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

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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Citation

Published Version (Please cite this version)

10.1371/journal.pone.0135869

Publication Info

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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Scholars@Duke

Muasher

Lisa Coates Muasher

Assistant Professor of Obstetrics and Gynecology
Schmitt

John Wilson Schmitt

Consulting Professor in the Department of Obstetrics and Gynecology
Ramanujam

Nimmi Ramanujam

Robert W. Carr, Jr., Distinguished Professor of Biomedical Engineering

Ramanujam obtained her Ph.D. degree at the University of Texas at Austin. She progressed through the ranks as an academic researcher; the first five years as a research scientist and postdoctoral fellow at the University of Pennsylvania, the next five as an assistant professor at the University of Wisconsin, Madison, and the following five as an associate professor in the Department of Biomedical Engineering at Duke University. In 2011 she was promoted to full professor.  Ramanujam is internationally recognized for her contributions in innovation, education and entrepreneurship and received numerous awards most notably, the IEEE  Biomedical Engineering Award Technical Field Award and the Social Impact Abie award . She is a Fulbright scholar, a member of the National Academy of Inventors, and a fellow of international professional societies in her field. She has also been invited for speaking engagements at the United Nations, as a TEDx speaker, and been invited to give plenary talks on her work all over the world.  

Ramanujam addresses pressing challenges in women’s cancers, specifically, cervical and breast cancer. Ramanujam creates technologies that transform complex diagnostic instruments and therapies into accessible, affordable, and appropriate solutions.  Several of these products are now being used in several countries in the U.S., Latin America, and Africa. She has developed a network of partners including academic institutions and hospitals, non-governmental organizations, ministries of health, and commercial partners to implement these technologies in diverse healthcare settings globally.

She has used her expertise in imaging and human-centered design to develop the Pocket colposcope which is on the WHO list of devices for cervical cancer imaging. A sister device, the Callascope is a self-use speculum-free imaging device, which allows women to screen themselves privately without the need for an intrusive pelvic exam. She has developed a translational microscope called the CapCell Scope to identify biomarkers of metabolism that reflect tumor behavior, including growth, proliferation, and treatment resistance, aimed at informing drug selection for breast cancer treatment. She has developed an ultra-low-cost injectable liquid ablation therapy that disrupts tumors locally as well as elicits an anti-tumor immune response to address an important gap – the lack of access to surgery to the world’s most vulnerable populations. 

Ramanujam has also created several global initiatives that strive to achieve enduring impact in health and education. Her innovations have a common wellspring - they are all connected and come from a place of wanting to create and make something that doesn’t exist.

The most prominent is a consortium called Women Inspired Strategies for Health (WISH) to improve cervical cancer prevention in low-resource settings globally.  She is working with partners worldwide to ensure that technologies and strategies for addressing cervical cancer are adopted by cancer control programs in geographically and economically diverse healthcare settings. These partnerships have resulted in see-and-treat cancer control strategies in the least resourced settings that are in clinical deserts. WISH has been recognized by the MacArthur Foundation as one of the top 100 most transformative and impactful solutions, a testament to its significance in redesigning the health system.

Ramanujam has launched an arts and storytelling initiative, The Invisible Organ to raise awareness of sexual and reproductive health inequities. An educational documentary with a similar name was created and has been screened at conferences and by multiple artists and students across the U.S. This film was officially selected for the Women at the Center Film Festival at the International Papillomavirus Conference in 2020. She also co-led the curation of an art exhibit to bring together a collection of visual arts, medical photography, sculptures, and installations, both a physical exhibit and a digital moving gallery to express the stigma and shame associated with female anatomy.

She has also created a global education program that intersects design thinking, STEM concepts, and the U.N. Sustainable Development Goals to promote social justice awareness: Ignite. The participatory learning curricula have been implemented in more than four countries with broad-ranging impact. For example, students living around the contaminated Lake Atitlan, in Guatemala learned how to design engineering solutions for clean water. Similarly,for personal use during frequent power outages.


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