Protocol: revolutionizing central nervous system tumour diagnosis in low- and middle-income countries: an innovative observational study on intraoperative smear and deep learning Authors Muhammad Shakir Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan. Ahmed Altaf Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan. Mahnoor Tariq Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan. Ahmed Gilani Department of Pathology, University of Colorado, Children's Hospital, Colorado, USA. Ihsan Ullah School of Computer Science, University of Galway, Galway, Ireland. Faiza Urooj Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan. Fatima Suleman Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan. Noman Ahmed Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan. Syed Ather Enam Department of Neurosurgery, The Aga Khan University, Karachi, Pakistan DOI: https://doi.org/10.47391/JPMA.S3.GNO-03 Abstract Objective: The aim of this study is to assess the feasibility and implementation of a novel approach forintraoperative brain smears within the operating room, which is augmented with deep learning technology.Materials and methods: This study is designed as an observational to evaluate the feasibility and implementationof using an innovative approach to intraoperative brain smears within the operating room, augmented with deeplearning technology. The study will be conducted at Aga Khan University Hospital in Karachi, Pakistan, from May2024 to July 2026, with an estimated sample size of 258. A neurosurgical trainee, trained by the studyneuropathologist, will prepare and examine the smears under a microscope in the operating room. The findings ofthe trainee will be documented and compared to routine intraoperative consultations (smear and/or frozen section)and final histopathology results obtained from the pathology department. Additionally, the study will incorporateartificial intelligence tools to assist with the interpretation of smear and a telepathology interface to enableconsultation from an off-site neuropathologist.Conclusion: The results of this study will hold significant potential to revolutionise neurosurgery practices in lowandmiddle-income countries by introducing a cost-effective, efficient, and high-quality intraoperative consultationmethod to settings that currently lack the necessary infrastructure and expertise. The implementation of thisinnovative approach has the potential to improve patient outcomes and increase access to intraoperative diagnosis,thereby addressing a significant unmet need in LMICs.Keywords: Artificial Intelligence, Neuropathology, Neurosurgery, Telepathology, Brain, tumour Downloads Full Text Article Published 2024-06-09 How to Cite Muhammad Shakir, Ahmed Altaf, Mahnoor Tariq, Ahmed Gilani, Ihsan Ullah, Faiza Urooj, Fatima Suleman, Noman Ahmed, & Syed Ather Enam. (2024). Protocol: revolutionizing central nervous system tumour diagnosis in low- and middle-income countries: an innovative observational study on intraoperative smear and deep learning. Journal of the Pakistan Medical Association, 74(3 (Supple), S8-S15. https://doi.org/10.47391/JPMA.S3.GNO-03 More Citation Formats ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver Download Citation Endnote/Zotero/Mendeley (RIS) BibTeX Issue Vol. 74 No. 3 (Supple) (2024): AKU Special Supplement: Global Neuro-Oncology Section Research Article License Copyright (c) 2024 Journal of the Pakistan Medical Association This work is licensed under a Creative Commons Attribution 4.0 International License.