More on disease diagnosis with a mobile phone

This is a quick follow up on an earlier post entitled "Did you say disease diagnosis with a mobile phone?" Newsweek recently did a story on this discovery entitled Dial "D" for Diagnosis. The story, for one, throws a human light on the discovery, by telling us that this potentially socially transforming technology came about from a challenge thrown to a class of Biomedical Engineering graduate students at University of California, Berkeley, by Professor Daniel Fletcher. He apparently asked the students to respond to an imaginary scenario where were hiking in a remote village where an unknown infectious disease was spreading, what could you build with only a camera cell phone and a backpack of lenses that might help identify the disease? This is a quick follow up on an earlier post entitled "Did you say disease diagnosis with a mobile phone?" Newsweek recently did a story on this discovery entitled Dial "D" for Diagnosis. The story, for one, throws a human light on the discovery, by telling us that this potentially socially transforming technology came about from a challenge thrown to a class of Biomedical Engineering graduate students at University of California, Berkeley, by Professor Daniel Fletcher. He apparently asked the students to respond to an imaginary scenario where they were hiking in a remote village where an unknown infectious disease was spreading, and they had to build a device that might help identify the disease, with only a camera cell phone and a backpack of lenses. The product: the Cellscope (please bear with the intro ad). Here is another link to a Youtube video.

Breslauer, D., Maamari, R., Switz, N., Lam, W., & Fletcher, D. (2009). Mobile Phone Based Clinical Microscopy for Global Health Applications PLoS ONE, 4 (7) DOI: 10.1371/journal.pone.0006320

Telemedicine with a twist: cutting costs for state-of-the-art medical imaging

It is not an exaggeration to day that medical imaging has revolutionized western medicine in the past two decades or so, with the frontiers being constantly pushed to allow better, earlier and faster diagnosis for a variety of diseases. The story is quite different, however, in the developing world where, according to recent WHO estimates, over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. WHO further estimates that some three quarters of the world population does not have access to medical imaging.

One problem that may be at least partially responsible for this discrepancy is that typical medical imaging equipment is large, non-portable, expensive, require multiple components to work in concert (viz., data acquisition, data analysis, image rendering and visual display), and require highly trained personnel to operate them optimally.

A collaborative group of researchers based at the University of California at Berkeley and at the Hebrew University in Jerusalem have come up with an ingenious solution to this intractable problem. These authors propose that one reason why medical imaging equipment are typically so expensive and complicated to use is that they are designed to be self contained units that combine all aspects of imaging, namely: (a) the data acquisition hardware which is in contact with the patient, (b) the imaging processing hardware and software, and (b) the image display unit. This causes substantial duplication in expensive components and places increased demands on operator training.

To make medical imaging feasible in regions of the world with minimal infrastructure, the authors propose to decentralize the different aspects of medical imaging, and generate a new medical imaging system made of two independent components connected through cellular phone technology which, as pointed out earlier in other posts, is quite ubiquitously available even in the remotest parts of the globe. The independent units of this proposed decentralized imaging system are: (a) a data acquisition device (DAD) at a remote patient site that is simple, with limited controls and no image display capability, and (b) an advanced image reconstruction and hardware control multiserver unit at a central site. The vision is that cellular phone technology will transmit unprocessed raw data from the patient site DAD. These will then be processed at a central location, which can have cutting edge image processing and rendering equipment and algorithms. Furthermore, being located at one or a few central site(s), they can be easily upgraded and kept current with the world standards. The final rendered images will then be sent back to the patient site via cell phone, where they can be displayed and reviewed. Of course, this format will also be accessible to real time expert consultation via “conventional” telemedicine.

In this initial report, the authors have confirmed the feasibility of this concept both for diagnostic as well as interventional imaging, by using a laboratory model of human breast cancer.

The next step in the journey, of course, will be to work out the logistics of getting such a system to work in the field. However, it is a great beginning, and this commentator surely hopes that this approach can be translated to real world public health scenarios in the near future.

Did you say disease diagnosis with a mobile phone?

A group of researchers from University of California at Berkeley and San Francisco have built a fascinating new device, which should make disease diagnosis in the field in the developing world a lot more feasible. The new device takes advantage of the recent penetration of mobile telephones in the remotest parts of the world – places where there are few health amenities, or even reliable roads and power. Most mobile telephones today have built-in cameras which, although they may not be the dream of a professional photographer, can nevertheless produce digital images at sufficient resolution for diagnostic pathology.

The researchers have combined a camera-equipped mobile phone with a simple light microscope, and packaged it into a simple, portable and rugged “diagnostic field microscope” (for technical details, please see here). This new-fangled contraption can not only take diagnostic images (e.g., from blood smears prepared from patients suspected to have malaria or sickle cell anemia), but can also transmit those images to trained Pathologists anywhere in the globe for professional diagnosis. And all this can be achieved, logistics permitting, in real time. As anyone who has any experience of healthcare in the remotest parts of the developing world knows, this latter is really a make or break factor. In many places, the patient and his/her family may have travelled for days, sometimes on foot, to see a doctor. The probability that the patient can be sent home, and then be expected to return in a week for diagnosis and follow up treatment is next to nil. Thus, this device, if deployed in the field, can potentially increase the rate of treatment by very large proportions, and may in fact help control the spread of epidemics such as malaria, by timely administration of treatment to an initially infected cluster.

The researchers have gone one more step, and have equipped this system not only for bright-field microscopy (e.g., taking photographs of blood smears that can be done using ambient light), but also for fluorescence microscopy using an inexpensive LED (light emitting diode) as the illumination source. They have tested the feasibility of using fluorescence microscopy to diagnose Tuberculosis from sputum samples, stained with a fluorescent dye that helps in the identification of the tubercolusis-causing bacteria. They have also tested ways in which the images obtained can be processed automatically, and have confirmed that the phone computational resources are sufficient for such processing.

After this initial and very exciting report, it will be great to see a translation of this technology to the real world, wherein a company comes up with a business model that’ll ensure sustainable production and distribution of these mobile phone microscopes to places where they can really make a difference in the lives of people.

I would love to hear ideas about translation. Please post comments below.