Digital Pathology in a Web-based System to Study

Renal Disease in Animals Worldwide

George E. Lees, DVM, MSSmall Animal Clinical Sciences

Texas A&M University

Outline of Presentation

• Background– Our challenges

• Goals & strategies– Our vision

• Implementation– Our steps forward

• Achievements– Our resultant solution

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

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

International Veterinary Renal Pathology Initiative

• Conceived in January, 2005

• Planning and development, 2005 2008

• Funding began January, 2008

International Veterinary Renal Pathology Initiative

Goals

• 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

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

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

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

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)

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

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)

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.

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

AchievementsHave Built A Core Infrastructure

That 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

Achievements‘Proof 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 > 275 cases so far– All are in the database already

AcknowledgmentsMany Contributors

• The organizing committee

• The sponsoring organization

• The financial sponsors

• The Prelude Dynamics team

• The Aperio team

• The TVRPS team

Veterinary Renal Pathology InitiativeThe Sponsoring Organization

The World Small Animal Veterinary Association

http://www.wsava.org

WSAVA Renal Pathology InitiativeThe Financial Sponsors

• Hills’ Pet Nutrition

• Bayer Animal Health

http://www.bayer-ah.comhttp://www.hillspet.com

Veterinary Renal Pathology InitiativeThe Prelude Dynamics Team

• Richard Tieken

• Alicia Browner

www.PreludeDynamics.com

Veterinary Renal Pathology InitiativeThe Aperio Team

• Mark Wrenn

• Many others

http://www.aperio.com

Veterinary Renal Pathology InitiativeThe TVRPS Team

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

Questions?

glees@cvm.tamu.edu