Digital Pathology in a Webbased System to Study Renal Disease in Animals Worldwide

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Digital Pathology in a Web-based System to Study
Renal Disease in Animals Worldwide
George E. Lees, DVM, MS Small Animal Clinical
Sciences Texas AM University
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Outline of Presentation

• Background
• Our challenges
• Goals strategies
• Our vision
• Implementation
• Our steps forward
• Achievements
• Our resultant solution

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BackgroundThe Challenges

• Renal pathology a specialized field with 2
  crucial features
• Specimen analysis routinely includes LM, TEM, and
  IF
• Diagnosis requires integration of pathologic
  findings with clinical information

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BackgroundThe Challenges

• Veterinary renal pathology status of the field
  (in 2005)
• Diagnostic standards lacking
• TEM and IF rarely done
• Few experts, widely scattered
• Historically, poor integration of clinical and
  pathologic findings

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International Veterinary Renal Pathology
Initiative

• Conceived in January, 2005
• Planning and development, 2005 ? 2008
• Funding began January, 2008

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International Veterinary Renal Pathology
InitiativeGoals

• Develop promulgate standards for diagnosis of
  kidney diseases in veterinary (animal) patients
• Facilitate prospective clinical studies (eg,
  therapeutic trials) in animal patients with
  well-defined kidney diseases

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Veterinary Renal Pathology InitiativeStrategies

• Study cases prospectively
• No archive of suitable cases exists
• Create a few specialized specimen evaluation
  centers
• Diagnostic Renal Pathology Centers
• Do a discrete study as a context in which to
  build infrastructure
• Start with canine glomerular disease

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Veterinary Renal Pathology InitiativeStrategies

• Gather cases from many localities
• An international, multi-center enterprise
• Evaluate informative cases
• Biopsies obtained early in disease
• Systematically collect and assess clinical
  information
• In concert with pathologic evaluations

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Veterinary Renal Pathology InitiativeStrategies

• All pathology (LM, TEM, IF) in digital form
• With high resolution sufficient for diagnosis
• On readily available viewing platforms
• Enable web-based case evaluation
• Clinical pathologic findings ? diagnosis
• Online conferencing for collaborative efforts
• Meet effectively and often with little cost

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ImplementationKey Steps

• Proof of concept (2005 2007)
• Started a prototype DRPC (at TAMU)
• Used Vision (Prelude Dynamics) to
• build an online pathology part for
• Communication with users
• Communication among providers
• Database and image archive
• Financial support obtained (2008)

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ImplementationKey Steps

• Started a second DRPC
• At Utrecht Univ., The Netherlands
• Added Aperio digital pathology
• ScanScopes
• ScanScope CS, with oil option at TAMU
• ScanScope XT, 2 at UU Medical Center
• Spectrum Plus and a DSR
• At both sites configured identically
• ImageScope
• For viewing, annotations, and DSC

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ImplementationKey Steps

• Enhanced the Vision system by
• Adding a robust clinical part
• Adding an interface w/ Spectrum
• Data from Vision into Spectrum
• Images on DSRs seen via Vision
• Use online conferencing for
• Frequent meetings without travel
• Voice communications (VoIP)

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AchievementsOur Solution The Concept

• To address our 3 key functional needs
• Multi-center data capture
• Digital pathology
• Online conferencing
• We used 3 separate but complementary systems (one
  especially well-designed for each of our 3 needs)
  and combined them in an innovative and effective
  way.

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AchievementsOur Solution An Admixture of

• Vision (Prelude Dynamics)
• A robust platform to gather and manage clinical
  and pathologic data from multiple sites
• Aperio digital pathology
• Effectively delivers high-resolution images (LM,
  TEM, IF) to all users and facilitates
  collaborative evaluation
• GoToMeeting (Citrix)
• Effective, cost-efficient online conferencing

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AchievementsHave Built A Core InfrastructureThat
Can

• Be expanded very readily
• Add new DRPCs as they are created
• Function as a simple registry of all cases
  submitted to the DRPCs
• Suitable for some kinds of studies
• Simultaneously be used to conduct prospective
  investigations that have specific study protocols

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AchievementsProof of Concept Start-up

• We have developed and tested the processes
  required to competently operate a DRPC
• Provide biopsy kits
• Receive and process samples
• Prepare and examine sections
• Report findings in a timely manner
• We have evaluated gt 275 cases so far
• All are in the database already

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AcknowledgmentsMany Contributors

• The organizing committee
• The sponsoring organization
• The financial sponsors
• The Prelude Dynamics team
• The Aperio team
• The TVRPS team

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Veterinary Renal Pathology InitiativeThe
Organizing Committee

• G. Lees
• C. Brown
• B. Spangler
• K. Shirota
• J. Jansen
• R. Heiene

• C. Brovida
• D. Polzin
• L. Cowgill
• S. Vaden
• A. van Dongen
• J. Elliott

and R. Goldschmeding, MD
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Veterinary Renal Pathology InitiativeThe
Sponsoring Organization
The World Small Animal Veterinary Association
http//www.wsava.org
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WSAVA Renal Pathology InitiativeThe Financial
Sponsors

• Hills Pet Nutrition

• Bayer Animal Health

http//www.bayer-ah.com
http//www.hillspet.com
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Veterinary Renal Pathology InitiativeThe Prelude
Dynamics Team

• Richard Tieken
• Alicia Browner

www.PreludeDynamics.com
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Veterinary Renal Pathology InitiativeThe Aperio
Team

• Mark Wrenn
• Many others

http//www.aperio.com
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Veterinary Renal Pathology InitiativeThe TVRPS
Team

• George E. Lees
• Brian R. Berridge
• Fred J. Clubb, Jr.
• Mary Sanders
• And many helpers

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Questions?
glees_at_cvm.tamu.edu