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个新的 每年都有口腔癌和口咽癌的病例被诊断出来。通过早期发现和 口腔癌的治疗，患者可以有很好的结果。然而，大多数患者 直到他们的疾病处于治疗更具侵入性的晚期才被诊断出来， 价格昂贵，而且效率较低。提高口腔癌及其前兆的早期发现 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方案。 癌在农村地区，口腔癌的早期诊断常常受到缺乏 具有适当专门知识的人员，缺乏保健基础设施，获得保健的机会有限 服务和长途旅行。农村县的患者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，我们将开发两种新的工具，以改善农村地区口腔癌的早期发现 （1）一种低成本、鲁棒的、基于移动的电话的成像系统，用于移动的 口腔癌（mDOC），和（2）低成本的培训模式，以帮助教学口腔癌检查 程序，包括使用mDOC。这些工具将提供改进检测的手段 通过自体荧光和白光成像技术， 客观的自动图像分析，以及由非现场牙医或医生进行的专家评审。 在目标1中，我们将开发mDOC仪器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名转诊至口腔专科医生的患者进行成像， 评估可疑的口腔病变。我们将使用此数据集来开发和验证mDOC 自动分析算法，以客观地识别高风险口腔粘膜病变。同时，我们 我将进行一项可用性研究，以评估和优化口语考试培训模式和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。 在德克萨斯州南部的格兰德河山谷的初级保健诊所， 在农村和服务不足的医疗环境中使用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。 我们的合作将生物医学成像的专业知识与检测的临床专业知识相结合， 口腔癌的诊断和治疗。创新的移动的成像 本提案中将开发的技术能够扩大有效的方案， 在美国农村和医疗服务不足的地区发现口腔癌。

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.