated.
Improve understanding of the implementation of portable Chest X-ray services in children
Exploring in-depth what it takes to set up and sustain portable Chest X-ray services for children with suspected TB, focussing on deployment in primary health centres, rather than hospitals
Tuberculosis kills more than 1.3 million people a year, and children carry a disproportionate share of that burden. They are also the hardest group to diagnose, as they present in different ways to adult patients.
Learning from Start4All Phase 1
Our previous contribution was to develop a library of up to 1,000 paediatric chest X-rays with best quality interpretations. That meant providing technical oversight on how images were collected and processed, providing quality assurance and bringing in the best people to provide image interpretation of the X-rays. We learnt a lot along the way that we can apply in Phase 2.
For example, when radiologists interpreted these children's chest X-rays carefully, they often identified abnormalities other than TB, which were hard to document in detail. The new Start4Kids data collection form will be improved to better capture alternative diagnoses.
The work we did in Start4All Phase 1 demonstrated the importance of developing high quality chest X-ray datasets. In phase 2, we will use our experience and learning to develop an even bigger and better chest X-ray library for AI- testing and training, aiming to increase the impact on diagnosing TB in this vulnerable group.
Dr Karen Chetcuti, Pediatric Radiologist and Start4Kids Technical Project Lead at Worldwide Radiology
Our contribution
Worldwide Radiology will again collaborate with the LSTM study team, leading on all radiology components of the study, from the design of the reading approach through to the training, support and quality assurance of the radiologists carrying it out.
Radiology expertise and reading standards
Input into the study protocol and X-ray interpretation methodology, and updating of the structured data collection form.
Training and quality assurance
Recruiting, training and supporting twelve study radiologists, with quality assurance running throughout a thirteen-month reading period.
Pediatric radiography expertise and implementation
Recruit a paediatric radiographer for technical oversight, quality-assurance and support for the implementation research strand, including at a Kenyan primary health centre.
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