03234nas a2200289   4500000000100000008004100001653001200042653003700054653003000091100001100121700001500132700002000147700001400167700002500181700001800206700002200224700002100246700001800267700001600285700001400301245018100315856009900496300001300595490000700608520231500615022001402930       2019                            d10aMhealth10aSoil-transmitted helminths (STH)10aPoint-of-care diagnostics1 aYang A1 aBakhtari N1 aLangdon-Embry L1 aRedwood E1 aGrandjean-Lapierre S1 aRakotomanga P1 aRafalimanantsoa A1 aDe Dios Santos J1 aVigan-Womas I1 aKnoblauch A1 aMarcos LA00aKankanet: An artificial neural network-based object detection smartphone application and mobile microscope as a point-of-care diagnostic aid for soil-transmitted helminthiases.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0007577&type=printable  ae00075770 v133 a<p><strong>BACKGROUND: </strong>Endemic areas for soil-transmitted helminthiases often lack the tools and trained personnel necessary for point-of-care diagnosis. This study pilots the use of smartphone microscopy and an artificial neural network-based object detection application named Kankanet to address those two needs.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>A smartphone was equipped with a USB Video Class (UVC) microscope attachment and Kankanet, which was trained to recognize eggs of Ascaris lumbricoides, Trichuris trichiura, and hookworm using a dataset of 2,078 images. It was evaluated for interpretive accuracy based on 185 new images. Fecal samples were processed using Kato-Katz (KK), spontaneous sedimentation technique in tube (SSTT), and Merthiolate-Iodine-Formaldehyde (MIF) techniques. UVC imaging and ANN interpretation of these slides was compared to parasitologist interpretation of standard microscopy.Relative to a gold standard defined as any positive result from parasitologist reading of KK, SSTT, and MIF preparations through standard microscopy, parasitologists reading UVC imaging of SSTT achieved a comparable sensitivity (82.9%) and specificity (97.1%) in A. lumbricoides to standard KK interpretation (97.0% sensitivity, 96.0% specificity). The UVC could not accurately image T. trichiura or hookworm. Though Kankanet interpretation was not quite as sensitive as parasitologist interpretation, it still achieved high sensitivity for A. lumbricoides and hookworm (69.6% and 71.4%, respectively). Kankanet showed high sensitivity for T. trichiura in microscope images (100.0%), but low in UVC images (50.0%).</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>The UVC achieved comparable sensitivity to standard microscopy with only A. lumbricoides. With further improvement of image resolution and magnification, UVC shows promise as a point-of-care imaging tool. In addition to smartphone microscopy, ANN-based object detection can be developed as a diagnostic aid. Though trained with a limited dataset, Kankanet accurately interprets both standard microscope and low-quality UVC images. Kankanet may achieve sensitivity comparable to parasitologists with continued expansion of the image database and improvement of machine learning technology.</p>
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