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Cancer detection and cervical cancer treatment using Mobile Tele-medicine Unit M.C.Kartha, ProjectManager ([email protected] ), S.Sudhamony, Add.Director ([email protected]), Elizabeth Thomas, Jt. Director ([email protected]), D. Dinu, Sr. Project Engineer([email protected]), Arun Kumar K.S, Project Engineer ([email protected]), C.Sudalaimani, Sc. B([email protected]), Suresh C.S, Sr. Project Engineer ([email protected]), Praveen V, Project Engineer([email protected]), Sumitha Sygal, Research Assistant ([email protected]), Medical Informatics Group, C-DAC, Thiruvananthapuram Summary: A Mobile Tele-Oncology Unit with V-SAT connection was developed and used in 16 medical camps organized in rural areas of Kannur and Wynad districts for cancer detection and treatment of initial stage cervical cancer among the rural population. In these camps 1584 people were screened 68 pre cancerous cases were detected. 16 ladies in whom cervical pre cancerous lesions were detected were given cryotherapy. 6 persons who were detected with oral pre cancerous lesions were referred to dentist for oral surgery and two suspected breast cancer cases were referred for confirmation and treatment. Replication of Mobile Units for service in rural areas will bring down morbidity and mortality. A Mobile Tele-Oncology Unit with V-SAT communication facility for Cancer Detection, follow up consultation for patients’ undergone treatment for cancer and treatment of initial stage Cervical Cancer at the patient location was built. The Mobile Unit is equipped with digital X-ray Unit, Ultrasound Scanner, Digital Video Colposcope, Cryosurgery Unit, Hematology Analyser, Biochemistry Analyser, Digital Microscope, Surgery table, Oxygen and nebulizer units, Sterilizer, Video Conferencing facility, centrifuge, blood mixer and a 50 liter refrigerator. Also, it has two water tanks of 135 liters each for storing fresh water and waste water. The unit is equipped with video conferencing facility for follow up consultation and for confirmation of doubtful cases with doctors of Regional Cancer Centre, Trivandrum. The mobile unit is designed and built by C-DAC, Thiruvananthapuram on an Ashok Leyland Viking Chassis (Wheel Base 222inches). Lead Shielding for radiation protection, as per the AERB guidelines, is provided for
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Cancer Detection and Cervical Cancer Treatment Using Mobile Tele-Medicine Unit

Sep 12, 2014

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Page 1: Cancer Detection and Cervical Cancer Treatment Using Mobile Tele-Medicine Unit

Cancer detection and cervical cancer treatment using Mobile Tele-medicine Unit

M.C.Kartha, ProjectManager ([email protected]), S.Sudhamony, Add.Director ([email protected]), Elizabeth Thomas, Jt. Director ([email protected]), D. Dinu, Sr. Project Engineer([email protected]), Arun Kumar K.S, Project Engineer ([email protected]), C.Sudalaimani, Sc. B([email protected]), Suresh C.S, Sr. Project Engineer ([email protected]), Praveen V, Project Engineer([email protected]), Sumitha Sygal, Research Assistant ([email protected]), Medical Informatics Group, C-DAC, Thiruvananthapuram

Summary: A Mobile Tele-Oncology Unit with V-SAT connection was developed and used in 16 medical camps organized in rural areas of Kannur and Wynad districts for cancer detection and treatment of initial stage cervical cancer among the rural population. In these camps 1584 people were screened 68 pre cancerous cases were detected. 16 ladies in whom cervical pre cancerous lesions were detected were given cryotherapy. 6 persons who were detected with oral pre cancerous lesions were referred to dentist for oral surgery and two suspected breast cancer cases were referred for confirmation and treatment. Replication of Mobile Units for service in rural areas will bring down morbidity and mortality.

A Mobile Tele-Oncology Unit with V-SAT communication facility for Cancer Detection, follow up consultation for patients’ undergone treatment for cancer and treatment of initial stage Cervical Cancer at the patient location was built. The Mobile Unit is equipped with digital X-ray Unit, Ultrasound Scanner, Digital Video Colposcope, Cryosurgery Unit, Hematology Analyser, Biochemistry Analyser, Digital Microscope, Surgery table, Oxygen and nebulizer units, Sterilizer, Video Conferencing facility, centrifuge, blood mixer and a 50 liter refrigerator. Also, it has two water tanks of 135 liters each for storing fresh water and waste water. The unit is equipped with video conferencing facility for follow up consultation and for confirmation of doubtful cases with doctors of Regional Cancer Centre, Trivandrum. The mobile unit is designed and built by C-DAC, Thiruvananthapuram on an Ashok Leyland Viking Chassis (Wheel Base 222inches). Lead Shielding for radiation protection, as per the AERB guidelines, is provided for the X Ray room. The medical equipments are powered by a 6 KVA online UPS. The mobile unit can operate from local grid power and a 75 meter cable is provided for drawing grid power. When grid power is not available, power for the unit can be taken from the 14Kw LPG generator mounted below the chassis. As the generator fuel is LPG, the generator is noiseless, vibration free and smokeless.

Page 2: Cancer Detection and Cervical Cancer Treatment Using Mobile Tele-Medicine Unit

Video Conferencing Room

The Mobile Unit is equipped with a work station for creation of the Electronic Medical Record (EMR) of the patient. EMR is created with e-Dhanwantari software developed by C-DAC, Thiruvananthapuram. e-Dhanwanthari is a web based, easily replicable and configurable, W3C compliant Telemedicine Software which facilitates Tele-consultation for patients at remote rural areas with specialist doctors at urban hospitals. It facilitates creation, storage, transfer and retrieval of EMR of patients with a unique patient Id (UID), interface with bio medical equipments, medical image processing, DICOM viewer, scheduling of appointment with doctors at specialty hospitals, audio/video/text communication between patients/doctors at distant hospitals, generation of various reports etc. It can be deployed and accessed from anywhere in a Telemedicine Network in which rural and urban hospitals are linked through Satellite, ISDN, State Wide Area Network (KSWAN for Kerala), Broad Band/Leased Line internet etc. EMR of patients visiting the Mobile Unit can be created, stored in the Mobile Unit and uploaded through the network to e-Dhanwanthari server at the RCC. Doctors at both hospital and Mobile Unit and patients can discuss about the case through video-conferencing with the help of the EMR. The expert doctor records his diagnosis and treatment details into the e-Dhanwanthari at RCC which will be immediately made available in the e-Dhanwanthari in the mobile unit.

Page 3: Cancer Detection and Cervical Cancer Treatment Using Mobile Tele-Medicine Unit

e-Dhanwantari Login Screen

Embedded Images The fully built mobile unit was handed over to Malabar Cancer Care Society (MCCS), Kannur, which is a nodal centre of Regional Cancer Centre, Trivandrum. MCCS is one of the five Early Cancer Detection Centres (Onconet Kerala Project) implemented by C-DAC, Thiruvananthapuram, with financial assistance of Dept. of Information Technology, Govt. of India. MCCS conduct medical camps on pre scheduled dates in the rural areas in the five northern districts of Kerala. The districts are Kannur, Kasaragod, Wynad, Malappuram and Kozhikkode covering 318 panchayaths. The medical camp activities of MCCS are organized by a gynecologist, an ENT surgeon, a cytologist and trained paramedical staff in colposcopy.

Cervical Cancer is a life threatening disease which is asymptomatic in the early stages and symptoms appear only in terminal stages. By that time, no effective treatment could be given to cure the disease and patients undergo tragic death. The best strategy to combat the disease is prevention and early detection. World Health Organization (1992) recommended that in low resource settings, the aim should be to screen every woman once in her lifetime-at 40 years. Frequency of screening should be increased to 'once every 10 years' and then 'once every 5 years' for women 35-55 years of age. The frequency could be increased based on resources” [1]

Mobile Oncology Unit helps to detect the onset of Cervical Cancer in the medical camps much earlier than the onset of full blown cancer. In early stages, the disease could be effectively cured by destroying the localized cancerous lesions using cryosurgery at very low expenses. Those women detected with Cervical Neoplasia are given treatment using the cryosurgery unit in the mobile unit. This helps the rural women, who are generally unaware of the disease, escape from the clutches of tragic death. Also, these medical camps help early detection of other cancers and refer those patients to RCC for treatment and thus mortality rates are drastically reduced.

Modus Operandi

Page 4: Cancer Detection and Cervical Cancer Treatment Using Mobile Tele-Medicine Unit

MCCS Kannur organizes medical camps at different locations in the five districts. House to house survey of people who need to attend the medical camp is done with the help of volunteers, who are trained by the medical staff for identification of cancer symptoms. The people who are registered for the camps are screened for cervical, oral and breast cancer by visual inspection, VIA/VILI, PAP smear and FNAC techniques. Multiple screening camps are conducted in nearby locations for identifying patients who need further medical attention. The people identified with positive symptoms or doubtful cases in the screening camps are referred to camp with Mobile Tele -Oncology Unit. At the end of the screening camps, date for medical camp with Mobile Tele-Oncology Unit is fixed. The screening camps act as a feeder camp to the camp with the Mobile Unit. Patients who have undergone treatment at Regional Cancer Centre (RCC), Trivandum and those who need follow up consultation also attend the camp. Patients who need consultation with the specialist at RCC who treated them are given the facility for video conferencing. All the people who were identified in the screening camps were further examined with ultrasound scanning, X-ray, blood tests, VIA/VILI tests, FNAC, digital video colposcopy and biochemistry tests as required. VIA/VILI, which are proven methods for cervical cancer detection in low resource setting [3] is adopted in the mobile unit. To improve the rate of detection of positive cases a combination of VIA/VILI and PAP smear tests were done [2]. In doubtful cancer cases, digital video images of the cervix, ultrasound and X-ray images were embedded in the patient EMR and sent to RCC for advice. Doctors at both ends can annotate on the images and share information easily. Those women who were identified with CIN1, 2, 3 and whose squamo columnar junctions (SCJ) are clearly visible were given cryotherapy. Those patients who were detected with pre cancerous lesions in the oral cavity, FNAC positive cases and those with invasive cervical cancer were referred to appropriate treatment centers. The patients who are given cryotherapy will be given a monthly review for the next three months and once in 6 months after that.

Page 5: Cancer Detection and Cervical Cancer Treatment Using Mobile Tele-Medicine Unit

Laboratory

Results

Table 1.1 Summary details of primary screening camps

Date Place Patients

Male

Femal

e

Pre Cancer Cases

Type of Cancer

Cervical

Breast

Oral

5/3/2010

Mananthawady, Wynad 130

10 120 3 2 1 0

6/3/2010

Mananthawady, Wynad 149

24 125 1 1 0 0

7/3/2010

Mananthawady, 139 9 130 2 1 0 1

Page 6: Cancer Detection and Cervical Cancer Treatment Using Mobile Tele-Medicine Unit

Wynad

17/3/2010

Mananthawady, Wynad 111

11 100 3 2 0 1

18/3/2010

Mananthawady, Wynad 149

15 134 4 2 0 2

19/3/2010

Mananthawady, Wynad 179

60 119 7 6 0 1

20/3/2010

Mananthawady, Wynad 158

15 143 2 1 0 1

24/4/2010

Kunhimangalam, Kannur 117 0 117 4 4 0 0

7/5/2010

Kunhimangalam, Kannur 105 0 105 8 8 0 0

8/5/2010

Kunhimangalam, Kannur 114 0 114 10 10 0 0

12/5/2010

Kunhimangalam, Kannur 128 0 128 6 6 0 0

14/5/2010

Kunhimangalam, Kannur 105 0 105 8 8 0 0

TOTAL158

4

144

1440 58 51 1 6

The Mobile Tele Oncology unit started functioning at Malabar Cancer Care Society (MCCS) on 3.1.2010. Twelve (12) screening camps were conducted in the suburbs of Kannur and Manantawady. In these camps 1544 people were examined. People with positive symptoms for oral, breast and cervical problems were subjected further examinations using Digital Video Colposcope, Ultrasound Scanner, Digital X-ray, VIA/VILI, hematology and biochemistry tests. Total 58 pre cancer cases were identified. Persons with pre cancerous lesions for oral and breast cancers were referred to appropriate treatment facilities. Twenty women were given cryotherapy. One online video consultation with specialist of RCC for a doubtful case (cervical) was done. Details of the results in the primary screening camps are given in table 1.1. Details of the tests carried out and cryotherapy given in the Mobile Unit are given in table 1.2.

Page 7: Cancer Detection and Cervical Cancer Treatment Using Mobile Tele-Medicine Unit

Table 1.2 Results of camps with mobile Tele oncology unit.

Date Place

Cryo

th

erap

y

X-ra

y

USG

Colp

osco

pe FNAC

Bioc

hem

ist

ry

Hem

atol

ogy

FNAC

VIA

/VIL

I

Vide

o Co

nsul

t

Ora

l Ex

am PAP

smea

r

03/10/2010

Karivellur,Kannur 3

13 2 1 7 2 2

67

14/02/2010

Kozhummal, Kannur

27 5 6

13

33

02/05/2010

KunhimangalamKannur 3 6

31

29

16

42

16/05/2010

Payyannur, Kannur

13 7

20

24 8

15

10 1

Total16

10

66

26 9

58

47

31

143

Conclusion

Early detection of any cancer will save patients from huge financial expenditure, morbidity and mortality. Cervical cancer is fully preventable by creating awareness, early detection and treatment of CIN immediately after detection. As cervical cancer is asymptomatic in early stages, proactive approaches for early detection and creating awareness at patient locality is extremely important. A mobile tele-oncology unit helps detection of cancers at patient locality, refer patients to treatment centers without loss of time and provide treatment for CIN there itself. Providing treatment for CIN in patient locality ensures treatment to the needy since women from low resource setting neither have the means for getting treatment away from their locality nor the sense of urgency to seek medical attention.

1. Appendix 1 - References2. Appendix 2 - Brief bio data of authors

Page 8: Cancer Detection and Cervical Cancer Treatment Using Mobile Tele-Medicine Unit

Appendix 1

References

1. Juneja A, Sehgal A, Sharma S, Pandey A. Cervical cancer screening in India: Strategies revisited. Indian J Med Sci 2007;61:34-47

2. Evaluation of visual inspection with acetic acid (VIA), Lugol’s iodine (VILI), cervical cytology and HPV testing as cervical screening tools in Latin America L O Sarian, S F Derchain, P Naud, C Roteli-Martins, A Longatto-Filho, S Tatti, M Branca,MErz_ en, L Serpa-Hammes, JMatos, RGontijo, J F Braganc-a,T P Lima,MYS Maeda, A Loº rincz,GBDores, S Costa, S Syrjaº nen and K Syrjaº nen: J Med Screen

2005; 12:142–149

3. "Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol's iodine (VILI) in cervical cancer screening in Kerala, India" Rengaswamy Sankaranarayanan, Ramani Wesley , Somanathan Thara , Namrata Dhakad,,Bharathykutty Chandralekha , Paul Sebastian , K. Chithrathara , Donald Maxwell Parkin, Madhavan Krishnan Nair :International Journal of Cancer, Volume 106 Issue 3, Pages 404 – 408

Appendix 2

Page 9: Cancer Detection and Cervical Cancer Treatment Using Mobile Tele-Medicine Unit

1. M.C. Kartha : Has 28 years experience in electronics hardware, software design and development. Currently working as Project Manager, Medical Informatics, C-DAC, Thiruvananthapuram

2. S. Sudhamony : Has 32 years experience in hardware, software design, development. Currently working as Additional Director, C-DAC, Thiruvananthapuram and Section Head, Medical Informatics Group.