Smartphone Thermal Analysis for Diabetic foot Ulcer Prevention and treatment

Marie Sk¿odowska-Curie Actions Research and Innovation Staff Exchange (RISE) Call: H2020-MSCA-RISE-2016 STANDUP Smartphone Thermal ANalysis for Diabetic foot Ulcer Prevention, detection and treatment) Summary Diabetic foot (DF) disease includes neuropathy, peripheral arterial disease and infection which may lead to complications as for example ulceration and subsequent lower limb amputation. This implies that nowadays 600.000 diabetic foot ulcers occur each year in the EU-27 of which 90.000 will require an amputation. DF ulcers could be reduced according to diabetes experts. Temperature is one of the possible clinical parameter which is not currently well exploited even though it is an important factor in the evaluation of foot health. For example, detecting hyperthermia in the plantar foot surface for DF patients at home and providing adequate therapy reduces the incidence of foot ulcer by 3. Current thermal systems in DF are neither really effective nor friendly. Thermal camera could be one solution as thermal camera are contact free, non-invasive, non-irradiating, and painless. Recent technological advances make that smartphone can acquire thermal images. The STANDUP project proposes a smartphone based system such that mobile, accurate, friendly, low cost and fast thermal analysis of the plantar foot surface can be achieved to detect DF in an early stage, and to better prevent and cure DF ulcers. The smartphone thermal imaging system will be composed of a smartphone running under Android and iOS, and of a FlirOne thermal camera. This system allows to take at the same time and at the same spatial position a thermal and a color image of the plantar foot surface. The smartphone will directly process the data and will provide an instantaneous, clear, accurate and deep analysis of the foot thermal characteristics. In the STANDUP project, two effective and friendly thermal smartphone applications will be developed. The first one (A1: hyperthermia detection and analysis of thermal variations in time) will permit to detect possible hyperthermia of the plantar foot surface and will analyze temperature variations related to various thermal or biomechanical solicitations in targeted regions of the plantar foot surface at two different time. The second smartphone application (A2: time follow up of temperature, color, and 3D shape of DF ulcer) will assess variations of these parameters along time. These smartphone applications will be evaluated during clinical trials. In the first clinical trial, a cold stress test will permit to detect neuropathy and peripheral arterial disease. Associated to ground truth measures of neuropathy and peripheral arterial disease, a method for an early detection of DF will be proposed from the thermal analysis only. In the second clinical trial, temperature, color, and 3D shape in DF ulcers will be studied during its treatment. These parameters can help to precisely assess ulcer evolution. The third clinical trial will measure temperature variations during biomechanical stress tests. It will help in improving foot insole and in proposing individual choice of foot pad. These smartphone applications will be evaluated by the medical staff in real clinical situation during the STANDUP project. They will be enhanced taking into accounts remarks of the users, to result in an advanced prototype of smartphone based system for the targeted medical applications. This advanced smartphone thermal prototype will rapidly address new market demands in DF early detection, and in ulcer prevention and treatment. None of the above systems are efficient, nor friendly and easy to use. In the recent past years, the price of traditional infrared camera has been dramatically reduced while their technical capacities strongly increased. Such technologies are serious candidates for detecting thermal changes in diabetic foot disorders [ROB-10. The main advantages of thermography are that it is simple to use, non-invasive, contactless, non-irradiating, and fast. In 2014, the Flir Company has proposed a new thermal camera (FlirOne) that allows a smartphone to take a thermal pictures [FLIR-16. A color image can also be taken at the same time and at the same spatial position. The cost of the FlirOne camera is very low, 280 Euros today (2016). It is very likely that the device will be cheaper in the next years. The use of a smartphone based system results in the fact that the thermal analysis system to assess DF thermal status can be portable, instantaneous, friendly and cheap. Based on the obvious lack in using thermal information in the domain of DF in a friendly and efficient way; based on the strong knowledge of our group regarding DF; based on thermal technologies that we have developed in that case; based on the recent tremendous technological developments of smartphone and of thermal camera for smartphones; based on the strong commercial potential of such system; based on the market knowledge of our group, we intend to develop, test, improve and disseminate to the market in a very near future a smartphone based system to assess hyperthermia in DF, to develop a system for an early diagnosis of DF, to follow in an efficient way DF ulcer during treatment, and to improve the conception of foot insole and the choice of personalized foot pad.}