MIT research scientist Rich Fletcher and graduate student Dan Chamberlain, in collaboration with the Chest Research Foundation (CRF) in India, have won the $100,000 third prize in Vodafone’s annual Wireless Innovation Project awards program. Three awards are given annually to the top wireless innovations applied to social benefit around the world.
Fletcher’s team, based at MIT D-Lab and at the Tata Center for Technology and Design, received the award for developing a low-cost mobile platform for diagnosing pulmonary disease. Approximately one-fifth of the world’s population suffers from some form of pulmonary disease, which includes asthma, pneumonia, tuberculosis, chronic obstructive pulmonary disease (COPD), and lung cancer. Pulmonary diseases such as COPD are responsible for over 14 percent of deaths worldwide.
Pulmonary disease presents a particularly high burden in developing countries, where urban air quality is often poor, cigarette smoking is common, and many people cook with biomass stoves that produce large amounts of toxic gases. Compounding the problem is the fact that most doctors in developing countries are generally not trained to diagnose pulmonary disease, and often practice other schools of medicine — such as homeopathy and Ayurveda, a traditional Hindu system of medicine — which provide little guidance for diagnosing lung diseases.
Although pulmonary testing equipment such as the body plethysmograph, impulse oscillometer, spirometer, and gas diffusion meter are available in many modern hospitals, this equipment typically costs over $100,000 and is extremely scarce in developing countries.
“We were surprised to learn that there are only approximately one dozen comprehensive pulmonary testing labs in the entire country of India,” Fletcher says. “Clearly, most of India’s population is diagnosed using very simple tools, which can result in misdiagnosis or underdiagnosis.”
“To address this problem, various research groups around the world have developed mobile versions of a spirometer,” Fletcher continues. “However, a spirometer can only diagnose certain types of pulmonary disease and requires too much physical effort from the patient. As a result, spirometers are only used by about 20 percent of general practitioner doctors in India, and cannot be used with sick children or elderly patients.”
Fletcher and Chamberlain teamed up with pulmonary experts at the Chest Research Foundation to develop a more general solution for diagnosing pulmonary disease that employs a simple mobile stethoscope and a common peak flow meter, which together cost less than $50 in low volumes. Using a combination of input methods — including the microphone, USB, and augmented reality — they developed a mobile application that is able to reliably capture various data on a mobile phone, and then run machine-learning algorithms to predict the probability that the patient has a specific pulmonary disease. The disease prediction algorithm is part of the new work which will be partially funded by the Vodafone award.
Chamberlain, who is developing the software algorithms as part of this Master’s thesis, explains, “There are two layers of algorithms used in the project: The first set of machine learning algorithms are used to automatically recognize and classify the different types of abnormal lung sounds, and a second layer of algorithms are then used to combine the lung sounds with other data to predict the likelihood of specific diseases.”
Fletcher, supported by the MIT-Singapore University of Technology and Design International Design Center, began collaborating with CRF in India over three years ago, enabled by initial funding from two programs at MIT: the MIT MISTI-India program, which provides initial seed grants for international collaborations, and the MIT Tata Center, which provides graduate student fellowships and holistic support to projects in India. Chamberlain is one of more than 60 graduate student Tata Fellows who are actively engaged with creating quality-of-life solutions in the developing world.
“A few years ago, I noticed that there were relatively few mobile health researchers working in the area pulmonary disease,” Fletcher says, “even though there was a huge need in Southeast Asia. We were fortunate to have a chance to work with CRF, which is one of the top lung physiology research labs in the world. Their expertise and field experience has been invaluable.”
Rahul Kodgule, head of research at CRF, developed advanced stethoscope techniques while serving as a doctor in the Indian Army stationed in a remote outpost in northern India that had no access to medical equipment. According to Kodgule, “These advanced diagnostic techniques are taught in some traditional medical schools, but they are rarely practiced, since the modern tendency is to rely on machines. By attaching the stethoscope to a mobile phone, we are able to exploit these techniques and convert the stethoscope into a much more powerful tool in the hands of a doctor who lacks this experience.”
Fletcher adds, “Our challenge as engineers was to capture some of the intelligence of an experienced pulmonologist and embed it into a mobile phone app that works with very low-cost devices and a simple intuitive interface. We also hope that our mobile platform can be used to help train young doctors, or to assist older doctors who have reduced auditory acuity.”
The team from MIT and CRF has been testing parts of the mobile solution with patients in India over this past year, and will be publishing their results at upcoming conferences and in clinical journals.
MIT director of the Tata Center, Rob Stoner, is pleased with the award, stating, “There is a wealth of innovation happening at MIT in the area of technology and design for low-resource settings. The Tata Center has helped to create a community of researchers across MIT connected by this common purpose, and we are happy to see this work receive international recognition.”
With the funding from Vodafone, the team is planning to conduct a comprehensive clinical study in rural India over the next two years. The diagnostic results from the mobile system will be compared against the diagnosis of experienced pulmonologists using state-of-the-art pulmonary function testing lab equipment. The team has also had conversations with industry partners in India who are interested in commercializing and scaling the technology.
“Surprisingly few mobile health apps and devices ever get deployed in the field and clinically validated,” Fletcher says. “We appreciate the support of Vodafone to allow us the chance to take our technology to the next level so it can have a real impact.”