Technologies that have been designed for use in high-income countries often fail to deliver their full potential when transposed to Low and Middle-Income Contexts (LMICs). The health sector is a case in point, as medical devices, whether donated or purchased, are generally short lived in those contexts. The mismatch between needs and available solutions originates from the inadequacy of both the technology and the business models. Essential medical technologies such as oxygen concentrators, neonatal incubators, anesthesia machines or diagnostic X-ray systems are classic examples. The case of diagnostic X-ray imaging is particularly striking: 125 years after its invention, up to two thirds of the world population still does not have access to radiology services, according to the World Health Organisation. This is despite the fact that X-ray radiology is one of the cornerstone of healthcare and a crucial instrument for diagnosing a variety of health issues ranging from trauma to tuberculosis and other lung diseases.We are presenting an integrated methodological approach, to develop innovative solutions adapted to the context of LMICs. The approach relies on three crucial pillars: cooperation, interdisciplinarity and entrepreneurship with a long-term sustainability perspective. We propose a set of four complementary tools that increase the chances of successfully developing and deploying the technologies at scale. The tools, while very practical, allow striking a balance between economic viability, environmental and social impact. We illustrate the use of these tools with the case of diagnostic X-ray imaging. We propose that using the approach and tools presented here could allow to rethink other complex technologies that have the potential to address social challenges, in the perspective of making them suitable for LMICs. We also believe that this approach to developing solutions addressing the needs of poorer communities, may lead to better products in industrialized contexts as well.

This paper describes the development of a novel medical x-ray imaging system adapted to the needs and constraints of low- and middle-income countries. The developed system is based on an indirect conversion chain: a scintillator plate produces visible light when excited by the x rays, and then, a calibrated multi-camera architecture converts the visible light from the scintillator into a set of digital images. The partial images are then unwarped, enhanced, and stitched through parallel field programmable gate array processing units and specialized software. All the detector components were carefully selected focusing on optimizing the system’s image quality, robustness, cost-effectiveness, and capability to work in harsh tropical environments. With this aim, different customized and commercial components were characterized. The resulting detector can generate high quality medical diagnostic images with detective quantum efficiency levels up to 60% (@2.34 μGy), even under harsh environments, i.e., 60 °C and 98% humidity.