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Digital Pathology Solutions for low-budget and low-tech regions of the world

Digital pathology is transforming possibilities for patient care and the nature of pathologists’ work. But it is clear that in low-income countries, access to pathology and laboratory medicine (PALM) services is very restricted and under-developed.[1] Low-income countries bear a disproportionate share of the global disease burden, yet they are so under-resourced in the pathology and laboratory services that are vital for the accurate diagnosis and treatment of disease.[2] This presents a huge issue for global health.

Given this global context, Rebecca Calder, Daniel Stevens and Zev Leifer’s poster, presented at the 5th Digital Pathology and AI Congress, is of notable significance.

Image analysis and AI is transforming pathology

It offers improved patient care. According to Marylin Bui, Professor of Pathology and Director of Analytic Microscopy Core, Moffitt Cancer Center, integrating digital pathology into clinical care will mean ‘augmented ability to deliver patient care’ and more patients on the right treatment path sooner. Marylin Bui’s work and insights are the focus of a recent post which you can find here.

It is also relieving the enormous pressure pathologists are facing and improving lab workflows. Professor David Snead has explained in another recent blog post: ‘As a practising histopathologist, the key reporting workload is going up; we are producing double the numbers of slides from the same number of cases and we need help as this avalanche of work continues.’ Computer aided image analysis is enabling his lab, one of five government funded centres advancing AI in image diagnostics, to improve efficiency and workflow.

It is also enabling effective archive searching to inform diagnosis and provide ‘virtual peer review’. Dr. Hamid Tizhoosh, also featured on the blog, explained how this works: ‘AI can access the knowledge of colleagues even when they are not there’ and images can even be shared around the world to serve diagnosis.

But implementing digital pathology in low-resource areas is incredibly challenging

There are a number of barriers. The workforce is insufficient and there is a shortage of facilities and human resources to train more pathologists. The telecommunication infrastructure and equipment is becoming available, but slowly. Access to the Internet is often slow, unreliable and expensive. The absence of consistent standardisation and quality control is another barrier. The high cost of equipment for even standard microscopy, let alone for digital image analysis, is prohibitive of its implementation. The result is situations such as Olaniyi Owoeye’s: he is a haematologist practising at the University Teaching Hospital in Ilorin, Nigeria, where his unit shares one microscope. In sub-Saharan Africa, the number of pathologists is approximately one per 1,000,000 patients.[3]

Are there solutions for low-budget and low-tech regions?

Initiatives such as X-WOW are seeking to facilitate the re-location of ‘retired’ microscopes to exactly these areas – read more about X-WOW here.

At last year’s Digital Pathology & AI Congress Rebecca Calder, Daniel Stevens and Zev Leifer presented a poster exploring the whether the inexpensive Foldscope paper microscope presented a digital pathology solution for diagnostic analysis of crystals in urine practicable in low-budget and low-tech regions of the world.

As a diagnostic tool the Foldscope has huge potential for under-resourced centres, and ultimately for global patient care.

Preliminary studies in the use of the Foldscope paper microscope for diagnostic analysis of crystals in urine

The Foldscope was developed by Dr. Manu Prakash at Stanford as a cheap (under $1.00) microscope made of paper and usable for microscopy by students and professionals all over the world. In this study the team sought to evaluate if the Foldscope could be used in urinalysis in regions of the world where budget and availability of high-end instrumentation is severely limited.

View the poster

Join us at the 6th Digital Pathology and AI Congress: Europe to engage with the latest developments in image analysis and AI applications for digital pathology. There are still some passes left – explore the programme.

[1]Michael L Wilson, Kenneth A Fleming, Modupe A Kuti, Lai Meng Looi, Nestor Lago, Kun Ru, ‘Pathology and laboratory medicine in low-income and middle-income countries: Access to pathology and laboratory medicine services: a crucial gap’, The Lancet 2018; 391, pp. 1927-38

[2]Ibid. p. 1927

[3]Ibid., p.1933

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