Reducing costs and promoting health with smartphone microscopy

Dr. Dongkyun Kang is an Assistant Professor of Optical Sciences and Biomedical Engineering. Dr. Kang is currently leading an NIH-sponsored research project for developing a smartphone confocal microscope and diagnosing Kaposi's sarcoma in Uganda. Through hard research and development, Dr. Kang's lab just might create the next big medical technology.

Taking a step back in time, what was it like growing up in Korea? Did you always have this dream to pursue a science or engineering background in America? 

I grew up in Korea and I went to college, and did my master's degree, PhD degree, so I spent the first 20 or so years in Korea and then I came to the United States in 2007 to the Mass General Hospital and Harvard Medical School so that's how my American dream got started. 

My father was an electrical engineer. He worked for LG electronics for 25-30 years, and his weekend activity was to fix one of the electric appliances in the neighborhood. 

Our home became this place for neighbors to bring in whatever they had problems with and my father would open things up and sort things together. I guess I got so used to seeing that and I feel like it was very natural for me to become an engineer. 

After middle school everything was so structured and there was not much room in terms of, you know, doing something creative. I mean you know starting something you know from your own initiation. When I was an elementary school student I put together this helicopter out of pieces and bits and then tried to make it fly. It never flew, but it was a really fun project and I really was proud of myself because there was no instruction on how to build it. I kind of came up with general thoughts and needed to put things together so that was really fun.

You have merged two ever emerging areas of optical sciences and biomedical engineering. Talk a little bit about how the emergence of those two fields have coincided with your ability to do the work that you do. 

I can give a little bit of background on how I ended up here. I did mechanical engineering for my PhD back in Korea and what I did for my PhD was develop optical microscopy equipment for inspecting semiconductors and LCD panels and things like that, for companies like Samsung. 

When I got my first job in the US as a postdoc fellow at the Harvard Medical School at Mass General Hospital, that's when I transitioned from applying optics for industrial applications to biomedical applications. That's where the transition happened for me personally, but biomedical optics has been around for decades. It's been very exciting and a somewhat successful discipline. 

To me it's always fascinating to be able to take a look at human tissue and human cells with optics without having to yank it out. Combining those two disciplines together, optical sciences and biomedical engineering, was a little bit of a struggle, initially, because I was trained as an engineer, rather than by a biomedical researcher. Understanding how to look at biomedical problems was very challenging initially. I didn't know all the terms about medical diagnosis, diseases and whatnot. 

More importantly, I think we engineers tend to overlook the importance of translation so oftentimes you develop something, you put things together in a lab, but then that just stays there and never goes out the door and is actually used at a clinic. Working at the Mass General Hospital and Harvard Medical School really helped me understand the importance of translation and how to make it happen.

I know that your focus right now is largely in the area of early prevention or diagnosis of cancer while pairing it with communities that are more in need, such as rural settings. Talk a little bit about how you came to do this. 

When I was working at the Mass General Hospital, I witnessed a lot of amazing technologies being developed. The challenge was that many of these fascinating imaging technologies tend to be very expensive. I saw that as a major issue in terms of actually making these new devices and technologies utilizable in clinics. 

I came to grow a passion for developing devices that are affordable in low resource settings or even in the US, something that is affordable in primary care clinics or any in a general clinical setting. That was my motivation and then I built this research in a program where we mainly focus on low cost optical imaging technologies that can take a look at cellular details or cellular changes that might be caused by cancer or precancer, all in other diseases, so that we can detect in the disease at an early stage, and we can intervene so that it doesn't progress to cancer at all. That is my motivation and what I really care about.

Everyone says “my  whole life is basically on my smartphone,” but I hadn’t ever imagined that it could be used as a microscope. How are you using the emergence of this technology and again this sort of innovative cycle of the smartphone in your work today? 

That was the motivation to get into mobile, Microsoft technologies. Currently we are using smartphones to sensor the camera, to capture images that were generated through microscopy optics. It's not just a smartphone alone that enables you to take a look at cellular structures from human skin, but there's gotta be a big attachment in front. Once that microscopy image is generated from the microscopy optics, then the data can be acquired by your fancy smartphone. 

Another nice thing about the smartphone is that they have a very nice display, it has cellular connectivity, it also has a pretty strong processing power, it has an AI engine these days. All these things are really useful in terms of analyzing the data and making actionable information for the clinicians.
 

What was your “Aha moment” where you were thinking about lower cost ways to do imaging and meet your research imaging objectives. 

What happened was there was this paper published by my postdoc mentor and you know it was really kind of an interesting idea. I built on their idea a little bit more, so that we can do microscopic imaging without using a fancy optic electrical component. We published the paper when I was a graduate student and I forgot about it. About six or seven years ago I wasn't taking shower and it really hit me hard that I could take that approach and make a smartphone based confocal microscope and that was my “Aha moment.” I didn't write down the date or year, but that was about 6-7 year ago when I was taking shower. When I talk about that story people say like “well yeah, we should take a shower more often than once a day.”

Where are you in terms of translating your work in cancer diagnosis and prevention into patient application? 

I closely work with Dr. Curiel here at the University of Arizona and she's just an amazing, phenomenal collaborator. We had a chance to image some skin cancer patients at her clinic and we had a chance to compare images from our low cost device versus images taken with a hundred thousand dollar microscope device. We published a nice paper comparing findings, basically saying that we're seeing the key features that are needed for diagnosing cancer. That was a big milestone for us. We also had submitted IP disclosures and they became the patent applications. Some of them have been licensed by a startup company and the company is really trying hard to make this technology as a commercial product, so they can be widely usable in clinics around the world.

Unfortunately, skin cancer has plagued me my whole life and I actually have a smartphone picture taken every time I go see Dr. Curiel. It is tough for patients to have to get a biopsy everytime. 

In a person like Dr. Curiel, I mean she's the world's expert on your basal cell carcinoma and other skin cancers. When she makes the call as to whether you need to be biopsied or not, she's really accurate. She's not really wasting or unnecessarily biopsying too many lesions. For the other less experienced dermatologists, the chances are that they take biopsies, but it turns out that it didn't have to be biopsied. That can be pretty frustrating for the patient, and for the healthcare system. That is one of the problems that we're trying to address.

It is really cool that you are able to have these collaborations with people and fields that you might not necessarily have seen yourself working with. 

I was very fortunate to be able to find Dr. Curiel as my collaborator. That intention that we have to collaborate with researchers from different backgrounds and disciplines is very strong here. We have this “let's go” kind of mindset, so once you have a device, then we just make it happen. University of Arizona IRB has been fantastic to me, and I think it's the best IRB in the world. 

I think a lot of people don't understand that you can have the smartest engineers, scientists, researchers there are, but if you don't have the support systems, infrastructure, the buildings, the equipment, and the core facilities to help you, it doesn't always tell the story well enough of how that enables you to do your job. 

Another positive thing about the U of A is that we have so many successful, well recognized biomedical optics researchers at the university, such as Dr. Barton. We have a really nice group of people working on biomedical optics, not necessarily the exact same thing, but we have this group that addresses a similar issue as a community, rather than individuals. I think that's another strong aspect about BIO5 and U of A in general. 

After hearing about some of the technology that you're working with and thinking about, I believe a researcher at Manchester reached out and thought “maybe this can be a collaboration for the work I'm doing on corneal ulcers” so what is going on with that? 

In 2019 I got a random email from this ophthalmologist at the University of Manchester in the UK. She was asking me whether we could collaborate. My collaborator and I stood there and she did fantastic clinical work in India, where she put this very expensive, confocal microscope and took a look at the eye of these patients with corneal ulcers. As she demonstrated with this non-invasive imaging technology, we could target those different types of the corneal ulcers correctly. We joined forces together and sort of put together grant applications and we finally got funded as of January this year from the NIH. Now we're putting together a portable invivo confocal ophthalmoscope which I call a pico. We are generating this pico device with the goal of addressing corneal ulcer diagnosis and treatment issues in low resource settings. Corneal ulcers happen quite often in places like India, where people need to go out in the field and do agriculture on the job, and they scratch their cornea. That is when the fungi, the bacteria, and the parasites can grow on them and there's not necessarily a good way of diagnosing it in a timely manner. 

Well, I think that's amazing that  again you're, not only are you just taking it at face value, but you're looking at where the need is greatest and really trying to make sure that those areas are addressed as well.

I was very fortunate that I got approached by all these amazing collaborators. Obviously I'm not a clinician so I don't really understand the problem, but I was very lucky to work with the world's best experts in the field and they bring clinical expertise and interest and I bring in a technology solution, so it's just the best marriage ever.

As you said, you're not a clinician so you may not understand the problem, but what you bring is the prospective solution, and so that is a perfect marriage. That's really exciting how you're also teaching and you know both are full time jobs in and of themselves.

That's another aspect that I didn't know that I would like so much before I joined the U of A. It's been really wonderful working with young minds, young engineers, so I love teaching. I've been teaching biomedical engineering courses. One was for the juniors and now I'm teaching a graduate senior course. It's really wonderful and I don't know if you have noticed it, but I tend to be very chatty and I like talking a lot. I started doing this new thing called “DK’s coffee hour” so every Friday at 8am I scheduled a one on one chat with one of my students. Obviously I buy the coffee and we talk about random things. Sometimes we talk about our favorite Netflix and TV shows, and any movies we've been watching and so on, but you know oftentimes we talk about careers. I obviously don't know everything, but I can give some idea about all devices as to what they are trying to do. I started doing it with students who were working in my lab, but then I kind of ran out of them, so I opened it up for any students that take my courses and then I just opened it up to anyone who's interested at the U of A. That coffee hour is more of entertainment for me, than for them, so I thank them for their time because I love hearing about their story, and what they're interested in rather than my boring life.

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