Cervical Pre-Cancer Imaging
Healthcare access in rural areas of the United States remains a persistent challenge due to a combination of geographic isolation, provider shortages, and limited healthcare infrastructure. Many rural communities face long travel distances to reach care, fewer specialists and primary care physicians, and hospital closures that further strain already limited resources. Socioeconomic factors, such as higher rates of uninsured individuals and lower income levels, compound these barriers leading to gaps in health outcomes compared to urban populations. Cervical cancer trends in urban vs rural populations are emblematic of this trend; though urban populations have seen a sharp downward trend in cervical cancer incidence and mortality, rural populations in the US have experienced an increase in cervical cancer diagnoses since 2012. The three-visit process for screening with Human Papilloma Virus (HPV) testing and/or Pap smear, diagnostic colposcopy with biopsy, and treatment with loop electrosurgical excision procedure (LEEP), which has resulted in the dramatic decrease in cervical cancer incidence and mortality in urban areas is not practical in rural areas for the reasons outlined above. New innovations in cervical cancer management that work within rural healthcare ecosystems are needed now to address this important gap.
We have established a transformative technology-enabled see-and-treat healthcare model for cervical cancer prevention in Peru, which has benefited thousands of women. We are inspired and informed by our experiences framework to create a systems-based approach for cervical cancer prevention. Our vision is to equip providers with the appropriate tools and knowledge to effectively manage screen-positive patients immediately and effectively. Our strategy is to create a digital innovation platform called Digitally Enabled Care Innovations for Decentralized Environments (DECIDE) to mirror the clinical decision-making process. DECIDE has three components: portable counterparts to the standard of care colposcope - commercialized Pocket colposcope, and upgraded version of the Pocket colposcope, a speculum free Lily shaped imaging module (SLIM) colposcope; a web server that houses patient and image information as well as a suite of algorithms that process the images and a mobile App that provides, prior screening results as well as clinically relevant outputs for patient management. The outputs of DECIDE are based upon Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors developed by the ASCCP and allow patient management over providing a diagnosis, the most common approach used in the development of current algorithms.
Our model is enabled by a suite of solutions for cervical cancer: screening (HPV), diagnosis, (Pocket colposcope) and treatment (thermocoagulator). An mHealth app and webserver coordinates all components of the model.
GWHT Cervical Cancer Imaging Research Team
Collaborators
Published Research
Lillian Ekem, Erica Skerrett, Megan J. Huchko, and Nimmi Ramanujam. "Automated Image Clarity Detection for the Improvement of Colposcopy Imaging with Multiple Devices." Biomedical Signal Processing and Control 100, Pt B, Feb 2025.
Marlee Krieger, Nimmi Ramanujam, Brian Crouch, and Mary Dotson. "PR007/#830 Implementing technology that disrupts health systems but not quality of care: the pocket colposcope." International Journal of Gynecological Cancer 34, no. 3, Oct 2024.
Jayashree Natarajan, Sandeep Mathur, Sreenivas Vishnubhatla, Sunesh Kumar, Shachi Vashist, Nimmi Ramanujam, Seema Singhal, Jyoti Meena, Pranay Tanwar, and Neerja Bhatla. "Can portable Colposcopes Repace Standard-of-Care Colposcopes? A Crossover Trial of Two Portable Colposcopes with a Standard-of-Care Video Colposcope." Asian Pacific Journal of Cancer Prevention 23 no. 12, Dec 2022.