LAB PROFESSIONALS WHO HAVE worked in regions like Africa know that the infrastructure in developing countries is limited or nonexistent. This makes it challenging to provide clinical laboratory testing services that are up to the standards common in developed countries.
For example, it can be difficult for a laboratory in a developing country to report lab test results in a timely fashion to those clinicians practicing medicine in remote settings that lack the fixed telephone and Internet services taken for granted in developed countries. That is why there is keen interest in finding ways to use cellular phones to support better clinical care in developing countries.
For example, researchers at the University of California, Los Angeles (UCLA), and the University of California, Berkley (UC), are developing ways to use cellphones to collect and transmit bio-medical data specifically to help laboratory professionals and physicians make diagnostic and treatment decisions. Researchers at each university are collecting images in different ways. In April, research teams at both UCLA and UC won awards from the Vodafone Americas Foundation, a foundation funded by the international cellphone company to promote innovative wireless technology.
At UCLA, the innovative technology is called LUCAS, which stands for Lensfree Ultra-wide field Cell-monitoring Array. It is based on Shadow imaging. Unlike most medical imaging technology, LUCAS involves viewing a hologram, or shadow image, of cells and cell structures. It is called the “CelloPhone Project” by the team of Drs. Aydogan Ozcan, Neven Karlovac, and Yvonne Bryson, and other colleagues in UCLA’s electrical engineering department.
“There are parts of the world unfortunately that don’t have medical resources,” stated UCLA’s Ozcan. “There are no [clinical] laboratories. There is no infrastructure; so there is no way to get [lab test] results. There is nothing out there to provide basic tests regarding patients’ health. Labs are too expensive.
“Cellphones Are Everywhere”
“But cellphones are everywhere, even in Africa!” continued Ozcan. “Almost 20% of the population uses cellphones actively and we can capture [medical] images with just a cellphone and wirelessly transmit that image to a personal computer workstation. The results of the analysis can be sent back via text message.”
Ozcan’s development is particularly remarkable because it involves collecting, transmitting, and analyzing holograms of cells to detect disease using the image sensor of a digital camera. Essentially, it allows microscopic particles to be viewed without using lenses.
To achieve this, Ozcan removed the cover of the sensor of a digital camera and placed cell samples directly on the imaging sensor. The pixels on the image sensor captured a shadow image of the cells. “That was the remarkable moment when I said, ‘Yes,’ This is going to work,” Ozcan explained. He then noted that the holographic image of the cells contains more information about the shape and the health of the cell than a regular microscope can detect.
We can detect holograms of cell bacteria digitally,” he said. “For each cell we want to analyze, we have library images of the same hologram of the same cell type. We load the library images of that hologram and the algorithm does pattern matches so we can identify the cells based on what we have in our library of images. If there was a disease like malaria, for instance, you would see the hologram of those red blood cells showing the deficiencies so that disease would actually show a contrast difference.”
For imaging and monitoring of discrete particles such as cells or bacteria, Ozcan believes viewing the shadow images is a better way of viewing cells and cell structures than is possible with current technology. “Technically, the shadow of a micro-object can be thought of as a hologram that is based on interference of diffracted beams interacting with each cell,” he explained. “Micro-scale shadows (or transmission holograms) contain an extremely rich source of quantified information regarding the spatial features of the micro-object of interest.”
Installing the requisite imaging technology adds about $50 to the cost of a cell-phone and the system is about 90% accurate, Ozcan said. More information about Oxcan’s research can be found at https://innovate.ee.ucla.edu.
Overcoming Challenges
At UC Berkley, researchers are using cell-phones to collect and transmit microscopic images for analysis. The “CellScope Project,” as it is called, is based on a mobile microscopy system. A compact optical microscope is attached to a cellphone with a digital camera. The device is designed to reduce the need for expensive microscopes in the field.
Drs. Daniel Fletcher, Erik Douglas, and Wilbur Lam, along with other researchers in the Bioengineering Department at UC Berkeley, hope their mobile microscopy system will increase the capabilities of health-care workers in resource-limited areas. They observe that optical microscopy is the diagnostic gold standard for many diseases, but the necessary equipment and trained personnel often are unavailable in a resource-poor area. However, a number of resource-limited areas in developing counties have reliable cellular communication systems. Thus, cellphones can be one affordable and reliable method to help clinicians diagnose patients in remote areas.
CellScope’s Potential
UC Berkeley’s CellScope is capable of on-site disease diagnosis and wireless transmission of patient data to clinical centers for further evaluation, treatment recommendations, patient management, and epidemiological studies. Details can be found at https://fletchlab.berkeley.edu/research_cellscope.htm.
THE DARK REPORT observes that the ubiquitous nature of the cellphone gives it the potential to become an inexpensive and useful laboratory tool in lesser-developed countries and regions. That is one reason why researchers at UC and UCLA are developing ways to capture and move bio-medical data by cellphone.
However, there is wider significance to these research initiatives that will be of interest to pathologists and pathology practices administrators. The two examples provided above illustrate how new cellular and wireless technologies have the potential to be disruptive to pathologists and the laboratory medicine profession.
In fact, as first movers in the pathology profession begin to utilize digitized pathology images, the ability of cellular telephones and wireless technology to move these images cheaply and with high resolution may actually increase the disruptive effect these two technologies have on anatomic pathology.
