Quality Assurance of Cervical Smear Slide Inspection Using a Novel Eye-Tracking Technique

A novel objective quality assurance system for smear slide screening is investigated in this thesis. A method of data validation was developed that compares data from an eye tracked image display, machine image colour texture analysis and expert judgements in a statistical manner to identify salient areas of cervical cytological images. These data are used to construct screener performance profiles, which have been compared to screener experience. The experimental methodology is described and how the screener performance profile is constructed. Results from a study of 10 screeners, checkers and pathologists are presented showing predicted trends of human performance. Relations to experience and strategy are also shown, though these relationships are not statistically significant. A standardised quality assurance test is developed that profiles screeners across many performance measures. Highly significant correlations were found between fixation saliency and machine colour texture (maxima density), though fixation saliency suffers from a lack of a significant statistical basis. Further fixation data is needed, however if it conforms to the existing trends then the results would support the new data validation method as a framework from which image analysis techniques applied to cytology may be objectively tested. Furthermore, this new approach to cervical cytology quality assurance would have the potential to further reduce human errors in the cervical smear inspection process by lowering levels of observer variation found in all aspects of the cervical screening process

Preventable cancer mortality in American Indian and Alaska Native women.

This report describes a series of six studies on cancer in American Indian and Alaska Native (AI/AN) women, with a particular emphasis on cancer of the breast and cervix. Data from the Indian Health Service (IHS) inpatient data system was used to generate estimates of incidence of cancer among AI/AN populations. Additionally, breast cancer rates among Indian women in Arizona and New Mexico were compiled from extensive chart review of the New Mexico Tumor Registry and the IHS Inpatient Data System. Study of the performance of the health care system for cancer screening in women suggest that the major deficiency lies not in a failure to bring women in for screening, but rather to complete the screening after contact has been made and the need for screening recognized. The studies indicate that cancer is generally diagnosed in American Indian women at a more advanced stage and survival experience of Indian cancer patients is worse than non-Indian, even when corrected for later stage at diagnosis. Several of the studies suggest that failure to diagnose cancer in its very early stages appears to be in large part dependent on patient behavior. An alarming number of women do not keep follow-up appointments, even after multiple referrals and rescheduling of appointments. These findings suggest the need for intervention strategies that encourage women to become knowledgeable about cancer and to accept responsibility for their screening. The studies suggest that the relative difficulty in improving screening rates are traced to an inadequate understanding of cancer and its prevention on the part of women in the community

Proceedings From the First Asia-Oceania Research Organisation on Genital Infections and Neoplasia (AOGIN) Meeting

The First Asia-Oceania Research Organisation on Genital Infections and Neoplasia (AOGIN) Meeting was held in Kota Kinabalu, Malaysia, in July 2005. The conference covered regional issues relating to infection with the human papillomavirus—epidemiology, virology, and immunology, testing, screening, and prevention strategies—as well as cervical cancer screening and its management

An investigation of specific contributing factors affecting quality assurance in the diagnosis of conventional cervical smears

The purpose of this study is to investigate specific contributing factors affecting quality assurance in the diagnosis of conventional cervical smears. More than half of South- African women fail to have one cervical smear in their lifetime and +/- 50 percent of those who do have cervical smears taken, are lost to follow-up. Since cervical cancer is the most common malignancy amongst women in developing countries, the medical profession will have to endeavor to screen a higher rate of women and ensure a 100 percent quality assurance with every patient treated in order to reduce the unacceptable high incidence of cervical carcinoma. At this stage it seems like an impossible task to screen all women in South Africa, due to far-off rural areas, shortage of medical professionals and the lack of knowledge of some women of the necessity of cervical smears. Many newly qualified South-African doctors leave the country to go and work elsewhere. South Africa then in turn has to recruit doctors from other countries to staff the State hospitals and clinics. Some areas have one doctor to thousands of patients, insufficient nursing personnel and inadequate equipment. Doctors in some areas cannot cope with the volume of work and the long hours. One has to accept that the quality of the management of some patients is affected negatively. There are a number of medico-legal issues (world wide) in relation to aspects of cervical cancer prevention practices which are controversial and are of particular concern to all of those involved in cervical cancer prevention. Various countries have therefore formed different national organizations to address the medico-legal issues in screening for the prevention of cancer. These organizations monitors procedures, internal quality control as well as external quality control. In South Africa, medico-legal cases are not so prevalent, but may become so shortly. The South-African medical professionals therefore have to ensure that their quality of work conforms to accepted good practice in all circumstances. State hospitals serve thousands of patients per month and it is an every day occurrence to see long queues of patients sitting waiting for doctors and who often have to come back the following day. The situation appears to be much improved in private practice and since patients have medical cover and accessible medical facilities. Since cervical cancer is the most common malignancy amongst women in developing countries, the medical profession will have to endeavor to screen a higher rate of women and ensure a 100 percent quality assurance with every patient treated in order to reduce the unacceptable high incidence of cervical carcinoma. At this stage it seems like an impossible task to screen 100 percent of women in South Africa, due to far-off rural areas, the shortage of medical professionals and ignorance of patients. Quality assurance is therefore of paramount importance to every medical professional for every patient treated. Laboratories all worldwide have been, or are in the process of being accredited by their specific accreditation authorities. The main reason for this is improvement of quality control and therefore quality assurance. The South African National Accreditation Society (SANAS) now accredits various laboratories in South Africa with the view of accreditting all laboratories within a certain time limit. The Ampath laboratory Port Elizabeth was successfully accredited during 2001. Accredited laboratories have to uphold a very high degree of quality to remain accredited. A team of professionals inspects the laboratory every 2 years and other quality assurance staff inspects the laboratories every few months. All aspects of the laboratory are checked, e.g. the qualification of staff, their registration with the Health Professions Council of South Africa (HPCSA), their curriculum vitaes, equipment, safety of the laboratory etc. Since the laboratory chosen for this study, is accredited, the author evaluated every cervical smear that was received in the laboratory since the year 2000, with the following objectives in mind: · Whether the presence or absence of an endocervical component has an effect on the adequacy of cervical smears · To determine the effect of using smaller coverslips on quality assurance in the cytology laboratory · Evaluate the effect that manual re-screening of smears has on quality assurance in the cytology laboratory. As there is a shortage of cytotechnologists and pathologists worldwide, several countries make use of automated screening devices as primary screening or secondary screening for quality assurance. These devices were tested in some laboratories in South Africa but were found to be very expensive and sensitivity and specificity were not up to standard. Sensitivity is a measure of the ability of a test to detect the abnormal - Sensitivity is the ratio of true positives to true positives + false negatives. Specificity is a measure of the ability of a test to correctly identify the negative - Specificity is the ratio of true negative to true negatives + false positives. The automated screening machines failed to identify abnormal cells amongst inflammatory cells, as well as in very blood stained smears. Several other problems also occurred and an increasing number of smears had to be manually rescreened, thus making this exercise costly and not helpful as a quality assurance instrument. The slides used for this thesis, have been retrieved from the archives of the Ampath laboratory in Port Elizabeth. Fourteen specific contributing factors affecting quality assurance in the diagnosis of cervical smears are also discussed and conclusions and recommendations given

A Survey on Deep Learning in Medical Image Analysis

Deep learning algorithms, in particular convolutional networks, have rapidly become a methodology of choice for analyzing medical images. This paper reviews the major deep learning concepts pertinent to medical image analysis and summarizes over 300 contributions to the field, most of which appeared in the last year. We survey the use of deep learning for image classification, object detection, segmentation, registration, and other tasks and provide concise overviews of studies per application area. Open challenges and directions for future research are discussed.Comment: Revised survey includes expanded discussion section and reworked introductory section on common deep architectures. Added missed papers from before Feb 1st 201

Deep Learning in Medical Image Analysis

The accelerating power of deep learning in diagnosing diseases will empower physicians and speed up decision making in clinical environments. Applications of modern medical instruments and digitalization of medical care have generated enormous amounts of medical images in recent years. In this big data arena, new deep learning methods and computational models for efficient data processing, analysis, and modeling of the generated data are crucially important for clinical applications and understanding the underlying biological process. This book presents and highlights novel algorithms, architectures, techniques, and applications of deep learning for medical image analysis

The epidemiology and knowledge of cervical cancer in Zimbabwe

Background: Chronic and persistent infection with human papillomavirus (HPV) is the most important factor associated with the development of cervical cancer. Cervical cancer deaths have been on the rise in recent years with 85% of about 270 000 annual deaths occurring in developing countries. The rise in cervical cancer trends in the past two decades has coincided with the human immunodeficiency virus (HIV) epidemic especially in the sub-Saharan African region. With the advent of HIV especially among young people in most of these developing countries, the incidence, morbidity and burden of cervical cancer are likely to continue increasing. Although cervical cancer prevention/screening and treatment is available in most developing countries, challenges and constraints still exist when it comes to HIV-positive women. Most developing countries, Zimbabwe included, do not have adequate infrastructure, funds, human resources, proper guidelines, and policies, which facilitate the adoption of effective prevention and treatment methods for cervical cancer among HIV-positive women. Therefore, the first part of this study involved two systematic reviews to weigh current evidence on screening and treatment of cervical cancer in HIV-seropositive women. In addition to the burden in HIVpositive women, the rise in HIV-incidence and risky sexual behaviour (multiple sexual partners, early sexual debut and use of contraceptives) among young people (15 to 24 years old), pose as barriers to successful establishment and implementation of cervical cancer control initiatives. In Zimbabwe, there is underutilisation of available cervical cancer services (although some are expensive) due to lack of knowledge and information about cervical cancer, a patriarchal and conservative society that views cervical cancer as a women’s issue. Adding to these issues, Zimbabwe does not have a cancer communication strategy that focuses on cancer risks factors as a cancer primary prevention. The National Cancer Prevention and Control Strategy for Zimbabwe (2014-2018) highlighted that underfunding has resulted in health education on cervical cancer to be unstructured. Therefore, as Zimbabwe sets out to strengthen cervical cancer prevention with the launch of the National Mass HPV Vaccination drive in May 2018, a number of questions still exists; how can a culturally patriarchal society aid and accept vaccination freely? How can young boys, men and the rest of the community be integrated within cervical cancer prevention programmes? Are there opportunities for HIV-positive women in these initiatives? How can the issue of health inequity which is associated with cervical cancer incidence be addressed? Aim: This PhD study weighed current evidence on screening and treatment of cervical cancer in HIV-seropositive women in developing countries through two systematic reviews; and assessed the knowledge, attitude and practices of young people towards cervical cancer, prevention/screening, HPV and vaccination. Methods: The research design was an integrative approach, which utilised a combination of two systematic reviews and a cross-sectional survey. The two systematic reviews explored cervical cancer prevention and treatment modalities for HIV-positive women, whilst the crosssectional survey assessed young people’s knowledge, attitude and practices concerning cervical cancer. Study participants for the cross-sectional survey were recruited through a three-stage cluster design from high schools and universities in Zimbabwe. Knowledge, attitudes and practices were assessed using questions based and adapted from the concepts of the Health Belief Model (HBM) and the Cervical Cancer Measuring tool kit-United Kingdom (UK). Results: The study found that HPV Deoxyribonucleic acid/Messenger RNA (DNA/mRNA) testing (n=16, 64.0%), visual inspection with acetic acid (VIA) (n=13, 52.0%) and Pap smear (n=11, 44.0%) are the mostly used cervical cancer screening methods. HPV testing has a better accuracy/efficiency than other methods with a sensitivity of between 80.0-97.0% and specificity of 51.0-78.0%. In addition, the study found that sequential screening using VIA or visual inspection with Lugol’s iodine (VILI) and HPV testing has shown better clinical performance in screening HIV-seropositive women. Whilst radiation, chemotherapy, chemoradiation, and surgery have shown the possibility of effectiveness among HIVseropositive women, cervical cancer stage, immunosuppressive level, and multisystem toxicities due to treatment are associated with treatment completion, prognosis and survival outcomes. Those infected with HIV are of a younger age and have more advanced cervical cancer as compared to those who are HIV-negative. The majority of young people, 87.47% (656/750), claimed to know what cervical cancer is. However, only 43.14% (324/751) had ever heard of cervical cancer prevention/screening and 53% (398/751) did not know about HPVhow it is transmitted or prevented. Misconceptions regarding cervical cancer causes exist, with some young people attributing cervical cancer to use of detergents, certain foodstuffs and having sex with an uncircumcised man. Conclusion and Recommendations: This research not only reports on the current screening and treatment modalities for cervical cancer among HIV-positive women, but it also offers a lens through which government can generate behavioural changes around cervical cancer among young people. Although cervical cancer screening exists in almost all developing countries, what is missing is both opportunistic and systematic organized population-based screening. Cervical cancer screening programmes need to be integrated into already existing HIV services, to enable early detection and treatment. The study suggests a need to offer opportunistic and coordinated screening programmes that are provider-initiated to young women (from 15 years), especially those who are HIV-infected, to promote early identification of cervical precancerous lesions. Opportunities to include young boys and HIV-positive middle-aged women in the recently launched mass HPV vaccination programmes exist and can be utilised. Ring-fencing budgets or introducing cancer levies and investing resources in evidence-based screen and treat strategies for precancerous lesions in HIV-seropositive women and young people will reduce morbidity and mortality due to cervical cancer. Developing a standard cervical cancer primary prevention tool that can be integrated into schools can be a step towards addressing health inequity. Research on cervical cancer management of HIVseropositive patients focusing on the quality of life of those treated, the effectiveness of the treatment method taking into account CD4+ count and ART is required.Thesis (PhD)--University of Pretoria, 2018.School of Health Systems and Public Health (SHSPH)PhDUnrestricte

Development and Validation of an Instrument to Predict Non-adherence to Medical Treatment Regimens

Evaluation of the Health Adherence Behavior Inventory (HABIT) is described with data pertaining to reliability and validity. The instrument was originally developed for use in a primary healthcare setting, to support the early identification of patients who are at risk for poor health outcomes and complications of chronic disease because of non-adherence to their healthcare provider’s instructions. The items were refined from the original HABIT (DiTomasso, 1997) and drawn from various sources, including health risk assessments, health screening questionnaires, and nationally accepted standards for disease treatment and prevention. The questionnaire consists of 50 items, 39 of which appear to load on one factor. Items were analyzed, revealing two clusters, which yielded one Main Factor (Prevention Factor). This factor represents positive health behaviors that have demonstrated a correlation with reduced risk for negative health outcomes. These behaviors address one domain of the multifaceted problem referred to as non-adherence. With respect to construct validity, the questionnaire correlated significantly with the widely used and reliable Health Risk Assessment developed by Lifestyle Directions, Inc. The strong correlation with an established Health Risk Assessment suggests promise for further refinement of the scale, offering a briefer alternative to full risk assessment. Through additional research, it is anticipated that a more comprehensive set of questions may uncover other key domains that offer valuable insight into the prevention and the treatment of non-adherence