BiliCam: Using Mobile Phones to Monitor Newborn Jaundice
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1 BiliCam: Using Mobile Phones to Monitor Newborn Jaundice Lilian de Greef, Mayank Goel, Min Joon Seo, Eric C. Larson, James W. Stout MD MPH, James A. Taylor MD, Shwetak N. Patel
2 What is BiliCam? A smartphone-based system to assess newborn jaundice.
3 Overview 100 newborn clinical study Performs similarly to an FDA approved device $7000
4 What is BiliCam? A smartphone-based system to assess newborn jaundice.
5 What is BiliCam? A smartphone-based system to assess newborn jaundice
6
7 Jaundice yellowish skin from excess bilirubin peaks in 3-5 days 84% of all newborns extreme levels devastating
8 worry
9
10
11 1 in 14 undergo phototherapy
12
13 Screening Method?
14
15 Total Serum Bilirubin
16 TSB Medical Gold Standard
17
18 Transcutaneous Bilirubinometer
19 TcB
20 TcB
21 TcB $7000 Non-invasive Quick results Correlates Screening tool for TSB
22 Bilirubin (mg/dl) Newborn Bilirubin Levels th percentile 25th percentile In Hospital Age (days)
23 Screening Challenges In Hospital At Home Visual Assessment Parents Many physicians Traveling practitioners Tend to underestimate
24 BiliCam cost portability accessibility
25 Using BiliCam
26 Using BiliCam
27 Using BiliCam
28 Study Design Informed by 6 months of formative work interviews focus groups contextual inquiry pilot study (40 newborns)
29 Study Design 100 newborn participants <1 day old when enrolled 59% white 2 medical centers Data collected by medical professionals using iphone 4S
30 Data Collected (for each participant) Photos: with & without flash TSB (ground truth) TcB (control)
31 Data Collected (for each participant) 3-5 days old Photos: with & without flash TSB (ground truth) TcB (control)
32 Data Collected (for each participant) < 1 day old 3-5 days old Photos: with & without flash Photos: with & without flash TSB (ground truth) TcB (control)
33 Data Collected (for each participant) Baseline < 1 day old Photos: with & without flash Follow-Up 3-5 days old Photos: with & without flash TSB (ground truth) TcB (control)
34 Data Collection App Standardize white balance card position phone position
35 Noisy Data
36 Automatic Quality Control Ideal Glare Overexposed Occlusion Shadow Underexposed
37 Algorithm Overview Color Balance Extract Features Apply Regressions Bilirubin Estimate
38 Algorithm Overview Color Balance Extract Features Apply Regressions Bilirubin Estimate
39 Color Balance Different lighting conditions
40 Color Balance
41 Algorithm Overview Color Balance Extract Features Apply Regressions Bilirubin Estimate
42 Bilirubin Absorption Properties Relative Bilirubin Absorption Probability Wavelength (nm)
43 Feature Extraction skin with & without flash Cr b* Y Cb L* a* RGB YCbCr L*a*b*
44 Feature Extraction skin Gradient (of RGB channels) with & without flash Cr b* Y Cb L* a* RGB YCbCr L*a*b*
45 Feature Extraction Cr b* Y Cb L* a* Gradient (of RGB channels) RGB YCbCr L*a*b* with flash without flash total: 21 features
46 Processing Features scaled - unit variance - zero mean PCA - 6 component features - to reduce redundancy use both scaled & PCA
47 Algorithm Overview Color Balance Extract Features Apply Regressions Bilirubin Estimate
48 Regression Ensemble Regression Regression Regression Combine Regression Regression Bilirubin Estimate
49 Regression Ensemble Least Angle Regressions LARS-Lasso Elastic Net Combine Bilirubin Estimate
50 Regression Ensemble Least Angle Regressions LARS-Lasso Elastic Net Support Vector Regressions Combine Bilirubin Estimate
51 Regression Ensemble Least Angle Regressions LARS-Lasso Elastic Net Support Vector Regressions Combine k-nearest Neighbor Random Forest Regression Bilirubin Estimate
52 Regression Ensemble Least Angle Regressions LARS-Lasso Elastic Net Support Vector Regressions k-nearest Neighbor regressions agree Yes mean Random Forest Regression Bilirubin Estimate
53 Regression Ensemble Least Angle Regressions Leave-One-Out Cross Validation LARS-Lasso Elastic Net Support Vector Regressions k-nearest Neighbor Random Forest Regression regressions agree Yes mean No 90th percentile Bilirubin Estimate
54 Results Estimated Bilirubin (mg/dl) TSB Ground Truth (mg/dl)
55 Results Estimated Bilirubin (mg/dl) TSB Ground Truth (mg/dl)
56 Results Estimated Bilirubin (mg/dl) BiliCam rank order 0.85 correlation Flash & no flash images Baselines made no difference TSB Ground Truth (mg/dl)
57 Results Estimated Bilirubin (mg/dl) BiliCam rank order 0.85 correlation TcB rank order 0.92 correlation TcBs correlate TSB Ground Truth (mg/dl)
58 Bilirubin (mg/dl) Interpretation high risk high intermediate risk low intermediate risk low risk Age (days)
59 Bilirubin (mg/dl) Bhutani Nomogram high risk high intermediate risk low intermediate risk low risk Age (days)
60 Bilirubin (mg/dl) Interpretation high risk high intermediate risk low intermediate risk low risk 9 high risk cases based on TSB Age (days)
61 Bilirubin (mg/dl) Interpretation high risk high intermediate risk low intermediate risk low risk BiliCam 2/9 missed high risk (22%) 85% blood draws avoided Age (days)
62 Bilirubin (mg/dl) Interpretation high risk high intermediate risk low intermediate risk low risk BiliCam 2/9 missed high risk (22%) 85% blood draws avoided Age (days) TcB 2/8 missed high risk (25%) 88% blood draws avoided
63 Limitations & Future Work Narrow demographic 100 newborns More studies worldwide in Seattle 59% white limited data with dark skin
64 Limitations & Future Work iphone 4S only Investigate other phones
65 Limitations & Future Work Good skin segmentation unclear with current card design
66 Limitations & Future Work New card design
67 BiliCam: Using Mobile Phones to Monitor Newborn Jaundice Lilian de Greef Lilian de Greef, Mayank Goel, Min Joon Seo, Eric C. Larson, James W. Stout MD MPH, James A. Taylor MD, Shwetak N. Patel
68
69 BiliCam
70 Conclusion Can be effective in-home screening tool Estimates bilirubin comparably to TcB Accessible, portable, low-cost
71 Kernicterus Statistics In the US Kernicterus:+ 21+($8+mill)+ Hazardous+ jaundice: ($50,000)+ Extreme+jaundice:++ 2,317+($20,000)+ Severe+jaundice:+35,000+ ($8,500)+ Middle- & low-income countries: 75,000 cases kernicterus/year 114,000 newborn deaths/year 65% newborn deaths Phototherapy:+290,000++($1,000)+ from kernicterus Visible+jaundice:+3.5+million+ Births/year:+4.1+million+
72 Study Demographics Number of Participants Reported Ethnicity White Asian African American / Black Latino American Indian / Alaska Native Pacific Islander / Native Hawaiian Other
73 Image Segments Forehead Sternum Card Patches
74 Icterometer
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