Fieldset
Innovation: A Smarter View on Photomicrography

Imagine being a doctor with MSF / Doctors without Borders. You are working in basic hospital in a remote location. A patient arrives with a dangerously high fever. Over the next few days you try all the most likely treatment options, but nothing seems to work. Their lab tests show results that no one at the hospital has seen before. What do you do? Kate Hughes blogs from MSF’s innovation team…

 
My name is Kate and I’m a volunteer with the Innovation Team in the Manson Unit of MSF UK, which works to manage and facilitate the field- focused innovation ideas proposed by MSF staff.
 
Image shows a smiling man in a lab coat with two large microscopes
The laboratory of the MSF hospital in Mweso in the DRC. Photo: Gwenn Dubourthoumieu
 

MSF works in conflict zones, natural disasters, and areas where health care simply isn’t available. These low-resource settings mean staff in our projects come up against all sorts of barriers. The ideas developed within the innovation team can lead to solutions that help to tackle some of these and so improve the service we can give our patients, who often rely on MSF as their only source of health care.

One pioneering idea, proposed by Dr. Jaap Karsten, a paediatric adviser with MSF, is to use smartphones, tools that are readily available in otherwise low resource settings, and to improve the practice of photomicrography in field locations.
 

What is photomicrography?

In hospitals and labs all over the world, microscopes are used to get a closer look at bacteria, viruses, parasites and cells that are invisible to the naked eye. This close-up perspective allows trained staff to diagnose diseases and assess the health of different organs in the body.
 
Image shows a photomicrograph with cells on it.
Photomicography of plague bacteria © ISOPIX
 
Photomicrographs are photos of specimen slides, such as blood sample slides, that are taken with the aid of a microscope and are essential for providing information on patient cases.
 
By uploading photomicrographs to an online ‘telemedicine’ platform, MSF clinical staff working in remote locations can share them with consultants in other parts of the world. The consultants can analyse the photomicrographs and make an expert, remote diagnosis. This means the absence of medical staff with a particular specialisation in field locations is not a barrier to the best possible care for patients.
 
 
Image shows a man in a bright printed shirt, looking intently into a microscope
Head laboratory technician Joseph Ngasain at the Niangara hospital lab in DRC. Photo: Robin Meldrum/MSF
 
 

The shaky hand problem

However, in order for this kind of telemedicine to work effectively, it is vital that the uploaded images are of the highest possible quality to ensure accurate analysis.
 
The specially designed cameras mounted to microscopes used in high-resource clinical settings are not readily available in MSF field projects.
 
In the field, images are usually produced by taking a picture with a smartphone camera, held against the eyepiece of the microscope. But this method depends very much on the steadiness, endurance and attention to detail of the person taking the picture, and can often mean that the quality of the photo is too low to allow for a precise assessment by an external expert.
 

The right tool for the job…

 
Image shows three white plastic devices, which look like a car cup holder, a mobile phone case , and a strange vice type gadget

iDU on top, left: Bresser, right: Syvu. Photo: MSF.

In order to overcome this challenge, Dr. Karsten and his team trialed various adaptors already on the market that allow a smartphone to be connected directly to a microscope. With the right equipment, the possibilities for improved patient care really are endless - such adaptors are not only useful for photomicrography but also for also for other types of remote diagnosis, such as ECG analysis, which can be used to identify heart problems.
 
With three adaptors to test, the pressure was on to find the one that would best meet the requirements of MSF field teams: it had to give great results in terms of picture quality, be easy to set up, compatible with existing MSF equipment and be relatively inexpensive.
 
The three adaptors tested were the Bresser, the Syvu and the iDU. The testing team consisted of medical and laboratory experts and through rigorous trails, each adaptor was tested and assessed.

 

The results are in…

The Bresser and Syvu, whilst universal and able to work with any phone, were complicated to set up and not very stable. The Bresser was made more stable with some modifications, and so the better of the two options.
 
Image shows a photomicrograph taken with and without the iDu device. The one with the device is much clearer.

The iDu in action. 

However, the iDU had a completely different design and actually replaced the eyepiece of the microscope. Although it was only compatible with iPhones, its easy set up, stability and fantastic image quality, as well as the option for live streaming of images, meant that it gave the best quality results
 
The iDU was the more expensive model at around €219, compared to the Bresser (€ 35) and the Syvu (€70) but the results that it produced made this the clear winner in this round of testing for Dr. Karsten’s team.
 
Innovation in this area continues to be made – since the end of this study, a new adaptor has become available, one that is cheaper and designed for use on any type of smartphone. The team has also contacted the producer of the iDU adapter on how best to make their product work for different phones. Dr Karsten’s team will continue their search for the best product in order to give patients the best possible outcomes. The most effective adaptor will soon become part of the essential kit for MSF field sites…