Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings.
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2015
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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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Lam, Christopher T, Marlee S Krieger, Jennifer E Gallagher, Betsy Asma, Lisa C Muasher, John W Schmitt and Nimmi Ramanujam (2015). Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings. PLoS One, 10(9). p. e0135869. 10.1371/journal.pone.0135869 Retrieved from https://hdl.handle.net/10161/10961.
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Lisa Coates Muasher
John Wilson Schmitt
Nimmi Ramanujam
Nirmala (Nimmi) Ramanujam is the Robert W. Carr Professor of Biomedical Engineering, Professor of Cancer Pharmacology and Cancer Biology, and Global Health at Duke University. She founded the Center for Global Women’s Health Technologies (GWHT) in 2013 to reshape women’s health through technology innovation. Her translation program in cervical and breast cancer has brought together multiple partners across U.S. and international academic institutions, hospitals, companies, non-governmental organizations, and ministries of health.
Prof. Ramanujam creates technological solutions to detect cancer at its earliest stages, improve the effectiveness of current treatments and refine them to be more effective and less toxic. Prof. Ramanujam has developed point of care imaging technologies (Pocket colposcope and Callascope) and deep learning algorithms for the global prevention of cervical cancer. She has implemented these technologies in global health care settings where access to cancer prevention and treatment is sparse or non-existent. Towards cancer treatment, Prof. Ramanujam has developed a drug releasing immunomodulating polymer that simultaneously disrupts tumor cells and elicits an immune boost. This injectable therapeutic can be deployed in settings where treatment is unavailable owing to its simple and low-cost formulation, and it can also provide an immune boost to checkpoint inhibitors. To understand why some tumors are resistant to therapy, she has created tools to image basic cellular processes that provide insight into tumor resistance. She has shown that metabolic plasticity in human residual disease can serve as a cue for treatment optimization and patient management.
Prof. Ramanujam has created a global consortium, Women Inspired strategies for health or WISH to establish technology-enabled community clinics for cervical cancer detection in Peru and Kenya. The MacArthur Foundation recognized WISH in 2019 as one of the top 100 most transformative and impactful global solutions. She founded Calla Health in 2019 to commercialize women’s health technologies developed by her group. Through WISH and Calla Health, her femtech innovations have been disseminated in 11 countries and has reached more than 8,000 women globally. She has also co-developed the (In)visible Organ documentary on reshaping the future of women’s health through femtech. Her documentary was officially selected for the Women at the Center Film Festival at the International Papillomavirus Conference in 2020. Prof. Ramanujam has seen the value of co-creating solutions with those that are at the level of the problem. This has led to the creation of a global education program IGNITE that intersects engineering design thinking, STEM concepts, and the U.N. Sustainable Development Goals. This peer mentoring model between undergraduate students and high school and middle students has been deployed in 5 locations globally, reaching more than 2,500 students and the online curriculum has more than 1000 users.
Prof. Ramanujam has received numerous awards, several of which are highlighted here. She received the prestigious DOD Breast Cancer Innovator award in 2024 given to gifted individuals who have a history of visionary scholarship, leadership, and creativity. She received the IEEE Biomedical Engineering Award Technical Field Award in 2023 given annually for outstanding contributions to the field of Biomedical engineering. She is a fellow of and has received several awards from professional societies in the field of biomedical optics. She is a Fulbright scholar, a fellow of the National Academy of Inventors, and the American Institute of Biomedical and Biomedical Engineering (AIMBE). She has been invited as a speaker at the United Nations and at TEDx events. Her textbook, Biomedical Engineering for Global Health (2024), examines the intersection of health systems, point of care technologies, and data analytics / artificial intelligence and how these technological capabilities can broaden access to care in the 21st century.
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