Smart Toilet is on Fire

How smart can a smart toilet be? What about privacy and accuracy?

Today's smart toilets have a variety of eye-catching new features. In addition to toilet seat heating, warm water washing, warm air drying, automatic sterilization, and other functions, the smart toilet can also be used as a small "private clinic" to monitor our physical health indicators in real-time. Our feces and urine carry useful information about life and health, and scientists are also working on some interesting projects to try to interpret this information. Recently, "Nature-Biomedical Engineering" (Nature Biomedical Engineering) magazine published a new study on "smart toilet", this study was completed by a number of Stanford University researchers, and it caused widespread concern. "In addition to the description of the contents of the paper, we are currently developing a method for detecting DNA, RNA modules from urine and feces, which will allow us to screen for diseases of colorectal cancer, urinary tract cancer, and the new coronavirus pneumonia." 

(Source: Nature Biomedical Engineering)

Fifteen years ago, Sanjiv Sam Gambhir, the corresponding author of the paper and a professor at Stanford University, proposed the concept of "Precision Health", emphasizing the continuous prevention and early detection of diseases. "Dr. Gambhir believes that every excrement in humans plays a vital role in health monitoring, especially feces and urine, which are natural, non-invasive excreta,". The smart toilet observes the user's feces through the camera and classifies the feces. The pressure sensor built into the toilet seat monitors the duration of defecation; users who stand and urinate can measure the speed, flow and duration of the urine through the camera. The test strip will automatically extend Into the urine for analysis to determine various chemical indicators and test a variety of substances. In this process, the smart toilet uses computer vision to analyze the user's urine to calculate the urine flow rate and volume and classifies the user's feces according to the deep learning method. According to the paper, the data obtained above will be safely stored in a cloud server, for subsequent analysis, and processing. The unique anal texture and fingerprint can enable users to match their specific health data. Although the smart toilet will scan the anus texture of the user, it will not upload the resulting image to the cloud or share it with the doctor.

The researchers said that this smart toilet can be used for screening, diagnosis and longitudinal monitoring of specific patient groups. At present, the smart toilet can track 10 different biomarkers, such as the number of white blood cells and the content of certain proteins, so as to determine whether the user is healthy or suffering from diseases such as bladder cancer, diabetes, and kidney failure. "Our smart toilet platform is based on clinically relevant analysis and can have far-reaching practical applications in diseases such as benign prostate hyperplasia (BPH), irritable bowel syndrome (IBS), and urinary tract infection (UTI). 

Seung-min Park believes that benign prostatic hyperplasia is common prostatic hyperplasia that occurs with age. 50% of men over the age of 50 have benign prostatic hyperplasia, often resulting in lower urinary tract symptoms due to obstruction of the urethra by prostate tissue LUTS, the urine flow meter is an important tool to quantify urine flow and screen for bladder outlet obstruction, the smart toilet will play an important role in it; urinary tract infection is also a very common for bladder or kidney infection, which can be directly monitored by the smart toilet system; Irritable bowel syndrome is the most common functional gastrointestinal disease, with a global prevalence rate of 10% to 15%, and is also one of the best examples of smart toilet systems that can be used in practice. In addition, the smart toilet system may also have practical applications in other potential fields in the future, such as nucleic acid amplification tests, Pneumocystis carinii, and methamphetamine detection.

Existing and potential application areas of Stanford Smart Toilet (Source: Seung-min Park)

The issue of privacy protection may be one of the concerns that affect the use of the smart toilet. To this end, the researchers will issue users with an encrypted device (including the toilet system) to collect the photos needed for the study; they will also establish a research electronic data collection (REDCap) web form, allowing participants to transfer the photos needed for the study Direct upload; the video and photos collected by the camera in the smart toilet system will be deleted from the camera immediately after being transferred to REDCap or Stanford Medicine Box in real-time. In addition, the researchers also recommend that when not in use, the camera of the smart toilet system must be stored in a safe area, such as a locked drawer. How accurate is the detection of smart toilets?  "The verification accuracy of our smart toilet is very good."

Due to the regulations of the Ethical Review Board (IRB), the diagnostic accuracy of the smart toilet has not been evaluated. However, according to Seung-min Park, the current IRB protocol mainly validates the module against the clinical gold standard. The smart toilet ’s computer vision urine flow measurement and the gold standard Pearson correlation coefficient are 92-96, and the performance of the defecation monitoring module is also comparable to well-trained medical staff.

However, the current version of the smart toilet is not suitable for female users. "We are currently developing proprietary technology to make the system gender-inclusive." Seung-min Park said. Although some modules of the smart toilet are only built for male users who sit and urinate, the research team hopes to continue to improve the smart toilet, starting with larger-scale research and involving more people, so as to expand the scope of application and achieve such as Personalized detection functions such as blood glucose monitoring for diabetic patients. In addition, the researchers also envisage that when a problem occurs, the toilet can be matched with the App to safely pass the data to the user's doctor. However, whether this intelligent toilet system is applicable still needs to be evaluated and optimized through large-scale clinical research. "We hope to release the current version of the smart toilet within 1 to 2 years. We are currently developing a second-generation smart toilet including cancer diagnosis, and we hope that this version will be available in the next 3 to 5 years. In recent years, smart toilets have become the focus of attention. The Rochester Institute of Technology in the United States and the University of Cambridge have also conducted related research on smart toilets.

In March 2019, Nicholas Conn, a postdoctoral fellow at the Rochester Institute of Technology in the United States, developed an intelligent toilet lid monitoring system that can track and measure the health of patients with heart failure and reduce the rate of hospital admissions for patients with congestive heart failure. The intelligent toilet lid data detection has a dedicated advanced algorithm that can capture more than 9 clinically relevant measurement data. The equipment on the toilet lid can monitor data such as human heart rate, blood pressure, blood volume, blood oxygen level, and weight. By analyzing these data through a certain algorithm, if it is found that the patient's condition has a tendency to deteriorate, the information will be directly transmitted to the patient's private doctor, and the doctor will determine whether the patient needs to be arranged for further treatment at the first time. In August 2018, scientists at the University of Cambridge in the United Kingdom designed a smart toilet that can be "urinated". It is understood that the built-in optical sensor of this smart toilet can capture the biomarkers in the urine between the gold nanoparticles and make them emit different colors to measure their concentration levels. The monitored biomarkers can reveal a lot of information about people's body, this smart toilet can also send monitoring reports to mobile phones, and even remind users of private doctors.

In the future, with the rapid development of technology, can smart toilets "fly into ordinary people's homes"? Applicability and privacy are issues that we must consider.