Jaundice—a yellowing of the skin and eyes—is a common concern for new parents. It doesn’t often signal anything serious in babies, but it can be damaging if left untreated. For adult patients, however, jaundice can be a telltale sign of hepatitis, alcoholism, or pancreatic cancer.
Graduate Student Member Alex Mariakakis and his team at the Ubiquitous Computing Lab at the University of Washington, Seattle, have been working on a better way to measure jaundice in adults. They are developing a smartphone app, BiliScreen, that detects bilirubin. High levels of the compound, which is produced during the normal breakdown of red blood cells and is processed by the liver, cause jaundice.
A patient takes a selfie, then the app’s computer-visualization and machine-learning algorithms detect yellow pigment in the person’s sclera (the part of the outer eye that’s ordinarily white). The yellow is sometimes too faint to be seen with the naked eye.
Confirming that a patient has elevated bilirubin levels typically is done by testing the blood, but doctors usually don’t order the test until jaundice is clearly visible, Mariakakis says.
In a recent trial of 70 people, the app identified bilirubin levels correctly with about 90 percent accuracy, according to Mariakakis. The app, still in development, is projected to launch in two to three years, he says.
HOW IT WORKS
BiliScreen can be used in conjunction with 3D-printed accessories: a box that goes around the smartphone to block out external light and cardboard glasses for the patient that are printed with tinted squares to help calibrate color. From the selfie, the app examines the sclera and displays on the screen the person’s bilirubin level. If the level is high, the patient is encouraged to see a doctor for further testing.
BiliScreen resulted from the team’s work on BiliCam, a nascent smartphone app that screens jaundice in newborns from a photo of the baby’s skin. The amount of bilirubin that can build up in a baby’s bloodstream is significant enough to have an effect on the skin, even though the eyes are more sensitive to bilirubin. BiliCam also is under development and not yet approved by the U.S. Food and Drug Administration (FDA).
Jaundice is more common in babies than adults because their systems are not developed enough to process bilirubin in the blood.
But in adults, jaundice often isn’t visible until bilirubin levels are at about 3 milligrams per deciliter of blood, Mariakakis says. The threshold to warrant concern is 1.3 mg. The team is hopeful its app will catch borderline levels of bilirubin and help doctors diagnose illnesses sooner. Pancreatic cancer, for example, currently has a five-year survival rate of only 9 percent, in part because patients usually do not present any visible symptoms until the disease is in its later stages.
The team is concerned about putting the bilirubin information in the hands of patients—which could cause them undue fear.
“We don’t want people to think a high bilirubin level is automatically cancer,” Mariakakis says. When it comes to pancreatic cancer, he says, the incidence rate is low, but false positives are costly. False positives can lead to unnecessary doctor visits and blood tests, wasting time and money. “That’s the concern with any e-health application,” he says, “which is why rigorous testing is essential.”
Before the app is launched, a larger study will need to be conducted to ensure its accuracy, he says. The app also will need FDA approval before it can be taken seriously by doctors.
For Mariakakis, the potential benefits of e-health apps are twofold. Not only can they help doctors detect diseases earlier, but they also provide inspiring examples of computing in action.
“Mentoring students who are interested in engineering becomes easier,” he says, “when I can show them how a smartphone—a device they use every day—can be used to do amazing things, like save people’s lives.”