Community education program developed with community members for emergency referral in northern Ghana: Lessons about active community participation for innovation and ownership of interventions

: 2.020_TEC A Novel, low-cost intraoperative fluorescent imaging system for surgical use: Opportunities for research capacity in lowand middle-income countries K. Oh, C. Kaddi, W.B. White, O.T. Okusanya, A. Mohs, S. Nie, M.D. Wang, S. Singhal; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA, Georgia Institute of Technology, Atlanta, Georgia, USA, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA, Emory University School of Medicine, Atlanta, Georgia, USA Background: Capacity-building efforts to train surgeons in lowand middle-income countries (LMICs) have increased the population of surgeons in these countries. Some of these surgeons may be interested in pursuing research but face prohibitive resource obstacles. For example, intraoperative fluorescent molecular imaging has emerged recently as a promising surgical adjuvant to better identify tumors, metastatic disease and diseased lymph nodes. The technology involves using a light source, filters and camera during surgery to view cancer-selective fluorophores that absorb and emit specific wavelengths of light. This growing area of research would welcome contributions from LMICs, but imaging systems remain expensive and not readily available. Our objective was to design a low-cost, easy-to-use fluorescent imaging system compatible with any traditional endoscope. Demonstrated efficacy of such system indicates that surgeons in LMICs can be not just recipients of training and resources but also drivers of research and innovation. Methods: The imaging system was constructed solely from readily available commercial materials. We performed verification testing of three design iterations to incorporate an LED light source, minimize loss of light output, and develop an effective filtering system for fluorescence detection. The device was tested in vitro and in an animal model (chicken) using fluorophores known as quantum dots of different concentrations. Findings: Criteria for an effective imaging system were satisfied. First, the system’s “white light” intensity was comparable to that of standard clinical xenon light sources. Second, the viewing lens provided the magnification and resolution required for intraoperative imaging. Third, the system distinguished fluorescent tissue from non-fluorescent tissue with appropriate sensitivity and specificity, both in vitro and in vivo. Finally, the entire system was constructed for under 500 U.S. dollars. Interpretation: Prohibitive cost remains an obstacle to surgeons in LMICs who pursue basic science and translational research. In the field of intraoperative fluorescent molecular imaging, we demonstrate that an imaging system can be designed at low cost and with applicability to preclinical testing. The system is compatible with standard clinical endoscopes and accommodates various fluorescent molecular contrast agents. This study represents a successful effort to potentially broaden the surgical research capacity in LMICs.