Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings

Lam, Christopher T.; Krieger, Marlee; Gallagher, Jennifer E.; Asma, Betsy; Muasher, Lisa C.; Schmitt, John W.; Ramanujam, Nirmala

doi:10.1371/journal.pone.0135869

Cited by 64 publications

(57 citation statements)

References 41 publications

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“…As a consequence of the prohibitive cost of colposcopes (US$10,000–$20,000), VIA is performed with a simple headlamp in most resource-limited settings 14. Nevertheless, the performance of naked eye VIA as a CC screening tool is far from optimal.…”

Section: Discussionmentioning

confidence: 99%

Cervical cancer screening in low-resource settings: a smartphone image application as an alternative to colposcopy

Gallay¹,

Girardet²,

Viviano³

et al. 2017

IJWH

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BackgroundVisual inspection after application of acetic acid (VIA) and Lugol’s iodine (VILI) is a cervical cancer (CC) screening approach that has recently been adopted in low- and middle-income countries (LMIC). Innovative technologies allow the acquisition of consecutive cervical images of VIA and VILI using a smartphone application. The aim of this study was to evaluate the quality of smartphone images in order to assess the feasibility and usability of a mobile application for CC screening in LMIC.MethodsBetween May and November 2015, women aged 30–65 years were recruited in a CC screening campaign in Madagascar. Human papillomavirus-positive women were invited to undergo VIA/VILI assessment. Pictures of their cervix were taken using a Samsung Galaxy S5 with an application called “Exam”, which was designed to obtain high-quality images and to classify them in the following sequence: native, VIA, VILI and posttreatment. Experts in colposcopy were asked to evaluate if the quality of the pictures was sufficient to establish the diagnosis and to assess sharpness, focus and zoom.ResultsThe application use was simple and intuitive, and 208 pictures were automatically classified and recorded in the patient’s file. The quality was judged as adequate for diagnosis in 93.3% of cases. The interobserver agreement was κ =0.45 (0.23–0.58), corresponding to a moderate agreement on the common scale of kappa values.ConclusionThis smartphone application allows the acquisition of good quality images for VIA/VILI diagnosis. The classification of images in a patient database makes them accessible to on- and off-site experts, and allows continuous clinical education. Smartphone applications may offer an alternative to colposcopy for CC screening in LMIC.

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Section: Discussionmentioning

confidence: 99%

Cervical cancer screening in low-resource settings: a smartphone image application as an alternative to colposcopy

Gallay¹,

Girardet²,

Viviano³

et al. 2017

IJWH

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“…To enable use of our SDFM for clinical applications, we have developed a low-cost, portable “Pocket” microscope that is capable of imaging tissue vasculature at high resolution (47). This technology closely mimics our dark field microscope and is well suited for visualization of oral mucosa in clinical applications.…”

Section: Discussionmentioning

confidence: 99%

Distinct Angiogenic Changes during Carcinogenesis Defined by Novel Label-Free Dark-Field Imaging in a Hamster Cheek Pouch Model

Martin

Martinez

et al. 2017

Cancer Research

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There remain gaps in knowledge concerning how vascular morphology evolves during carcinogenesis. In this study, we imaged neovascularization by label-free dark field microscopy of a DMBA-induced hamster cheek pouch model of oral squamous cell carcinoma (SCC). Wavelength-dependent imaging revealed distinct vascular features at different imaging depths and vessel sizes. Vascular tortuosity increased significantly in high-risk lesions, while diameter decreased significantly in hyperplastic and SCC lesions. Large vessels preserved the same trends seen in the original images, whereas small vessels displayed different trends, with length and diameter increasing during carcinogenesis. Based on these data we developed and validated a classification algorithm incorporating vascular features from different vessel masks. Receiver operator curves generated from the classification results demonstrated high accuracies in discriminating normal and hyperplasia from high-grade lesions (area under the curve>0.95). Overall, these results provided automated imaging of vasculature in the earliest stages of carcinogenesis from which one can extract robust endpoints. The optical toolbox described here is simple, low-cost and portable and can be used in a variety of health care and research settings for cancer prevention and pharmacology research.

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“…A detailed comparison of both the POCkeT colposcope and standard-of-care colposcope systems has been previously described 12 . Briefly, the POCkeT colposcope is an investigational research device that is intra-vaginal, portable, and low cost (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…This provides comparable image quality while substantially decreasing cost through the use of a consumer grade light source and camera. The POCkeT colposcope is no more expensive than a SLR digital camera, but through bench testing we have demonstrated that it has comparable field of view, resolution and contrast compared to a standard-of-care colposcope 12 . Additionally, the POCkeT colposcope can be plugged into a cell phone, tablet or computer which provides power to the device; therefore, it does not directly require electricity from a wall plug or power adapter, which enables it to be used in low resource environments where a majority of the population may not have access to electricity 13 .…”

Section: Introductionmentioning

confidence: 92%

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International Image Concordance Study to Compare a Point-of-Care Tampon Colposcope With a Standard-of-Care Colposcope

Mueller

Asma

Lam

et al. 2017

J Low Genit Tract Dis

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Objective Barriers to cervical cancer screening in low resource settings include lack of accessible high quality services, high cost, and the need for multiple visits. To address these challenges, we developed a low cost intra-vaginal optical cervical imaging device, the Point of Care Tampon (POCkeT) colposcope, and evaluated whether its performance is comparable to a standard-of-care colposcope. Methods There were two protocols, which included 44 and 18 patients respectively. For the first protocol, white light cervical images were collected in vivo, blinded by device, and sent electronically to 8 physicians from high, middle and low income countries. For the second protocol, green light images were also collected and sent electronically to the highest performing physician from the first protocol who has experience in both a high and low income country. For each image, physicians completed a survey assessing cervix characteristics and severity of precancerous lesions. Corresponding pathology was obtained for all image pairs. Results For the first protocol, average percent agreement between devices was 70% across all physicians. POCkeT and standard-of-care colposcope images had 37% and 51% percent agreement respectively with pathology for high-grade squamous intraepithelial lesions (HSILs). Investigation of HSIL POCkeT images revealed decreased visibility of vascularization and lack of contrast in lesion margins. After changes were made for the second protocol, the two devices achieved similar agreement to pathology for HSIL lesions (55%). Conclusions Based on the exploratory study, physician interpretation of cervix images acquired using a portable, low cost, POCkeT colposcope was comparable to a standard-of-care colposcope.

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Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings

Cited by 64 publications

References 41 publications

Cervical cancer screening in low-resource settings: a smartphone image application as an alternative to colposcopy

Cervical cancer screening in low-resource settings: a smartphone image application as an alternative to colposcopy

Distinct Angiogenic Changes during Carcinogenesis Defined by Novel Label-Free Dark-Field Imaging in a Hamster Cheek Pouch Model

International Image Concordance Study to Compare a Point-of-Care Tampon Colposcope With a Standard-of-Care Colposcope

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