Mobile Imaging for Oral Cancer Screening Programs in Rural US Settings

摘要 口腔癌是全球第六大常见恶性肿瘤。在美国，53,000 名新 每年都会诊断出口腔癌和口咽癌病例。通过早期发现和 治疗后，口腔癌患者可以获得良好的治疗效果。然而，大多数患者是 直到疾病处于晚期才被诊断出来，此时治疗更具侵入性、更多 价格昂贵，而且效果较差。改善口腔癌及其癌前病变的早期检测 是降低口腔癌发病率、发病率和死亡率的最佳机会。 在美国，农村地区尤其可能缺乏早期发现口腔疾病的有效计划。 癌症。农村地区口腔癌的早期诊断常常因缺乏相关手段而受到阻碍。 具备适当专业知识的人员、缺乏医疗保健基础设施、获得医疗服务的机会有限 服务和长途旅行。农村县的患者会经历更长的延误和旅行 与城市地区的患者相比，专家诊断和治疗的距离更远。 在这个项目中，我们将开发两种新工具来改善农村地区口腔癌的早期检测 美国：（1）一种低成本、强大的、基于手机的成像系统，用于移动检测 口腔癌 (mDOC)，以及 (2) 帮助口腔癌检查教学的低成本培训模式 程序，包括 mDOC 的使用。这些工具将提供改进检测的方法 通过自发荧光和白光成像技术在农村地区预防口腔癌， 客观的自动图像分析以及异地牙医或医生的专家审查。 在目标 1 中，我们将开发 mDOC 工具和交互式口语考试培训模型。在 目标 2 我们将使用 mDOC 设备对 120 名转诊至口腔专家进行治疗的患者进行成像 评估可疑的口腔病变。我们将使用该数据集来开发和验证 mDOC 自动分析算法可客观识别高风险口腔粘膜病变。与此同时，我们 将进行可用性研究，以评估和优化口语考试培训模型和 mDOC 设备。在目标 3 中，我们将在一项试点研究中使用 mDOC 对 50 名在牙科诊所寻求护理的患者进行成像 和德克萨斯州南部里奥格兰德河谷的初级保健诊所，以评估口腔治疗的可行性 在农村和服务不足的医疗机构中使用 mDOC 进行癌症检查；我们将培训当地 医疗保健提供者使用培训模型和 mDOC 设备进行口腔检查。 我们的合作伙伴关系将生物医学成像方面的专业知识与检测方面的临床专业知识相结合， 不同人群口腔癌的诊断和治疗。创新的移动成像 该提案中要开发的技术可以扩大早期有效计划的规模 在美国农村和医疗服务不足的地区检测口腔癌。

Abstract Oral cancer is the sixth most common malignancy worldwide. In the United States, 53,000 new cases of oral and oropharyngeal cancer are diagnosed annually. With early detection and treatment, patients with oral cancer can have excellent outcomes. However, most patients are not diagnosed until their disease is at a late stage when treatment is more invasive, more expensive, and less effective. Improving early detection of oral cancer and its precursors represents the best opportunity to reduce the incidence, morbidity, and mortality of oral cancer. In the US, rural areas are especially likely to lack effective programs for early detection of oral cancer. Early diagnosis of oral cancer in rural settings is frequently hampered by a lack of personnel with appropriate expertise, lack of health care infrastructure, limited access to health services, and long travel distances. Patients in rural counties experience longer delays and travel greater distances for diagnosis and treatment by a specialist, compared to patients in urban areas. In this project we will develop two new tools to improve early detection of oral cancer in rural areas of the US: (1) a low-cost, robust, mobile phone-based imaging system for mobile Detection of Oral Cancer (mDOC), and (2) a low-cost training model to aid in teaching oral cancer examination procedures, including the use of mDOC. These tools will provide the means to improve detection of oral cancer in rural areas through autofluorescence and white-light imaging technology, objective automated image analysis, and expert review by off-site dentists or doctors. In Aim 1 we will develop the mDOC instrument and the interactive oral exam training model. In Aim 2 we will use the mDOC device to image 120 patients referred to an oral specialist for evaluation of suspicious oral lesions. We will use this data set to develop and validate mDOC automated analysis algorithms to objectively identify high risk oral mucosal lesions. In parallel, we will conduct a usability study to evaluate and optimize the oral exam training model and the mDOC device. In Aim 3, we will use mDOC in a pilot study to image 50 patients seeking care at dental and primary care clinics in the Rio Grande Valley of south Texas, to evaluate the feasibility of oral cancer exam using mDOC in rural and underserved healthcare settings; and we will train local healthcare providers to perform oral exams using the training model and the mDOC device. Our partnership combines expertise in biomedical imaging with clinical expertise in detection, diagnosis, and treatment of oral cancer in diverse populations. The innovative mobile imaging technology to be developed in this proposal can enable scale-up of effective programs for early detection of oral cancer in rural and medically underserved regions of the United States.