Development of smartphone imaging technology for screening maternal and neonatal anaemia

Brief description of the context of the research including potential impact

Anaemia affects a quarter of the world population with a greater prevalence of 42% in pregnant women. The aim of the project is to use affordable smartphone imaging as a diagnostic strategy in maternal and neonatal anaemia. At present, diagnosis requires a blood test, which is costly and invasive. Blood tests may not be accessible in countries and regions without effective transport and hospital systems, such as in countries experiencing political unrest. A timely diagnosis of anaemia can allow for easier treatment (for example, via iron supplementation) with a greater chance of efficacy.

The approach is based upon imaging of the eye and the periocular region, including the lower eyelids. We aim to develop a smartphone application called the integrated maternal and neonatal care app which will provide diagnostic information on anaemia and jaundice (outside this project), to be used on women during pregnancy, their babies shortly after birth, and preschool-aged children. The group have previously utilised similar technology in detection of neonatal jaundice, which has established links for clinical studies and achieved widespread media attention.

Aims and Objectives

- The primary objective is to develop the integrated maternal and neonatal care (iMANC) app for screening for maternal anaemia, which can be used by trained healthcare workers, parents and patients.

- The specific objectives are to:
o Improve image acquisition and pre-processing:
- Develop sclera segmentation by machine learning in order to identify appropriate regions of the image for further analysis
- Develop automated processes for quality assurance to detect and replace images which are not suitable for analysis
- Investigate and utilise advances in affordable smartphone imaging technology (such as dual camera sensors) in order to improve image quality
o Improve image analysis:
- Use the programmable camera settings to investigate techniques for minimising the effects of varying ambient lighting
- Investigate additional parameters within the acquired image which might improve diagnostic ability
o Clinical validation:
- Statistically analyse the accuracy of the iMANC application through design, implementation, and analysis of clinical studies
- Understand the challenges to clinical use of this technique, including both ethical and financial concerns, as well as effects on clinician workflow which may pose barriers to wider use

Novelty of Research Methodology

Although the research group have used this technology to carry out pilot studies, the pilot studies have not worked in all subpopulations. In order to overcome this, the research will develop novel techniques with two areas: (1) human-computer interaction, for guiding image acquisition, automatically obtaining regions of interest in the gathered data, and presenting the output data in an accessible and responsible manner; and (2) optimising the diagnostic algorithm. This includes development of new techniques for controlling for the effect of ambient light and using new smartphone camera technologies which have not been used widely.

Alignment to EPSRC's strategies and research areas

This project lies within the healthcare technology theme, in particular aligning with the areas of clinical technology, medical imaging, and analytical science. This is because it aims to develop novel techniques to analyse a biological system in a clinical setting through controlled acquisition of a medical image. This project may also align against the artificial intelligence technologies theme through development of automatic image segmentation algorithms.

Any companies or collaborators involved

Collaborators: Dr Sara Hillman (UCLH), Dr Judith Meek (UCLH), Dr Vatsla Dadhwal (AIIMS), Dr Anubhuti Rana (AIIMS)

Companies: All India Institute of Medicine Science, University of Ghana, Greater Accra Regional Hosp

The critical mass of scientists and engineers that i4health will produce will ensure the UK's continued standing as a world-leader in medical imaging and healthcare technology research. In addition to continued academic excellence, they will further support a future culture of industry and entrepreneurship in healthcare technologies driven by highly trained engineers with deep understanding of the key factors involved in delivering effective translatable and marketable technology. They will achieve this through high quality engineering and imaging science, a broad view of other relevant technological areas, the ability to pinpoint clinical gaps and needs, consideration of clinical user requirements, and patient considerations. Our graduates will provide the drive, determination and enthusiasm to build future UK industry in this vital area via start-ups and spin-outs adding to the burgeoning community of healthcare-related SMEs in London and the rest of the UK. The training in entrepreneurship, coupled with the vibrant environment we are developing for this topic via unique linkage of Engineering and Medicine at UCL, is specifically designed to foster such outcomes. These same innovative leaders will bolster the UK's presence in medical multinationals - pharmaceutical companies, scanner manufacturers, etc. - and ensure the UK's competitiveness as a location for future R&D and medical engineering. They will also provide an invaluable source of expertise for the future NHS and other healthcare-delivery services enabling rapid translation and uptake of the latest imaging and healthcare technologies at the clinical front line. The ultimate impact will be on people and patients, both in the UK and internationally, who will benefit from the increased knowledge of health and disease, as well as better treatment and healthcare management provided by the future technologies our trainees will produce.

In addition to impact in healthcare research, development, and capability, the CDT will have major impact on the students we will attract and train. We will provide our talented cohorts of students with the skills required to lead academic research in this area, to lead industrial development and to make a significant impact as advocates of the science and engineering of their discipline. The i4health CDT's combination of the highest academic standards of research with excellent in-depth training in core skills will mean that our cohorts of students will be in great demand placing them in a powerful position to sculpt their own careers, have major impact within our discipline, while influencing the international mindset and direction. Strong evidence demonstrates this in our existing cohorts of students through high levels of conference podium talks in the most prestigious venues in our field, conference prizes, high impact publications in both engineering, clinical, and general science journals, as well as post-PhD fellowships and career progression. The content and training innovations we propose in i4health will ensure this continues and expands over the next decade.