Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.

Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.





New Page 1
Application of  Reverse Agglutination for
Identification Diseases such as Coronavirus COVID-19 .

The  Medicheck system utilises a variable orifice that uses an
impedance technique to measure, size and count particles varying in size from
1um to 30 um.

The sample (e.g. blood, urine, sputum) is pippeted into a well of a 
tray and placed on a conveyer. The agglutinant / antibody antigen is added to
the sample. After sufficient time for agglutination / clumping to take place has
elapsed, the well is moved  and presented to a probe for analysis. A saline
solution is used to dilute the sample. The probe sucks some of the sample
through the orifice. The impedance across the orifice changes when particles
pass through the orifice, in proportion to the size of the particle. The number
of particles are counted and sizes are measured and stored in a histogram of
size (x axis) versus against count of number of particles. The histogram is
analysed to determine particles per litre of different sized particles.
Absolute numbers are counted and are then classified for significance.
The user can set the threshold values for calibration, and indicating significance since not all
laboratories use the same criteria for determining a ‘positive’ sample.

Ordinarily large particles will block the orifice. However the Medicheck
probe filters out large particles and is less susceptible to blocking (if
blockage is detected and unblocking routing is run to automatically remove the
blockage)..

Because large particles are filtered out, a comparison of sample particle
sizes and counts with and without agglutination can determine the presence or
absence of a disease. When disease is absent no clumping / agglutination takes
place so sample histogram will not change. When disease is present clumping
takes place so counts of particles of various sizes will change. Additionally,
due to filtering effect, large clumps will be filtered out and not counted or
counted in sized multiples.

A trial for rheumatoid arthritis (R A) in serum, where only 10% of the
normal agglutinant per sample was used, reported a Sensitivity of 99.7% Specificity of 90.88%

This system can be used for hundreds of antibody antigen
agglutinations or lateral flow technology tests that utilise particles sized  between
1um and
30 um.

Diseases include Coronavirus COVID-19
antibody  test.

List of some of the
Agglutination tests available

Rheumatoid Factors (R.A.).
Hepatitis B (RPHA)
Weil-Felix
Cytomegalovirus (CMV)
C-Reactive Protein (CRP)
E.coli 0157
E.coli K1
E.coliSP3112
ASL
Syphilis (SPHA)
HIV 1 / 2
Rickettsia
Candida Mannan

 

Summary

Samples

  • Urine
  • Sputum
  • Blood
  • Serum

Particle sizing and counting of particles 1um to 30 um

Filtering – Large particles filtered out, they do not enter probe. (Reverse
agglutination)

Re-agent amount    Less than 10% of  amount used by
normal visual tests.

Speed of test        About 2 minutes,
depends on time antigen-anti body takes to bind.

Automation

  • multiple samples on conveyor
  • results transmitted to laboratory computer
  • barcode positive sample Identification
  • Multiple tests possible with multiple antibody antigens.

Performance

  • Sensitivity of 99.7%
  • Specificity of 90.88%

 

The Medicheck system is no longer in production.

However if you are interested in developing a new version (laboratory or
doctors office) contact us at

Tel: +44 7903 967 355 Email:
kmuk1@btinternet.com

Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.

Lifelinger

A new ICT-based diagnosis procedure and tool set for early detection of cervix cancer


Author: Eduardo Merino MacDonnell
Email:mermac@telefonica.net
Edited by: Karl Miller
Email: arayltd@btinternet.com
Home Page: www.arayltd.co.uk
Consortium Web Site: http://www.lifelinger.net/menu/home.htm

Introduction

The Social Problem – Cervical Cancer

The Social Problem – Waiting

The Social Problem – Early Diagnosis

The Medical Problem – Pap Smear

The Medical Problem – Colposcopy

The Medical Problem – Scarcity of trained medical personnel

Diagnosis procedures required:

Lifelinger objectives

Optical Signature’ of disease tissues

Detecting abnormal tissues

Workstation – Hardware

Camera and Light

Colposcope

Central Database

Evolving, extensible software

Working procedure

Adding Lifelinger to current colposcopy :

Lifelinger Imagination

End of Slide show



Lifelinger: A new ICT-based diagnosis procedure and tool set for early detection of Cervix cancer

Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.

An overview of cervical cancer screening systems in Europe

European Federation for Colposcopy
French Society for Colposcopy and Cervical Pathology

3rd European Congress for
Colposcopy and Cervical Pathology

Paris, January 23-24, 2004

M. ARBYN 1,2

1European Network for Cervical Cancer Screening
2Scientific Institute of Public Health, Brussels

Table of Contents

Introduction

Cancer Screening policy in the EU – (Council recommendation)

Conference on Screening and Early Detection of Cancer November 18-19th, 1999, Vienna

Vienna Conference, 1999

Council recommendation on cancer screening (a long way …)

Summary of the Council recommendation

Summary of the Council recommendation (2)

Council recommendation but …

References

Burden of Cervical Cancer

W-Age standardised mortality from and incidence of cervical cancer European Union, 2000

W-Age standardised mortality from and incidence of cervical cancer Acceding EU member states, 2000

Burden of cervical cancer – European Continent, 2000

Cervical Cancer Mortality In Europe

Evolution of the proportion of uterince cancer deaths NOS

Trend of Cervical Cancer Mortality. Finland, 1960, 1975, 1990

Trend of Cervical Cancer Mortality. England & Wales, 1960, 1975, 1990

Number of deaths by cancer of the uterus (Belgium 1954-94)

Estimated number of deaths by cancer of cervix and corpus uteri (Belgium 1954-94)

Standarised Mortality Rate for Cervical Cancer

Cervical cancer screening systems

Screening systems

Effectiveness opportunistic versus organised screening

National cervical cancer policies in EU countries

Screening Coverage in EU Countries

Study: current status CC screening in Europe

Questionnaire

Questionnaire

Q1: National screening policy

Q2-3: target age groups & frequency (2004)

Q5: Screening test

Q6: organised national programme

Q17: Cytological report form

Q19: informed consent for data registration

Q 21: screening coverage UK – England, 2003, 5-year coverage for Pap smear screening

Q 21: screening coverage – The Netherlands, 2001, 5-year coverage

Q 21: screening coverage France – 1995-2000, % of women with Pap < 3y ago

Screening status in Belgium (Health Interview Survey, 1996 & 2000)

Q 21: screening coverage UK

Other questions

To conclude

To conclude (2)

End of Slide Show



An overview of cervical cancer screening systems in Europe

Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.

Some Colposcopy links

Lifelinger http://www.lifelinger.net/menu/home.htm Arays LIFELINGER page

(In no particular order within rough sections)

General Overview

Heterocopulative Syndrome: Clinico-Pathologic Correlation in 260 Cases , M Scarce, Int J Epidemiol 2002;31:498-9 http://www.asccp.org/journal.shtml and http://www.jlgtd.com/

Medceu Cervical Cancer http://www.medceu.com/tests/cervicalcancer.htm

Cervical Cancer Prevention Diagnosis and Therapeutics CA Cancer J Clin 2001;51:92-114, Mike F. Janicek, MD; Hervy E. Averette, MD

Colposcope. Samir fouad abdel aziz assist.professor al-azhar university

Colposcopy Today Prof. Aboubakr Elnashar Benha University Hospital. EGYPT

Introduction to Colposcopy. E.J. Mayeaux, Jr., M.D http://lib-sh.lsumc.edu/fammed/atlases/colpo.html

WHAT’S NEW IN CERVICAL DYSPLASIA – 1996 Thomas J. Zuber, M.D.

WHAT’S NEW IN CERVICAL DYSPLASIA – 2000 Thomas J. Zuber, M.D

Cervical cancer information, precancerous conditions of the cervix, prevention, symptoms, and cervical cancer treatment http://www.medicinenet.com/Cervical_Cancer/article.htm

Cervical ‘Pap’ Smears and Colposcopy http://www.colposcopy.org.uk/

CPAAINDIA recent cancer-related news http://www.cpaaindia.org/infocentre/clipping_cc.htm#3

Screening for Cervical Cancer: Recent Advances http://www.health.state.mn.us/htac/papupdate.htm

Cervical Cancer: Screening and Prevention of Invasive Disease http://www.moffitt.usf.edu/pubs/ccj/v2n6/article3.html

Summary minutes of the microbiology devices panel meeting open session, March 8, 2002, Gaithersburg Holiday Inn, Gaithersburg, MD http://www.fda.gov/ohrms/dockets/ac/02/minutes/3846m2.pdf

Screening for various cancers (from WHO) http://www.who.int/cancer/detection/variouscancer/en/

Organisations

JOURNAL OF LOWER GENITAL TRACT DISEASE http://www.asccp.org/journal.shtml

and http://www.jlgtd.com/

SOGC (The Society of Obstetricians and Gynaecologists of Canada) http://sogc.medical.org/SOGCnet/index.html

British Society of Colposcopy and Cervical Pathology http://www.bsccp.org.uk

EBCOG (European Board and College of Obstetrics and Gynecology) http://www.ebcog.org/

EUROGIN (European Research Organization on Genital Infection and
Neoplasia) http://www.rcog.org.uk/ http://www.eurogin.com

European Association for Cancer Research http://www.eacr.org

European Society of Gynaecological Oncology (ESGO) http://www.who.ch

Federation of European Cancer Societies http:// www.fecs.be

http://www.pmpr.co.uk/clientsg.htm

http://www.digital-pathology.com

National Ovarian Cancer Coalition www.ovarian.org

Gynecologic Cancer Foundation www.wcn.org/gcf/.

The National Cancer Institute( www.nci.nih.gov)

American College of Radiology www.acr.org

AMA – American Medical Association Home Page http://www.ama-assn.org/

ASC Introduction http://www.cytopathology.org/guidelines/guide_cervical_cytology.php

British Society for Colposcopy and Cervical Pathology – Welcome http://www.bsccp.org.uk/

Cancer News http://www.asrt.org/profession_glance/cancer.htm

Journal of Lower Genital Tract Disease http://ipsapp003.lwwonline.com/

Journal of Lower Genital Tract Disease http://www.jlgtd.com/

NUS MEDICAL SOCIETY http://medsoc.org.sg/academic/

NCRI http://www.ncri.org.uk/

For links, pictures & free software database http://www.ifcpc.org/education.html

Diagnosis & Screening

Lifelinger http://www.lifelinger.net/menu/home.htm

Arays Lifelinger page

Diagnosis-Histopathology-Pathogenesis of Cervical Cancer – September 2001 http://acor.org/cnet/709180.html

Computer-Aided Diagnosis Is Improving Early Detection Of Many Cancers http://www.asrt.org/profession_glance/cancer.htm

Identifying Squamous Cancer at Colposcopy by V. Cecil Wright, MD

Cytological sampling and cell morphology as evidences of the major role played by the endocervical epithelium in carcinogenesis of the uterine cervix http://www.cancerprev.org/Journal/Issues/26/101/1010/4298

Evaluation of Human Papillomavirus Testing in Primary Screening for Cervical Abnormalities

Comparison of Sensitivity, Specificity, and Frequency of Referral Shalini L. Kulasingam, PhD; James P. Hughes, PhD; Nancy B. Kiviat, MD; Constance Mao, MD; Noel S. Weiss, MD, DrPH; Jane M. Kuypers, PhD; Laura A. Koutsky, PhD AMA. 2002;288:1749-1757

ACR Appropriateness Criteria™ for the role of imaging in cancer of the cervix. http://www.acr.org/cgi-bin/fr?tmpl:appcrit,pdf:0925-930_cancer_of_the_cervix_ac.pdf

Evaluation of Colposcopically Directed Cervical Biopsies Yielding a Histologic Diagnosis of CIN 1,2 http://www.jlgtd.com/http://www.jlgtd.com/

Qualitative Assessment of Telemedicine Network and Computer-Based Telecolposcopy Daron G. Ferris, MD; Mark S. Litaker, PhD Jill A. Miller, MD Michael S. Macfee, MD; Debra Crawley, MD Diane Watson, MSN

Telemedicine Network Telecolposcopy Compared with Computer-Based Telecolposcopy. DG Ferris, DM Bishai, MS Macfee, M Litaker, ED Dickman, and JA Miller Medical College of Georgia, Augusta, GA

The Correlation Between Colposcopic Diagnosis and Colposcopically Directed Biopsy. YC Collins1 and LS Massad2 1Roswell Park Cancer Institute, Buffalo, NY; and 2Cook County Hospital, Chicago, IL

Colposcopic and Cytologic Findings Among Women with Abnormal Vaginal Flora. Ana V. Georgijevi, MD1; Jadranka R. iovi, MD2; Slobodanka V. Djuki, MD, PhD3; Marina J. Bujko, MD, PhD4

Efficacy of Teleconsultation in Colposcopy. M Roy, Y Ansquer, R Barrasso, L Benedet, J-C Boulanger, D Dargent, D Ferris, M Marien, and I Bairati Hôpital Edouard-Herriot, Pavillon L,

In Vivo Detection of Cervical Intraepithelial Neoplasia Using a Practical Prototype Optical Detection Device DM Harper,1 RD Alvarez,2 WK Huh,2 RM Cestero,3 FA Garcia,4 MA Gold,5 RS Guido,6 K McIntyre-Seltman,6 and L Burke7

Morphology of Cancer Cells http://www.edvotek.com/990.html

An Important Biomarker for Cervical Lesion http://www.albany.edu/chemistry/sarma/cwabstracts_nov99.html

Human Papillomavirus and Cervical Cancer Screening http://www.advancefornp.com/common/editorial/editorial.aspx?CC=7415

ACOG: Endocervical Brush as Effective as Endocervical Curette for Colposcopy Evaluation Following Abnormal Pap Test http://www.pslgroup.com/dg/21544e.htm

HPV Testing vs. Cervical Cytology / ASCUS and above http://www.fda.gov/ohrms/dockets/ac/01/slides/3805S1_03%20Wilkerson/tsld020.htm

Multispectral Digital Imaging Colposcope http://www.utexas.edu/academic/otl/SpecSheets/ImagingColposcope.html

Equipment

http://www.colposcope.com/content/pricing.phtml

http://physicianequipment.com/seilercolposcopy.html

Styles Of Colposcopes http://www.mdsi.org/Rep/Rep_2000_August/Rep_810002595684.htm

Purchasing a Colposcope? http://www.nyscasa.org/projects/sae_safe/forensics.cfm

Sanwe Medical Science and Technology Co.,Ltd http://sanwe.medincn.com/ specialize in researching and producing digital colposcope, b-ultrasound scanner, infrared mammary diagnosis & treatment device, x-ray machine, sperm analyzer and male erectile dysfunction therapeutic and diagnostic products.

Identification of Squamous Intraepithelial Lesions: Fluoresence of Cervical Tissue
During Colposcopy http://www.medispectra.com/detection/burke.html

HOW TO PERFORM THE COLPOSCOPIC EXAMINATION E.J. Mayeaux, Jr., M.D. http://lib-sh.lsumc.edu/

Controversies and Decision Making for Uterine Cervical Disease E.J. Mayeaux, Jr., M.D. http://lib-sh.lsumc.edu/

Colposcopy in Pregnancy E.J. Mayeaux, Jr., M.D. http://lib-sh.lsumc.edu/

Colposcopy of the Vagina and VAIN E.J. Mayeaux, Jr., M.D http://lib-sh.lsumc.edu/.

Vulvar Dysplasia and Colposcopy E.J. Mayeaux, Jr., M.D http://lib-sh.lsumc.edu/

Colposcopy of DES Daughters E.J. Mayeaux, Jr., M.D. http://lib-sh.lsumc.edu/

Optimal Excitation Wavelengths for Discrimination of Cervical Neoplasia Sung K. Chang, Michele Follen, Anais Malpica, Urs Utzinger, Gregg Staerkel, Dennis Cox, E. Neely Atkinson, Calum MacAulay, and Rebecca Richards-Kortum* IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 49, NO. 10, OCTOBER 2002

Detecting Cervical Cancer

Biomedical researchers develop a new optical tool based on the use of flourescence spectoscopy to achieve early detection of cervical cancer http://www.utexas.edu/admin/opa/discovery/disc2000v15n3/disc_biomedical.html

Cervical Cancer Research at UT: Instant, More Accurate Detection through Fiber Optic Technology http://txtell.lib.utexas.edu/stories/c0009-full.html

New Way to Spot Pre-Cancer Cells http://www.wired.com/news/technology/0%2C1282%2C37384%2C00.html

MIT researchers create noninvasive new methods for early cancer diagnosis. Ability to detect invisible, early-stage disease could save lives http://web.mit.edu/newsoffice/nr/2000/cancer.html

Imaging human epithelial properties with polarized lightscattering spectroscopy Rajan S. Gurjar1, Vadim Backman2, Lev T. Perelman1, Irene Georgakoudi1, Kamran Badizadegan3, Irving Itzkan1, Ramachandra R. Dasari1 & Michael S. Feld1 http://www.northwestern.edu/bme/faculty/NatureMedicine_01.pdf

Image analysis for discrimination of cervical neoplasia. Pogue BW, Mycek MA, Harper D.

Computerized colposcopy: results of a pilot study and analysis of its clinical relevance. Cristoforoni PM, Gerbaldo D, Perino A, Piccoli R, Montz FJ, Capitanio GL. Department of Obstetrics and Gynecology, University of Genoa, Italy.

The technical performance and clinical feasibility of telecolposcopy. Harper DM, Moncur MM, Harper WH, Burke GC, Rasmussen CA, Mumford MC. Department of Obstetrics and Gynecology, Dartmouth Medical School, Hanover, New Hampshire, USA.

Digital color imaging colposcopy: a matter of choice. Hopman EH, Rozendaal L, Verheijen RH, Kenemans P, Helmerhorst TJ. Department of Obstetrics and Gynecology, Free University Hospital, Amsterdam, The Netherlands.

Detection of preinvasive cancer cells Early-warning changes in precancerous epithelial cells can now be spotted in situ. http://www.nature.com/cgi-taf/DynaPage.taf?file=/nature/journal/v406/n6791/full/406035a0_r.html

Factors affecting light-scattering properties of cervical cells studied Rice University April 2, 2003 http://www.obgyn.net/newsheadlines/womens_health-Rice_University-20030402-62.asp

Fluorescence Spectroscopy Helps Diagnose Cervical Intraepithelial Neoplasia http://www.cancerpage.com/cancernews/cancernews1057.htm

Oral 5-Aminolevulinic Acid Administration Allows Fluorescence of Cervix http://www.docguide.com/news/content.nsf/news/8525697700573E1885256B960053BF1D

The future of cancer imaging David A. Benaron Stanford University School of Medicine, Palo Alto, CA, USA

Cancer and Metastasis Reviews 21: 45–78, 2002.

Diagnostic Optical Spectroscopy http://www.spie.org/Conferences/Programs/03/ebo/conferences/index.cfm?fuseaction=5141

DISCOVERY v15n3 Detecting Cervical Cancer http://www.utexas.edu/admin/opa/discovery/disc2000v15n3/disc_biomedical.html

http://www.efg2.com/Lab/Library/ImageProcessing/MedicalApplications.htm

efg’s Image Processing Medical Applications Entrez-PubMed http://www.ncbi.nlm.nih.gov/

www.gyncancer.com-pap-test.html

http://www.gyncancer.com/pap-test.html

Laboratory Testing for Cervical Cancer PAP Smear Activities http://www.phppo.cdc.gov/clia/cyto.asp

Treatment

Cervical cancer stages http://www.acor.org/cnet/200103.html#2

Heat, Cold, Lasers, Lights: Throwing the Book at Cancer http://www.cancerpage.com/cancernews/cancernews1013.htm

Radiofrequency Ablation and Chemotherapy Show Promise in Treating Cancer http://www.asrt.org/profession_glance/cancer.htm

very useful medical procedures http://www.medicalprocedures.com/

Management & Guidelines

FINAL Bethesda 2001 Terminology http://bethesda2001.cancer.gov/terminology.html

American Society of Colposcopy and Cervical Pathology (ASCCP) Web site. Journal of the American Medical Association (JAMA)

Bethesda Revised Guidelines on Cervical Cytology Issued http://www.ama-assn.org.

Cervical cancer clasification National Cancer Institute: Concurrent chemoradiation for cervical cancer: February 1999. NCI Cancer Trials Resource Page Available at: http://cancertrials.nci.nih.gov/NCI_CANCER_TRIALS/zones/TrialInfo/News/cervcan/clinann.html

Cost-effectiveness of Alternative Triage Strategies for Atypical Squamous Cells of Undetermined SignificanceJane J. Kim, MS; Thomas C. Wright, MD; Sue J. Goldie, MD,MPH JAMA. 2002;287:2382-2390 http://jama.ama-assn.org/cgi/content/abstract/287/18/2382?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=cervical+AND+cytology+AND+Bethesda+&searchid=1065277668816_1038&stored_search=&FIRSTINDEX=0&journalcode=jama

Improving Compliance with Cervical Cancer Prevention Programs L. Stewart Massad, MD Journal of Lower Genital Tract Disease 2003; 7(2):95-100

CDC Reports First-time Race- and Ethnicity-specific Cervical Cancer Rates http://www.asrt.org/profession_glance/cancer.htm

Colposcopy Position Paper aafp http://www.aafp.org/x6665.xml

FDA Cervical Cancer Global Perspective Nice Slide show at: http://www.fda.gov/ohrms/dockets/ac/01/slides/3805S1_01%20Goldenthal.ppt

Cervical Cancer Global Perspective

http://www.fda.gov/ohrms/dockets/ac/01/slides/3805S1_01%20Goldenthal/tsld003.htm

Medical Devices; Draft Guidance for Industry on the Electro- Optical Sensors for the In Vivo Detection of Cervical Cancer and its Precursors

http://www.fda.gov/OHRMS/DOCKETS/98fr/082599e.txt

Clinical Management / Natural History of Cervical Dysplasia (CIN) and Related Findings http://www.fda.gov/ohrms/dockets/ac/01/slides/3805S1_03%20Wilkerson/

COLPOSCOPIC TERMINOLOGY E.J. Mayeaux, Jr., M.D. http://lib-sh.lsumc.edu/

Extract from OBSTETRICS AND GYNECOLOGY DEVICES ADVISORY PANEL http://www.fda.gov/ohrms/dockets/ac/97/transcpt/3307t2.pdf

Colposcopy and Programme Management Guidelines for the NHS Cervical Screening Programme http://www.cancerscreening.nhs.uk/cervical/publications/nhscsp20.html

Medical http://www.medicinenet.com/Cervical_Cancer/article.htm

Medline Digital imaging colposcopy

A Few Colposcopy books

  • 1 Colposcopy: Principles and Practice: An Integrated Textbook and Atlasby Barbara S. Apgar (Editor), Mark Spitzer (Editor), Gregory L. Brotzman (Editor),Donna D. IgnataviciusPublisher: W B Saunders; 1st edition (February 22, 2002) ISBN: 0721684947
  • 2 Colposcopy-Cervical Pathology: Textbook and Atlasby Erich Burghardt, Hellmuth Pickel, Frank GirardiPublisher: Thieme Medical Pub; 3rd edition (June 1998) ISBN: 0865776342
  • 3 A Manual of Clinical Colposcopyby Thomas M. Julian, Valle (Hardcover)
  • 4 Integrated Colposcopy: For Colposcopists, Histopathologists, and Cytologistsby Malcom Anderson, et al (Hardcover)
  • 5 Handbook of Optical Biomedical DiagnosisEditor: Valery V TuchinPublisher: SPIE Press (2002) ISBN: 0819442380
  • 6 Handbook of Colposcopy – “Handbook of Colposcopy. 2nd Edition.Edited by David M. Luesley , Professor of Gynaecological Oncology, Birmingham Women’sHospital …http://www.arnoldpublishers.com/Scripts/webbook.asp?ISBN=0340806605
  • 7 Atlas of Colposcopy by Per KolstadPublisher: Univ Park Pr; 3rd edition (February 1983) ASIN: 0839117558
  • 8 Colposcopy of the Cervix, Vagina, and Vulva: A Comprehensive Textbookby Michael S. Baggish, Micheal Baggish (Hardcover – August 2003)
  • 9 Atkinson’s Correlative Atlas of Colposcopy, Cytology and Histopathologyby Giuntoli
  • 10 Lower Genital Tract Precancer: Colposcopy, Pathology and Treatmentby Albert Singer, et al (Hardcover)
  • 11 Handbook of Colposcopyby David M. Luesley (Editor), et al (Paperback – July 2002)
  • 12 Minimum datasets for Reporting Common CancersBt Cross, Feery and Angel (1998)
  • 13 Otoscopy: A structured ApproachP J Wormald, G S BrowningPublisher: Arnold (1996) ISBN: 0340613769

For More See http://www.amazon.com/exec/obidos/search-handle-url/index=books&field-keywords=Colposcopy/ref=br_sub_/102-6018372-8796931

British Society of Colposcopy and Cervical Pathology – Resourceshttp://www.bsccp.org.uk

Some Internet References to Various Cancers

Reflectance Spectroscopy for In Vivo Characterization of Ovarian Tissue Urs Utzinger, PhD,1 Molly Brewer, DVM, MD, MS,2,3 Elvio Silva, MD,4 David Gershenson, MD,3, Robert C. Blast, Jr., MD,5 Michele Follen, MD, PhD,3 and Rebecca Richards-Kortum, PhD1

The future of cancer imaging, David A. Benaron

Glottic Cancer, Mary C Snyder, MD http://www.emedicine.com/ent/topic688.htm

Priorities of the Gynecologic Cancer Progress Review Group – November 2001 http://prg.nci.nih.gov/gyno/finalreport.html

Cancer Stomach, Robert J Fingerote, MD http://www.emedicine.com/aaem/topic531.htm

Imaging/Technologies , Welch, Michael & Van Dam, Jacques, Fischman, Alan http://prg.nci.nih.gov/stomach/prgimag.html

Imaging diagnosis for staging of gastric cancer. Kuntz C, Herfarth C. Abstract. Abstract.

Diagnosis and staging of gastric cancer. alvorsen RA Jr, Yee J, McCormick VD. Abstract.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=96242999

Early Gastric Cancer : pretreatment diagnosis. Romeo Giuli MD, http://www.geocities.com/surgoncnet/dag.htm

gastric cancer http://www.oncologychannel.com/gastriccancer/diagnosis.shtml

Staging in gastric cancer: imaging diagnosis.Romeo Giuli MD,. http://www.geocities.com/surgoncnet/staging2.htm

Report of the Stomach/Esophageal Cancers Progress Review Group National Cancer Institute, December 2002, Timothy J. Eberlein, M.D , Brian J. Reid, M.D., Ph.D., Ernest T. Hawk, M.D., MPH, http://prg.nci.nih.gov/stomach/finalreport.html

State of the Science http://prg.nci.nih.gov/stomach/prgsci.html

Recommendations http://prg.nci.nih.gov/stomach/prgrec.html

Gastric , Ajani, Jaffer; Coit, Daniel & Correa, Pelayo, Macdonald, John http://prg.nci.nih.gov/stomach/prggas.html

Disease Sites Adenocarcinomas, Tepper, Joel; Forastiere, Arlene & Blaser, Martin J., Spechler, Stuart http://prg.nci.nih.gov/stomach/prgaden.html

National Institutes of Health Roadmap http://www.nihroadmap.nih.gov

Squamous, Hamilton, Stanley R.; Castell, Donald O. & Orlando, Roy C., Leichman, Lawrence http://prg.nci.nih.gov/stomach/prgsqua.html

Elective Diagnostic Laparoscopy and Cancer Staging, Frederick L. Greene, M.D., F.A.C.S. http://www.sages.org/primarycare/chapter12.html

Cancer Spreads in Tumor Margins http://www.ncrr.nih.gov/newspub/oct02rpt/reports3.asp

Thoracoscopy/Laparoscopy Is Feasible For Esophageal Cancer Staging http://www.cancerpage.com/cancernews/cancernews2747.htm

Diagnosis Histopathology Pathogenesis of Gastric Cancer – May 2001 http://www.acor.org/cnet/705065.html

Staging laparoscopy in gastric cancer. Romeo Giuli MD,. http://www.geocities.com/surgoncnet/staging4.htm

Staging laparoscopy in gastric cancer: updating. Romeo Giuli MD,. http://www.geocities.com/surgoncnet/staging7.htm

MIT Detection of preinvasive cancer cells http://www.nature.com/cgi-taf/DynaPage.taf?file=/nature/journal/v406/n6791/full/406035a0_r.html

Some Internet References to Endometrial Carcinoma Summaries

# Emedicine summary Endometrial Carcinoma, William T Creasman, MD http://www.emedicine.com/med/topic674.htm
# From the American Academy of Family Physicians is Endometrial Cancer Timothy P. Canavan, M.D., and Nipa R. Doshi, M.D. http://www.aafp.org/afp/990600ap/3069.html
# Information modified from that furnished by the National Institutes of Health and the National Cancer Institute of the United States of America. Cancer Of The Uterus (Endometrial Cancer) http://www.medicinenet.com/Uterine_Cancer/page1.htm
# Premalignant Lesions of the Endometrium Susan B Tate, MD, Charles N Landen, MD, http://www.emedicine.com/med/topic3334.htm
# Of Hysteroscopy http://www.medceu.com/tests/hysteroscopy.htm
# Hysteroscopy FAQ, Paul D. Indman, MD, http://www.obgyn.net/displayarticle.asp?page=/hysteroscopy/indman/hsc
# What Are The Diagnostic Procedures For Heavy Menstrual Bleeding?- Hysteroscopy Harvey
Simon, MD, http://www.umm.edu/patiented/articles/what_diagnostic_procedures_heavy_menstrual_bleeding_000080_5.htm
# Hysteroscopy Dr G.D. Reid & Dr H.F. Joycehttp://www.pta.net.au/sgeg/PatInfo/Hysteroscopy.html
# Endometrial Biopsy Thomas J. Zuber, M.D http://www.aafp.org/afp/20010315/1131.html
# From National Cancer Institute Screening for Endometrial Cancer http://www.cancer.gov/cancerinfo/pdq/screening/endometrial/healthprofessional/http://www.cancer.gov/cancer_information/cancer_type/endometrial/
NCI A Snapshot of Endometrial Cancer http://prg.nci.nih.gov/snapshots/Endometrial-Snapshot.pdf
# Gynecologic Procedures http://medicine.nova.edu/online/reproductive_sys/forms/IndependentStudySupplement101.pdf
# Elective Diagnostic Laparoscopy and Cancer Staging Frederick L. Greene, M.D., F.A.C.S.http://www.sages.org/primarycare/chapter12.html
# Diagnostic hysteroscopy G. Benagiano, L. Mencaglia http://www.gfmer.ch/Books/Endoscopy_book/Ch19_hysteroscopy_diagnostic%20.html
#

Some emedicine summaries for other cancers include:

# Cervix – http://www.emedicine.com/radio/topic140.htm
# Colon / Rectum – http://www.emedicine.com/aaem/topic80.htm
# Oesophagus http://www.emedicine.com/aaem/topic530.htm
# Bladder – http://www.emedicine.com/med/topic2344.htm>
# Mouth –
# Stomach http://www.emedicine.com/aaem/topic531.htm
# Uterus (Endometrial Carcinoma )- http://www.emedicine.com/med/topic674.htm
# Pathology: Squamous Cell Carcinoma http://www.emedicine.com/ent/topic671.htm







Aray Limited – Some Colposcopy links

Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.

MEDICHECK

Clinics and Doctors office Urine Screening, Disease Identification and Blood testing.

The ability to carry out a range of tests on one system at a G,P.’s office or medical centre immediately would save millions of pounds in staff time, antibiotic usage, collection and delivery of specimens, laboratory time, repeat calls for patients and Doctors time. Seventy-five percent of all testing is negative and if these results were available to the GP in the surgery no further action would be required and this would add to the savings already noted. Medicheck accomplishes all of this.

The product is suitable for world-wide distribution. It is small enough to be used by a single doctor practice, in a clinic or a small hospital both in the developed and the third-world.
All patents on this product are internationally valid.

PRICING About £10,000 plus one PC.

DESCRIPTION OF MEDICHECK

The heart of the Medicheck system is the patented variable orifice that uses an impedance technique to measure particles. This device has been tested over some ten years in hospitals and proved to be reliable, giving excellent numeric results. It is a non-growth method so is perfectly safe to be used in a primary care situation by any of the in-house staff.

Medicheck is designed for use in medical centres or the G.P.’s office. It has a footprint of 825 sq cm (33cmx25cm) and weighs only 4Kg. It can be connected to a range of PCs with the appropriate specification. The software to operate the system is loaded via a CD and a simple connection from the PC to Medicheck completes the installation.

Disposable plastic circular plates with four compartments as sample wells are used to hold the samples. When used for urine screen the disposable plate is supplied empty as the reagent to carry out the test is provided from the container in the side of the unit. A second range of disposable plates has sealed within it reagents for the identification of specific micro-organisms, such as E coli, or components such as rheumatoid arthritis antigen. A separate disposable plate for standard blood tests takes up all four compartments within one plate.

Medicheck

OPERATION OF MEDICHECK

Medicheck is simple to use and is designed to be operated by a Doctor or Practice Nurse. The liquid sample is loaded into the disposable plastic plate and this is then placed into the plate holder in Medicheck. The cover on the instrument is pulled down and the test started from the computer. Medicheck controls all sample uptake and dilution.

In the case of standard urine screen and identification of bacterial contamination in urine, four different samples can be loaded into the disposable plate. A blood test will use all four wells in the plate to complete one test. All tests are fully automatic and the computer will calculate and tabulate the results.

A second plate can be loaded into Medicheck to carry out further tests directly the first tests are completed. Normal lapsed time for a single test is 1 minute. Results of the tests can be printed out or can be transmitted via the Internet to other data collecting systems for further analysis.

The test diluent and waste are contained in sealed plastic bottles held in a compartment at the side of the instrument. Waste liquid should be disposed of in a manner appropriate to clinical waste.

This is a prototype but we know from previous experience that it would pass for urine screening and blood. Other tests such as identification would need to go through a certification procedure.

SPECIFICATION OF THE MEDICHECK SYSTEM URINE SCREEN

Medicheck reports count for the following particles in urine:

  • Micro organisms
  • White Blood Cells
  • Red Blood Cells
  • Epithelial Cells

Absolute numbers are counted and are then classified for significance. The user can set the threshold values for indicating significance since not all laboratories use the same criteria for determining a ‘positive’ sample.

Results reported in a DOH evaluation of the counting technology was: sensitivity of 93% and negative predictive value of 98%

IDENTIFICATION

Medicheck will identify and report the presence of a particular organism or factor in urine. A diagnostic kit contained within the disposable plastic plate will indicate the presence of E-coli in any liquid sample. Other organisms can also be identified using the appropriate test kits.

Results from a trial for rheumatoid arthritis (R A) in serum where reported as a Sensitivity of 99.7% Specificity of 90.88%

List of some of the Agglutination tests available

  • Rheumatoid Factors (R.A.).
  • Hepatitis B (RPHA)
  • Weil-Felix
  • Cytomegalovirus (CMV)
  • C-Reactive Protein (CRP)
  • E.coli 0157
  • E.coli K1
  • E.coli SP3112
  • ASL
  • Syphilis (SPHA)
  • HIV 1 / 2
  • Rickettsia
  • Candida Mannan

Up to 80 tests for different diseases / Bacteria / viruses are available on latex beads which are applicable to our technology. Any conditions which the G.P. would be interested in can be arranged to work on the system these include respiratory (flu Bronchitis) Women’s problems (Thrush Cystitis etc.). These all come under the title of Identification (Reverse agglutination). There are also 30 tests for the veterinary profession.

BLOOD TESTING

Medicheck will carry out standard blood tests for Red Blood Cells, White Blood Cells and platelets. (A standard 13 Parameter result.) The results generated are equivalent to those produced by a Coulter (TM) counter.

PARTICLE COUNTING

Medicheck will count and size particles. Increase or decrease in particle size is the basis of the diagnostic testing methods outlined above.

Possible additions to the system: HAEMOGLOBIN The inclusion of a detector, which can identify the grey scale, would give the unit the capability to read changes in density.

COMPUTER

A standard PC compatible computer is required with each Medicheck system. The detailed specification of the computer may vary. The computer should include a colour monitor, data backup disks and printer to complete the system .

SOFTWARE

The software to run Medicheck is supplied on a CD and is fully compatible with Windows 98 and above. Written within the software is the capability to organise test structures to cover the various reagents, which are supplied, packed, within the disposable specimen container.

MEDICHECK HARDWARE DIMENSIONS

  • Height 32 cm
  • Width 26 cm
  • Depth 45 cm

All dimensions are maximum

POWER CONSUMPTION

  • 25 VA max.
  • Power input switchable
  • 100 to 240 V AC
  • 50 to 60 Hertz

WEIGHT 4 kg

CAPACITY OF RESERVOIRS

  • Diluent 1 litre
  • Waste 1 litre

ENVIROMENT

  • Maximum ambient temperature for operation +10 to + 350Celsius
  • Maximum humidity for operation 10 to 90% (non-condensing)
ARC Logo

The EVOLUTION and RATIONALE of MEDICHECK

Ten years ago we developed a large automated urine screen system called Questor, which was marketed by Difco Ltd in the U.K. some thirty units were manufactured. The manufacturing and running of the system gave us considerable experience with this type of testing and along with the standards we produce, enabled us to keep some of these units in service up to the present day. At the beginning of that project we acquired a “blue book” certification from the Medical Devices Agency and a short form copy of that document is enclosed. The essence of this system is a variable orifice device, which is a counting and sizing technology based on impedance particle counting. This is a patented device, which is part of our portfolio of patents.

The Questor system solved the urine-screening problem, satisfying the Department of Health Evaluation Unit, Public Health Laboratory to the highest level. This was the only unit (of many which were designed and marketed at that time) which successfully carried out the urine-screen function, and in fact it is still performing satisfactorily in several UK hospitals.

For some time now we have been investigating the way that testing is carried out in the UK hospital microbiology laboratories. The reluctance of these laboratories to move away from their media based procedures. There are a few progressive laboratories who will invest in new ideas but the large majority of the laboratories will not give up their media plate testing for any reason. They seem to be afraid that any method which appears to attack their present technology. This may be an unconscious reaction and irrational but we have heard it many times in lectures and seminars. It may also be that the cost of these systems appears to them to be beyond their budgets at present. This has made it very difficult to introduce any other system in large numbers into the microbiology field. A media based system is very hard to speed up and automate; in fact its very nature is one of an overnight test of more than eight hours.

As you may know the hospital laboratories earn most of their money out of the negative tests, which they consistently carry out, and this can amount to maybe 75% of all the tests they process. This is the area we am aiming at with this new product. The product we are developing at the moment is designed to cover this new market. We have called it MEDI-CHECK and it is a non-growth system based on the techniques used in our previous Questor system. To bring the technology up to date we were able to redevelop the electronics using the modern FPGA techniques and in designing the system for a lower throughput drastically reducing the build costs and size. There is a small four-well disposable, which is in a vacuum form of AB grade plastic. For the urine screen and the blood test the tray is supplied empty but for the whole range of identification the reagents will be supplied in the trays as a pre-packed product.

We contend that this new equipment will revolutionise the near-patient testing field by moving a significant proportion of the negative testing down towards the General Practitioner or medical clinic level. They would not use a growth-based system for safety reasons, but if non-media based system is offered it would appear from our investigations that they would take it on. MEDI-CHECK is a non-growth based system. The incentive is that they could gain income from it, reduce patient call-back and improve patient care simultaneously. These areas are all the initiatives the Government are calling for. The one thing they do not want is a different piece of equipment for each test. In our discussions with the doctors it was suggested that if they were able to ascertain that the test was negative then they could look elsewhere for cause or release the patient at the first visit. If the test shows positive then the patient can be given antibiotics or will be referred to the local hospital.

Some time ago we designed and built a small urine screening system to test this theory and arranged for it to be placed in a local medical centre. It won second prize it its category in a national competition and had an article published about it in a medical publication.

The information, which we were able to gather while working with the centre, was of considerable value in the design of the new equipment. The doctors wanted to know, for instance, whether a urine screen was positive or negative. If it was negative the patient was released immediately and if positive they wanted to know if the organism was e.coli or not. We carried out a study on this problem and discovered that we could indicate the type of organism by using coated beads in the system. If the beads are coated with the appropriate enzyme then the beads will clump and the system picks this up very easily. We have documented evidence of the procedure that we call reverse agglutination. One can of course coat many different enzymes on to beads and this lead us towards a very neat identification solution. The system can be organised for both organisms and virus, in the same unit. The sensitivity is greatly superior to the visual tests used for agglutination at present, i.e. as used in pregnancy testing. It uses about one tenth of the reagents used in visual tests. The instrument can count individual beads and will quickly locate two or more if they clump together. The cycle time for the technology used in both Questor and Medi-check is approximately one minute per sample.

The next area that the doctors were concerned about was an indication of negativity on a blood test. We carried out a blood test similar to the Coulter test used in hospitals and came up with the same results. This proved to us that a blood type test could be accomplished on the same unit. We also investigated a way of testing haemoglobin which could be incorporated into the system, but we were not able to work on it at the time.

The one reservation that the doctors and nurses had was the size of the Questor unit. Space is at a premium in these places. We have since been successful in reducing the size and cost considerably as previously described. The MEDI-CHECK unit is able to carry out Urine Screen, Identification and Blood Testing, which could include haemoglobin.

There is a world-wide market for this type of product. The strategy is that it would move some of the testing from the hospital laboratory down to the medical centres who would be able to charge for it, or because of the low cost of manufacture it could be marketed on a reagent rental basis. If you require further information on the patents we have been granted over the years these are available to you on the Internet in the patent section.

Refer to http://users.aber.ac.uk/dgw/patent.htm ,
http://patents.cos.com/ , http://www.patent.gov.uk/, http://www.european-patent-office.org/

Tel: +44 7903 967 355 Email: arayltd@btinternet.com or john@jhassociates.freeserve.co.uk

Information supplied by Aray and John Holley Associates . Aray
supplies the software for Medicheck.

Copyright 2002. All copyrights and Trademarks acknowledged.
24 November 2002








Medicheck – Clinics and Doctors offices Urine screening, Disease Identification and ; blood Testing


Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.

Aray

Software for Medical Applications

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.
We can

  • Develop a complete medical instrument (in conjunction with our hardware partners).
  • Develop medical software from inception; includes instrumentation, databases, clinical trials, embedded systems, internet systems, etc.
  • Perform Clinical trials and other tests
  • Provide software expertise (including specification, quality assurance and testing) in medical projects.

Aray – Medical Systems Software

Medicheck An instrument for Clinics and Doctors office that performs Urine Screening, Disease Identification and Blood Counting. ARAY developed the software from inception working closely with our hardware partners.
Lifelinger A system for use by colposcopists to assist in the early diagnosis of cervix cancer. ARAY provided software expertise to the European Union Craft project. http://www.lifelinger.net/menu/home.htm
Hearing A prototype Hearing diagnostic software system for audiologists testing hearing with Audiometry, Tympanometry and Otoscopy functions. ARAY provided software expertise to the European Union Craft project. http://open.cineca.it/entunibo/hearing/hearing.htm
Antimicrobial Susceptibility Testing An instrument for use in microbiology laboratories that captures and analyses petri dish images; measures zones sizes and determine the susceptibility of organisms to antibiotics. ARAY developed the instrumentation software from inception working closely with our hardware partners. and developers of the Epidemiology database.
Others We also have experience in developing software for a large automated urine screening system; a clinical chemistry analyser, metal sheet cutting tool, and transient recorders.







Aray – Software for Medical Applications

Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.

Lifelinger London Meeting 2004

Introduction to Lifelinger (Cervical Cancer Imaging) Project

At Trident Business Centre, 89 Bickersteth Road, Tooting, London. SW17 9SH, UK
Tuesday 21st September 2004, 2.00 pm., Free
Cancer and health professionals welcomed.

Organised by Aray . Tel: 07903 967 355 Email: arayltd@btinternet.com web: Home

To help our planning please indicate your intention to attend by emailing arayltd@btinternet.com.

LIFELINGER Objectives

Cervical cancer is the third most common type of cancer in women. The LIFELINGER project’s (http://www.lifelinger.net/menu/home.htm) objectives are the development, testing, validation and exploitation and early-commercialisation of a new cervix cancer early diagnosis system based on the integration of optical imaging, image analysis and statistical analysis.
This meeting introduces the LIFELINGER project and presents an opportunity to meet with many of the LIFELINGER project team.
Intended audience: Health Professionals Gynaecologists, Department of health / politicians, Students, Cancer workers / organisations, Press, Embassies

Draft Lifelinger Project Introduction Programme

Tuesday 21st September 2004 2-5 pm
Trident Business Centre, 89 Bickersteth Road, Tooting, London SW17 9SH, UK
Topic Presenter / Moderator Duration
Welcome Aray / MP? 5 mins
Introduction to Lifelinger ISQ 30 mins
Lifelinger Video Duvideo 15 mins
Lifelinger Clinical Sintef / Dr Daniel 30 mins
Lifelinger Hardware ISQ 15 mins
Lifelinger Software IAITI 45 mins
Discussion Aray 30 mins
Comments and questions are welcomed from the audience throughout as well as contributions during the discussion.

Light Refreshments will be served.

==============================================================

Directions

The Lifelinger meeting is being held at Trident Business Centre, 89 Bickersteth Road, Tooting, London SW17 9SH This is in Wandsworth, South West London, about 6 miles out from the Centre of London.
For further information visit www.tridentcentre.co.uk
For info on the area visit: www.tootinglife.com

TRAVEL DIRECTIONS
BY TUBE – TOOTING BROADWAY STATION: Northern Line (Zone 3)
BY RAIL – TOOTING STATION – THAMESLINK:
(Services to Wimbledon, Blackfriars, Kings Cross & Luton)
BY BUS – ROUTE NUMBERS: 44; 57; 77; 127; 133; 219; 264; 270; 280; 355;

Trident Business Centre Local Map

==============================================================

I Name :……………………………………………………

Organisation:……………………………………………………

Email :……………………………………………………

Intend to attend the Introduction to Lifelinger (Cervical Cancer Imaging) Project meeting 2pm Tuesday 21st September 2004 at Trident Business Centre.
Please keep informed about Lifelinger [ ].
email: arayltd@btinternet.com






Introduction to Lifelinger (Cervical Cancer Imaging) Project – London Meeting 2004

Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.

Lifelinger

A new ICT-based diagnosis procedure and tool set for
early detection of cervix cancer

K. Miller1, V. Marques2, Lifelinger Consortium3
1Director, Aray UK arayltd@btinternet.com;
2Duvideo Cooperativa – Profissionais Imagem Crl , Lisbon, Portugal lifelingeradmin@duvideo.pt;
3 European Project Number.: IST-2001- Craft- 72031 http://www.lifelinger.net/menu/home.htm

Abstract – Cervical cancer is the third most common type of cancer in women. The LIFELINGER project objectives are the development, testing, validation and exploitation and early-commercialisation of a new cervix cancer early diagnosis system based on the integration of optical imaging, image analysis and statistical analysis. This paper introduces the LIFELINGER project.

I. INTRODUCTION

Cervical cancer is the third most common type of cancer in women. Cervical cancer is still a major global health problem with striking geographical variation. In the underdeveloped world, established and advanced stage disease constitutes the bulk of the problem whereas in those more developed countries, particularly those with screening programs, there has been a decline in mortality from invasive disease.

Effective screening for cervical cancer and pre-malignant lesions does requires a test which is easy to apply, inexpensive, with a good cost/benefit ratio, providing little or no discomfort to the women and with a good acceptance; and a high sensitivity and specificity to identify individuals with pre-clinical disease.

II. CERVICAL CANCER SCREENING

The cause of cervical cancer is unknown; however, virtually all cancers of the cervical epithelium arise as a consequence of human papilloma virus (HPV). A number of co-factors have been identified. These include: smokers, multiple sexual partners, early onset of sexual activity (less than 18 years) or early childbearing (less than 16 years), and others sexually transmitted diseases, specifically genital herpes and trachomatis clamydia. Approximately 4-5% of all women age 20 – 65 years will have some form of pre-cancer lesion of the cervix.

The Pap smear has been the main test for a number of years now. However, recently, its sensitivity and specificity have been questioned, with false negative rates of cytology in the 10-30% domain, which is considerably high.

Additionally there are problems related to the lack of training of medical staff reporting cervical smears. At a conference on quality standards in cervical cancer screening in the European Union some serious weaknesses in the standards of training of medical and paramedical personnel was presented [1]. Few countries have nationally organised training programmes or proficiency testing schemes for personnel who undertake the reporting of cervical smears.

In order to optimise screening and prevention and improve efficacy, the Pap test has been combined with other techniques such as cervicography, speculoscopy and colposcopy. Colposcopy is a microscopic observation of the cervix. The cervix epithelium is examined with low and high magnification, first without preparation, and afterwards after acetic acid and Lugol solution application. The visual analysis of colposcopic images is based on recognising variations in colour; mainly to assess the size, location and distribution of the lesion. Biopsies are taken from the worst areasand sent to the Histology laboratory to confirm diagnosis. Colposcopy not only determines if there is cancer, but also where.

But traditional colposcopy still requires experience for a correct interpretation of the atypical cervix patterns and recognition of the areas to biopsy. The colposcopic examination presents two major problems. It requires long-term experience and training to acquire expertise in pattern recognition; and remains extremely subjective (several studies where inter and intra-observer variations have been noted, pointed to less that 50% of lesions are agreed by all observers). The complexity of the disease is paired with the extreme subtleties of the distinctions between pathologic and non-pathologic lesion patterns leading to variations in the diagnosis between physicians and even for the same physician during his/hers examinations. The interpretation of the results of direct observation is dependent on very small, subtle and subjective differences in coloration, brightness, tissue pattern etc. that depend on the physician’s perception, background, experience and so on. The colposcopic diagnosis has a higher sensitivity (95%), but has lower specificity (45%), with positive predictive value about 82% and negative predictive value of 79%.

As such, the screening and early diagnosis of pre-malignant lesions of the cervix is a major problem of the primary health care. Improvement on the examination itself has been achieved by providing doctors with additional test, such as illuminating the cervix using filtered light and by colouring it with chemical solutions that improve colour and brightness reflection differentiation on the tissues but further scientific and technical developments are urgently needed.

III. PROJECT LIFELINGER

The LIFELINGER project is an EU project being undertaken by a consortium of companies from several EU Countries. Its objectives include the development, testing, validation and exploitation and early-commercialisation of a new cervix cancer early diagnosis system; based on the integration of optical imaging, image analysis and statistical analysis.

Some of the project’s results will include:

  • An interrelated set of software tools, to be installed on a PC-Based workstation or powerful laptop computer. Additional hardware includes a CCD based camera, a light emitting device covering a wide and non-biased frequency spectrum, a fixing arm for the camera/light;
  • The workstations will be networked through the Internet; thus creating a global environment that will process an increasing number of cases.
  • A centrally managed database system to collect data from the networked workstations and distribute the updated database to the users of the product;
  • An extendible software system that will provide users with the ability to add functionality over the time.

The PC based workstation will act as an add-on to the standard doctors equipment (colposcope) and will support the physician during the examination, identifying potential disease by ranking its likeliness against a set of predetermined parameters.

Lifelinger Processing

FIGURE I: LIFELINGER PROCESSING

The LIFELINGER project aims at improving the diagnosis by:

  • The use of advances in state of the art IT technology.
  • Implementing data fusion concepts, integrating a set of complementary image and data processing mechanisms.
  • Deploying IT based image enhancing processes; reducing the needs of chemical based human tissue contrasting substances.
  • Creating and maintaining a large database of cases that enables trend identification by using data mining processes.
  • Deploying the expertise and specific clinical know-how of the medical specialists to the general practitioner. Consequently a much larger population will benefit, namely in areas where expert know-how is scarce.

The LIFELINGER results are expected to provide the practitioner that is performing the examination, with a tool that not only helps to better distinguish the lesion patterns and their image properties such as shapes, contrast, tone, brilliance; but also makes available, during the examination, the best available specialist know-how. Thereby improving the quality of the examination and lowering the number of incorrect pathology diagnoses.

The main Lifelinger outputs will be:

  • The doctors workstation;
  • The database of cases;
  • The Knowledge Base subsystem;
  • The image analysis subsystem;
  • The data fusion subsystem;
  • Overall methodology for the introduction of the ICT supported examination; and;
  • Guidelines and support materials for training on the new systems.

IV. CONCLUSION

LIFELINGER is a computerised imaging aid for clinical diagnosis of cervical cancer. It is used as an aid to colposcopic examination; whose primary goal is to ensure that invasive disease is not missed. The purpose of a thorough and systematic colposcopic assessment is to assist the colposcopist in selecting the most abnormal lesions to biopsy and to rule out the presence of invasive cancer.

LIFELINGER’s benefits include:

  • An innovative system that improves diagnostic accuracy and reliability.
  • A record of personal details, diagnosis and treatment that correlates a wide variety of elements.
  • Low production costs, since the LIFELINGER System exploits and adopts commercially available technologies.

The ideal LIFELINGER system will take one (or more) picture of the cervix, locate, characterise, grade and highlight on the display lesions and abnormal tissue, and indicate where to biopsy; within one minute; with sensitivity and specificity greater than 90% when compared to histology. This may be possible given powerful enough computers, and clever image processing algorithms. We are not there yet; but with its user extensibility feature perhaps you; networking with others; will be able to improve its performance.

References

[1] ECTPCCS Conference on Quality Assurance in Cervical Cancer Screening, 1993.

[3] C.J. James and D. Lowe, “Using dynamical embedding to isolate seizure components in the ICTAL EEG”, IEE Proceedings: Science, Measurement and Technology, vol.147(6), 2000, pp. 315-320.

For more information see: http://www.lifelinger.net/menu/home.htm

Lifelinger Related presentations
1 Lifelinger Introduction
2 European Federation for Colposcopy French Society for Colposcopy and Cervical Pathology 3rd European Congress for Colposcopy and Cervical Pathology Paris, January 23-24, 2004
2 European Union Cancer Prevalence
4 Introduction to Lifelinger (Cervical Cancer Imaging) Project – London Meeting 2004
5 5 Some Colposcopy Links






LIFELINGER – A new ICT-based diagnosis procedure and tool set for early detection of cervix cancer

Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.

HEARING

Development of a syntHEsis set for AudiometRIc statioNs and self diaGnosis

CRAFT RESEARCH PROJECT N° IST- 2001 -52125

http://open.cineca.it/entunibo/hearing/hearing.htm

Aray is seeking appropriate local partners for targeted marketing, assembly, testing, distribution and support and commercialization of the hearing system in:

* United Kingdom

* Caribbean countries:

Bahamas, Barbados, Belize, Grenada, Guyana, Jamaica, Saint Lucia, Trinidad and Tobago

* African Countries:

Botswana, Ghana, Kenya, Lesotho, Liberia, Mauritius, Nigeria, Sierra Leone, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe, Benin, Burundi, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of Congo, Cote D’Ivore, Equatorial Guinea, Gabon, Guinea, Madagascar, Malawi, Mali, Namibia, Niger,Rwanda, Senegal, Seychelles, Togo, Uganda, Zambia, Zimbabwe

Hearing Prototype System

A prototype Hearing diagnostic software system with Audiometry, Tympanometry and Otoscopy functions. Includes a patient and clinician demographics, capture, analysis, management and display of data. Based on Windows 98/2000 and Access 98/2000 based software.
The Hearing software system enables the audiologist to:

  • Enter and maintain clinician / audiologist demographics data.
  • Enter, maintain and report on patient demographics, clinical and diagnosis data.
  • Perform audio logical consultations for automated Audiometry, manual Audiometry, speech Audiometry and Tympanometry and Otoscopy. Controlling settings, capturing data, performing some diagnosis and displaying results (including appropriate graphs).
  • For Otoscopy perform a direct observation of the ear cavity by means of a micro camera in order to identify morphologic anomalies or causes of hearing pathologies. Controlling settings, capturing and displaying images.
  • Create an archive of the case history of patients; loading and displaying the results of consultations.

The multi-function HEARING system has good market potential in the general purpose
screening and clinical diagnostics market segments. The system is easy to use and
competitively priced, for successful market penetration in the low-end market sectors.
For more information see: http://open.cineca.it/entunibo/hearing/hearing.htm






HEARING – Development of a syntHEsis set for AudiometRIc<br /><br /><br /><br /><br /><br /><br /><br /><br /> statioNs and self diaGnosis

Category: Medical

Aray has extensive experience in developing software for medical applications; such as urine screening, disease identification, blood counting, cervix cancer, hearing, Audiometry, Tympanometry, Otoscopy, antimicrobial susceptibility and clinical chemistry.

European Union Cancer Prevalence

Cancer Cases Crude ASR (E) ASR (W) Deaths Crude ASR (E) ASR (W)
All sites but skin

1,580,096

421.57

338.83

238.85

929,992

248.12

186.54

123.93

Bladder *

73,132

19.51

14.7

9.78

29,773

7.94

5.44

3.35

Brain, nervous System

28,866

7.7

6.91

5.66

21,681

5.78

4.97

3.77

Breast

210,631

56.2

48.84

35.38

73,592

19.63

15.57

10.61

Cervix Uteri *

22,618

11.8

10.3

8.08

10,098

5.27

3.97

2.83

Colon / Rectum *

217,526

58.04

44.04

29.36

111,781

29.82

21.38

13.63

Corpus Uteri (Uterus) *

37,411

19.51

15.35

10.87

8,998

4.69

2.94

1.89

Hodgkin’s disease

8,407

2.24

2.13

2.01

2,251

0.6

0.49

0.36

Kidney etc

46,228

12.33

10.1

7.21

22,418

5.98

4.54

3.03

Larynx

23,304

6.22

5.45

3.92

10,326

2.75

2.28

1.59

Leukaemia

43,518

11.61

9.55

7.52

29,714

7.93

5.97

4.2

Liver

31,057

8.29

6.41

4.37

34,132

9.11

6.81

4.51

Lung

196,836

52.52

42.16

29.12

183,653

49

38.27

25.96

Melanoma of Skin

38,213

10.2

8.89

6.81

9,010

2.4

1.94

1.37

Multiple Myeloma

21,426

5.72

4.36

2.92

15,259

4.07

2.93

1.88

Non-Hodgkin lymphoma

52,440

13.99

11.5

8.46

25,906

6.91

5.24

3.55

Oesophagus *

24,812

6.62

5.38

3.71

22,917

6.11

4.85

3.29

Oral Cavity and pharynx (mouth) *

53,556

14.29

12.71

9.28

20,178

5.38

4.64

3.31

Ovary etc

34,468

9.2

7.74

5.6

22,999

6.14

4.78

3.23

Pancreas

41,340

11.03

8.35

5.53

45,599

12.17

9.02

5.88

Prostate

144,504

38.55

27.77

17.97

56,035

14.95

9.73

5.72

Stomach *

70,798

18.89

14.13

9.35

54,919

14.65

10.58

6.81

Testis

8,810

2.35

2.25

2.13

641

0.17

0.15

0.13

Thyroid

16,311

4.35

3.99

3.22

3,245

0.87

0.63

0.41

* Lifelinger
Technology is most applicable

Table 1 EUCAN Cancer incidence, mortality and prevalence in the European Union 1998 – All ages -Both Sexes

From < http://www-dep.iarc.fr/eucan/eucan.htm

For more cancer statistics (e.g. mortality) see
http://www-dep.iarc.fr/dataava/infodata.htm


How to interpret cancer data

Population at risk

The part of a population which is susceptible to have a specific cancer. It is defined on the basis of demographic data, such as place of residence, sex, age group, etc.

Incidence

The incidence is the number of new cancer cases arising in a given period in a specified population. This information is collected routinely by cancer registries.

Mortality

The mortality is the number of cancer deaths occurring in a given period in a specified population.

Prevalence

The prevalence of cancer is the number of cancer cases in a given population at a specified point in time. It depends on the incidence and on the duration of the disease, that is, on survival.

Crude Rate

Data on incidence or mortality are often presented as rates. For a specific tumour and population, a crude rate is calculated simply by dividing the number of new cancers or cancer deaths observed during a given time period by the corresponding number of people in the population at risk. For cancer, the result is usually expressed as an annual rate per 100,000 persons at risk.

Age-standardized rate

An age-standardized rate (ASR) is a summary measure of a rate that a population would have if it had a standard age structure. Standardization is necessary when comparing several populations that differ with respect to age because age has such a powerful influence on the risk of cancer. The most frequently used standard population are the World and the European standard populations. The calculated incidence or mortality rate is then called World Standardized incidence or mortality rate. It is also expressed per 100,000.

Cumulative rate

Cumulative incidence is the probability or risk of individuals getting the disease during a specified period. For cancer, it is expressed as the number of new born children (out of 100, or 1000) who would be expected to develop a particular cancer before the age of 65 (or 70, or 75) if they had the rates of cancer currently observed. Like the age standardized rate, it permits comparisons between populations of different age structures.



European Union Cancer Prevalence

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