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Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings. PLoS One 2015; 10:e0135869. [PMID: 26332673 PMCID: PMC4557989 DOI: 10.1371/journal.pone.0135869] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Current guidelines by WHO for cervical cancer screening in low- and middle-income countries involves visual inspection with acetic acid (VIA) of the cervix, followed by treatment during the same visit or a subsequent visit with cryotherapy if a suspicious lesion is found. Implementation of these guidelines is hampered by a lack of: trained health workers, reliable technology, and access to screening facilities. A low cost ultra-portable Point of Care Tampon based digital colposcope (POCkeT Colposcope) for use at the community level setting, which has the unique form factor of a tampon, can be inserted into the vagina to capture images of the cervix, which are on par with that of a state of the art colposcope, at a fraction of the cost. A repository of images to be compiled that can be used to empower front line workers to become more effective through virtual dynamic training. By task shifting to the community setting, this technology could potentially provide significantly greater cervical screening access to where the most vulnerable women live. The POCkeT Colposcope’s concentric LED ring provides comparable white and green field illumination at a fraction of the electrical power required in commercial colposcopes. Evaluation with standard optical imaging targets to assess the POCkeT Colposcope against the state of the art digital colposcope and other VIAM technologies. Results Our POCkeT Colposcope has comparable resolving power, color reproduction accuracy, minimal lens distortion, and illumination when compared to commercially available colposcopes. In vitro and pilot in vivo imaging results are promising with our POCkeT Colposcope capturing comparable quality images to commercial systems. Conclusion The POCkeT Colposcope is capable of capturing images suitable for cervical lesion analysis. Our portable low cost system could potentially increase access to cervical cancer screening in limited resource settings through task shifting to community health workers.
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Galeano J, Perez S, Montoya Y, Botina D, Garzón J. Blind source separation of ex-vivo aorta tissue multispectral images. BIOMEDICAL OPTICS EXPRESS 2015; 6:1589-1598. [PMID: 26137366 PMCID: PMC4467706 DOI: 10.1364/boe.6.001589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/18/2015] [Accepted: 02/24/2015] [Indexed: 06/04/2023]
Abstract
Blind Source Separation methods (BSS) aim for the decomposition of a given signal in its main components or source signals. Those techniques have been widely used in the literature for the analysis of biomedical images, in order to extract the main components of an organ or tissue under study. The analysis of skin images for the extraction of melanin and hemoglobin is an example of the use of BSS. This paper presents a proof of concept of the use of source separation of ex-vivo aorta tissue multispectral Images. The images are acquired with an interference filter-based imaging system. The images are processed by means of two algorithms: Independent Components analysis and Non-negative Matrix Factorization. In both cases, it is possible to obtain maps that quantify the concentration of the main chromophores present in aortic tissue. Also, the algorithms allow for spectral absorbance of the main tissue components. Those spectral signatures were compared against the theoretical ones by using correlation coefficients. Those coefficients report values close to 0.9, which is a good estimator of the method's performance. Also, correlation coefficients lead to the identification of the concentration maps according to the evaluated chromophore. The results suggest that Multi/hyper-spectral systems together with image processing techniques is a potential tool for the analysis of cardiovascular tissue.
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Affiliation(s)
- July Galeano
- Grupo de Materiales Avanzados y Energía -MatyEr-. Línea Electromedicina. Instituto Tecnológico Metropolitano. Calle 54A No. 30-01 Medellín-
Colombia
| | - Sandra Perez
- Grupo de Dinámica Cardiovascular. Universidad Pontificia Bolivariana, Circular 1 No. 73-76, Medellín-
Colombia
- Grupo de Óptica y Espectroscopía -GOE- Universidad Pontificia Bolivariana, Circular 1 No. 73-76, Medellín-
Colombia
| | - Yonatan Montoya
- Grupo de Materiales Avanzados y Energía -MatyEr-. Línea Electromedicina. Instituto Tecnológico Metropolitano. Calle 54A No. 30-01 Medellín-
Colombia
| | - Deivid Botina
- Grupo de Materiales Avanzados y Energía -MatyEr-. Línea Electromedicina. Instituto Tecnológico Metropolitano. Calle 54A No. 30-01 Medellín-
Colombia
| | - Johnson Garzón
- Grupo de Óptica y Espectroscopía -GOE- Universidad Pontificia Bolivariana, Circular 1 No. 73-76, Medellín-
Colombia
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Yamal JM, Zewdie GA, Cox DD, Atkinson EN, Cantor SB, MacAulay C, Davies K, Adewole I, Buys TPH, Follen M. Accuracy of optical spectroscopy for the detection of cervical intraepithelial neoplasia without colposcopic tissue information; a step toward automation for low resource settings. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:047002. [PMID: 22559693 PMCID: PMC3380950 DOI: 10.1117/1.jbo.17.4.047002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 01/30/2012] [Accepted: 02/17/2012] [Indexed: 05/24/2023]
Abstract
Optical spectroscopy has been proposed as an accurate and low-cost alternative for detection of cervical intraepithelial neoplasia. We previously published an algorithm using optical spectroscopy as an adjunct to colposcopy and found good accuracy (sensitivity=1.00 [95% confidence interval (CI)=0.92 to 1.00], specificity=0.71 [95% CI=0.62 to 0.79]). Those results used measurements taken by expert colposcopists as well as the colposcopy diagnosis. In this study, we trained and tested an algorithm for the detection of cervical intraepithelial neoplasia (i.e., identifying those patients who had histology reading CIN 2 or worse) that did not include the colposcopic diagnosis. Furthermore, we explored the interaction between spectroscopy and colposcopy, examining the importance of probe placement expertise. The colposcopic diagnosis-independent spectroscopy algorithm had a sensitivity of 0.98 (95% CI=0.89 to 1.00) and a specificity of 0.62 (95% CI=0.52 to 0.71). The difference in the partial area under the ROC curves between spectroscopy with and without the colposcopic diagnosis was statistically significant at the patient level (p=0.05) but not the site level (p=0.13). The results suggest that the device has high accuracy over a wide range of provider accuracy and hence could plausibly be implemented by providers with limited training.
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Affiliation(s)
- Jose-Miguel Yamal
- The University of Texas Health Science Center at Houston, Division of Biostatistics, School of Public Health, 1200 Herman Pressler, RAS W928, Houston, Texas 77030, USA.
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Buys TPH, Cantor SB, Guillaud M, Adler-Storthz K, Cox DD, Okolo C, Arulogon O, Oladepo O, Basen-Engquist K, Shinn E, Yamal JM, Beck JR, Scheurer ME, van Niekerk D, Malpica A, Matisic J, Staerkel G, Atkinson EN, Bidaut L, Lane P, Benedet JL, Miller D, Ehlen T, Price R, Adewole IF, MacAulay C, Follen M. Optical technologies and molecular imaging for cervical neoplasia: a program project update. ACTA ACUST UNITED AC 2011; 9:S7-24. [PMID: 21944317 DOI: 10.1016/j.genm.2011.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 08/02/2011] [Indexed: 12/23/2022]
Abstract
There is an urgent global need for effective and affordable approaches to cervical cancer screening and diagnosis. In developing nations, cervical malignancies remain the leading cause of cancer-related deaths in women. This reality may be difficult to accept given that these deaths are largely preventable; where cervical screening programs have been implemented, cervical cancer-related deaths have decreased dramatically. In developed countries, the challenges of cervical disease stem from high costs and overtreatment. The National Cancer Institute-funded Program Project is evaluating the applicability of optical technologies in cervical cancer. The mandate of the project is to create tools for disease detection and diagnosis that are inexpensive, require minimal expertise, are more accurate than existing modalities, and can be feasibly implemented in a variety of clinical settings. This article presents the status and long-term goals of the project.
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Affiliation(s)
- Timon P H Buys
- Imaging Unit, Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada.
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Cantor SB, Yamal JM, Guillaud M, Cox DD, Atkinson EN, Benedet JL, Miller D, Ehlen T, Matisic J, van Niekerk D, Bertrand M, Milbourne A, Rhodes H, Malpica A, Staerkel G, Nader-Eftekhari S, Adler-Storthz K, Scheurer ME, Basen-Engquist K, Shinn E, West LA, Vlastos AT, Tao X, Beck JR, MacAulay C, Follen M. Accuracy of optical spectroscopy for the detection of cervical intraepithelial neoplasia: Testing a device as an adjunct to colposcopy. Int J Cancer 2011; 128:1151-68. [PMID: 20830707 PMCID: PMC3015005 DOI: 10.1002/ijc.25667] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 07/12/2010] [Indexed: 12/11/2022]
Abstract
Testing emerging technologies involves the evaluation of biologic plausibility, technical efficacy, clinical effectiveness, patient satisfaction, and cost-effectiveness. The objective of this study was to select an effective classification algorithm for optical spectroscopy as an adjunct to colposcopy and obtain preliminary estimates of its accuracy for the detection of CIN 2 or worse. We recruited 1,000 patients from screening and prevention clinics and 850 patients from colposcopy clinics at two comprehensive cancer centers and a community hospital. Optical spectroscopy was performed, and 4,864 biopsies were obtained from the sites measured, including abnormal and normal colposcopic areas. The gold standard was the histologic report of biopsies, read 2 to 3 times by histopathologists blinded to the cytologic, histopathologic, and spectroscopic results. We calculated sensitivities, specificities, receiver operating characteristic (ROC) curves, and areas under the ROC curves. We identified a cutpoint for an algorithm based on optical spectroscopy that yielded an estimated sensitivity of 1.00 [95% confidence interval (CI) = 0.92-1.00] and an estimated specificity of 0.71 [95% CI = 0.62-0.79] in a combined screening and diagnostic population. The positive and negative predictive values were 0.58 and 1.00, respectively. The area under the ROC curve was 0.85 (95% CI = 0.81-0.89). The per-patient and per-site performance were similar in the diagnostic and poorer in the screening settings. Like colposcopy, the device performs best in a diagnostic population. Alternative statistical approaches demonstrate that the analysis is robust and that spectroscopy works as well as or slightly better than colposcopy for the detection of CIN 2 to cancer.
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Affiliation(s)
- Scott B. Cantor
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jose-Miguel Yamal
- Division of Biostatistics, The University of Texas School of Public Health, Houston, Texas
| | - Martial Guillaud
- Department of Cancer Imaging, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Dennis D. Cox
- Department of Statistics, Rice University, Houston, Texas
| | - E. Neely Atkinson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J. L. Benedet
- Department of Cancer Imaging, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Dianne Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Ehlen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasenka Matisic
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monique Bertrand
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Milbourne
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Helen Rhodes
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anais Malpica
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregg Staerkel
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shahla Nader-Eftekhari
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Karen Adler-Storthz
- The University of Texas Health Science Center at Houston Dental Branch, Houston, Texas
| | - Michael E. Scheurer
- Department of Pediatrics and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eileen Shinn
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loyd A. West
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anne-Therese Vlastos
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xia Tao
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Calum MacAulay
- Department of Cancer Imaging, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Michele Follen
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, the Lyndon Baines Johnson Hospital, Houston, Texas
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