Automated Image-Diagnosis for Female Genital Schistosomiasis

Context and Potential Impact Schistosomiasis is the second most devastating tropical disease in terms of public health burden and economic growth. More than 240 million people worldwide suffer from schistosomiasis. Merck has been fighting against this Neglected Tropical Disease with its partner, the World Health Organization, since 2007 in the scope of its Merck Schistosomiasis Elimination Program and donates up to 250 million praziquantel tablets for treatment per year. Merck and WHO committed themselves to continue their work in fighting the disease until its elimination. Female Genital Schistosomiasis (FGS) is acquired from untreated infection with Schistosoma haematobium, which results from contact with contaminated freshwater bodies used by rural communities, specifically by women and girls, for daily chores and activities. FGS affects 56 million African women and girls. FGS can gradually evolve towards reproductive organ damage characterized by sub-fertility or infertility, ectopic pregnancy, spontaneous abortion, premature birth, low birth weight and maternal death. Additionally, there is concern and biological plausibility that FGS increases susceptibility to HIV and HPV infection, and cervical cancer. Nevertheless, FGS remains largely underreported, under- and misdiagnosed and untreated. FGS is characterized by a pattern of lesions that manifest at the cervix and the vagina, such as homogeneous and grainy sandy patches. At present, a key challenge in eliminating FGS is that there is no gold-standard diagnostic suitable for endemic settings. Laboratory diagnostics are currently inadequate and a low index of suspicion among healthcare professionals can lead to misdiagnosis of sexually transmitted infections. An automated image diagnostic system could improve FGS treatment and research programs by providing a low-cost, point-of-care diagnostic aid for local healthcare professionals. This would help diagnose FGS, leading to better patient outcomes, and help awareness and treatment programs to better target at-risk communities. Aims and Objectives The doctoral research project aims to build an open-source, automated, image-based, digital point-of-care diagnostic system for FGS to operate in resource-poor settings. This tool could subsequently be trialed in a global health setting with Merck's clinical partners. Objectives will include designing and implementing a lightweight network architecture for use in an ultra-low powered environment, evaluating data augmentation methods for enriching limited clinical datasets and investigating best practice for model explainability and diagnostic reporting to build trust with clinicians and end-users. Through this research project and the creation of a well-documented, open-source tool, a secondary goal will be to enable reproducibility of similar solutions in other resource-constrained global health applications. EPSRC Alignment and Industrial Collaboration This project falls within the EPSRC Medical Imaging research area, part of the broader Healthcare Technologies portfolio, and targets the Earlier Diagnosis research priority. The project is in collaboration with Merck.

The main impact of the SABS CDT will be the difference made by the scientists trained within it, both during their DPhils and throughout their future careers.

The impact of the students during their DPhil should be measured by the culture change that the centre engenders in graduate training, in working at the interface between mathematical/physical sciences and the biomedical sciences, and in cross sector industry/academia working practices.

Current SABS projects are already changing the mechanisms of industry academic collaboration, for example as described by one of our Industrial Partners

"UCB and Roche are currently supervising a joint DPhil project and have put in two more joint proposals, which would have not been possible without the connections and the operational freedom offered by SABS-IDC and its open innovation culture, a one-of-the-kind in UK's CDTs."

New collaborations are also being generated: over 25% of current research projects are entirely new partnerships brokered by the Centre. The renewal of SABS will allow it to continue to strengthen and broaden this effect, building new bridges and starting new collaborations, and changing the culture of academic industrial partnerships. It will also continue to ensure that all of its research is made publically available through its Open Innovation structure, and help to create other centres with similar aims.

For all of our partners however, the students themselves are considered to be the ultimate output: as one our partners describes it,

"I believe the current SABS-IDC has met our original goals of developing young research scientists in a multidisciplinary environment with direct industrial experience and application. As a result, the graduating students have training and research experience that is directly applicable to the needs of modern lifescience R&D, in areas such as pharmaceuticals and biotechnology."

However, it is not only within the industrial realm that students have impact; in the later years of their DPhils, over 40% of SABS students, facilitated by the Centre, have undertaken various forms of public engagement. This includes visiting schools, working alongside Zooniverse to develop citizen science projects, and to produce educational resources in the area of crystal images. In the new Centre all students will be required to undertake outreach activities in order to increase engagement with the public.

The impact of the students after they have finished should be measured by how they carry on this novel approach to research, be it in the sector or outside it. As our industrial letters of support make clear, though no SABS students have yet completed their DPhils, there is a clear expectation that they will play a significant role in shaping the UK economy in the future. For example, as one of our partners comments about our students

"UCB has been in constant search for such talents, who would thrive in pharmaceutical research, but they are rare to find in conventional postgraduate programmes. Personally I am interested in recruiting SABS-IDC students to my group once they are ready for the job market."

To demonstrate the type of impact that SABS alumni will have, we consider the impact being made by the alumni of the i-DTC programmes from which this proposal has grown. Examples include two start-up companies, both of which already have investment in the millions. Several students also now hold senior positions in industry and in research facilities and institutes. They have also been named on 30 granted or pending patents, 15 of these arising directly from their DPhil work.

The examples of past success given above indicate the types of impact we expect the graduates from SABS to achieve, and offer clear evidence that SABS students will become future research leaders, driving innovation and changing research culture.