Evaluation of photography using head-mounted display technology (ICAPS) for district Trachoma surveys

<h4>Background</h4> As the prevalence of trachoma declines worldwide, it is becoming increasingly expensive and challenging to standardize graders in the field for surveys to document elimination. Photography of the tarsal conjunctiva and remote interpretation may help alleviate these ch...

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Autores principales:	Fahd Naufal, Christopher J. Brady, Meraf A. Wolle, Michael Saheb Kashaf, Harran Mkocha, Christopher Bradley, George Kabona, Jeremiah Ngondi, Robert W. Massof, Sheila K. West
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/bcf08409ec634917b954d9ebdd78e66c
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spelling	oai:doaj.org-article:bcf08409ec634917b954d9ebdd78e66c2021-11-25T06:33:05ZEvaluation of photography using head-mounted display technology (ICAPS) for district Trachoma surveys1935-27271935-2735https://doaj.org/article/bcf08409ec634917b954d9ebdd78e66c2021-11-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601615/?tool=EBIhttps://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4> As the prevalence of trachoma declines worldwide, it is becoming increasingly expensive and challenging to standardize graders in the field for surveys to document elimination. Photography of the tarsal conjunctiva and remote interpretation may help alleviate these challenges. The purpose of this study was to develop, and field test an Image Capture and Processing System (ICAPS) to acquire hands-free images of the tarsal conjunctiva for upload to a virtual reading center for remote grading. <h4>Methodology/Principal findings</h4> This observational study was conducted during a district-level prevalence survey for trachomatous inflammation—follicular (TF) in Chamwino, Tanzania. The ICAPS was developed using a Samsung Galaxy S8 smartphone, a Samsung Gear VR headset, a foot pedal trigger and customized software allowing for hands-free photography. After a one-day training course, three trachoma graders used the ICAPS to collect images from 1305 children ages 1–9 years, which were expert-graded remotely for comparison with field grades. In our experience, the ICAPS was successful at scanning and assigning barcodes to images, focusing on the everted eyelid with adequate examiner hand visualization, and capturing images with sufficient detail to grade TF. The percentage of children with TF by photos and by field grade was 5%. Agreement between grading of the images compared to the field grades at the child level was kappa = 0.53 (95%CI = 0.40–0.66). There were ungradable images for at least one eye in 199 children (9.1%), with more occurring in children ages 1–3 (18.5%) than older children ages 4–9 (4.2%) (χ2 = 145.3, p<0.001). <h4>Conclusions/Significance</h4> The prototype ICAPS device was robust, able to image 1305 children in a district level survey and transmit images from rural Tanzania to an online grading platform. More work is needed to improve the percentage of ungradable images and to better understand the causes of disagreement between field and photo grading. Author summary Trachoma is the leading infectious cause of blindness worldwide, caused by the bacterium Chlamydia trachomatis. Programs targeting trachoma elimination in endemic regions largely rely on periodic prevalence surveys to monitor progress, but training field graders requires active cases, which is becoming challenging as prevalence declines. Photography of the tarsal conjunctiva with remote interpretation via telemedicine may serve as a more auditable, effective, and cost-efficient method for surveys. We developed and evaluated the Image Capture and Processing System (ICAPS), a smartphone-based, hands-free, head-mounted camera system (Samsung Galaxy S8 with custom app, Samsung Gear VR headset, and a Bluetooth-linked foot pedal trigger). The ICAPS was easy to use in challenging field conditions, was able to upload images from Tanzania and link images to field data. The percentage of TF was 5% by both field grade and photo grade, with agreement kappa = 0.53. Additional field training and enhanced certification of photographers may help reduce the proportion of ungradable images; further research on reasons for mismatch of grades between field and photo is needed.Fahd NaufalChristopher J. BradyMeraf A. WolleMichael Saheb KashafHarran MkochaChristopher BradleyGeorge KabonaJeremiah NgondiRobert W. MassofSheila K. WestPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Fahd Naufal Christopher J. Brady Meraf A. Wolle Michael Saheb Kashaf Harran Mkocha Christopher Bradley George Kabona Jeremiah Ngondi Robert W. Massof Sheila K. West Evaluation of photography using head-mounted display technology (ICAPS) for district Trachoma surveys
description	<h4>Background</h4> As the prevalence of trachoma declines worldwide, it is becoming increasingly expensive and challenging to standardize graders in the field for surveys to document elimination. Photography of the tarsal conjunctiva and remote interpretation may help alleviate these challenges. The purpose of this study was to develop, and field test an Image Capture and Processing System (ICAPS) to acquire hands-free images of the tarsal conjunctiva for upload to a virtual reading center for remote grading. <h4>Methodology/Principal findings</h4> This observational study was conducted during a district-level prevalence survey for trachomatous inflammation—follicular (TF) in Chamwino, Tanzania. The ICAPS was developed using a Samsung Galaxy S8 smartphone, a Samsung Gear VR headset, a foot pedal trigger and customized software allowing for hands-free photography. After a one-day training course, three trachoma graders used the ICAPS to collect images from 1305 children ages 1–9 years, which were expert-graded remotely for comparison with field grades. In our experience, the ICAPS was successful at scanning and assigning barcodes to images, focusing on the everted eyelid with adequate examiner hand visualization, and capturing images with sufficient detail to grade TF. The percentage of children with TF by photos and by field grade was 5%. Agreement between grading of the images compared to the field grades at the child level was kappa = 0.53 (95%CI = 0.40–0.66). There were ungradable images for at least one eye in 199 children (9.1%), with more occurring in children ages 1–3 (18.5%) than older children ages 4–9 (4.2%) (χ2 = 145.3, p<0.001). <h4>Conclusions/Significance</h4> The prototype ICAPS device was robust, able to image 1305 children in a district level survey and transmit images from rural Tanzania to an online grading platform. More work is needed to improve the percentage of ungradable images and to better understand the causes of disagreement between field and photo grading. Author summary Trachoma is the leading infectious cause of blindness worldwide, caused by the bacterium Chlamydia trachomatis. Programs targeting trachoma elimination in endemic regions largely rely on periodic prevalence surveys to monitor progress, but training field graders requires active cases, which is becoming challenging as prevalence declines. Photography of the tarsal conjunctiva with remote interpretation via telemedicine may serve as a more auditable, effective, and cost-efficient method for surveys. We developed and evaluated the Image Capture and Processing System (ICAPS), a smartphone-based, hands-free, head-mounted camera system (Samsung Galaxy S8 with custom app, Samsung Gear VR headset, and a Bluetooth-linked foot pedal trigger). The ICAPS was easy to use in challenging field conditions, was able to upload images from Tanzania and link images to field data. The percentage of TF was 5% by both field grade and photo grade, with agreement kappa = 0.53. Additional field training and enhanced certification of photographers may help reduce the proportion of ungradable images; further research on reasons for mismatch of grades between field and photo is needed.
format	article
author	Fahd Naufal Christopher J. Brady Meraf A. Wolle Michael Saheb Kashaf Harran Mkocha Christopher Bradley George Kabona Jeremiah Ngondi Robert W. Massof Sheila K. West
author_facet	Fahd Naufal Christopher J. Brady Meraf A. Wolle Michael Saheb Kashaf Harran Mkocha Christopher Bradley George Kabona Jeremiah Ngondi Robert W. Massof Sheila K. West
author_sort	Fahd Naufal
title	Evaluation of photography using head-mounted display technology (ICAPS) for district Trachoma surveys
title_short	Evaluation of photography using head-mounted display technology (ICAPS) for district Trachoma surveys
title_full	Evaluation of photography using head-mounted display technology (ICAPS) for district Trachoma surveys
title_fullStr	Evaluation of photography using head-mounted display technology (ICAPS) for district Trachoma surveys
title_full_unstemmed	Evaluation of photography using head-mounted display technology (ICAPS) for district Trachoma surveys
title_sort	evaluation of photography using head-mounted display technology (icaps) for district trachoma surveys
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/bcf08409ec634917b954d9ebdd78e66c
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Evaluation of photography using head-mounted display technology (ICAPS) for district Trachoma surveys

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