Digital Pathology Blog

Remote Microscopy - Cell Phone Microscope Attachment

Came across this at another blog - The Medical Quack through the Medicine 2.0 blog carnival.

Both of these blogs have some excellent content.  The original story was on technologyreview.com last month with its own great items!

Researchers at the University of California, Berkeley, have developed a modular, high-magnification microscope attachment for cell phones. The device will enable health workers in remote, rural areas to take high-resolution images of a patient's blood cells using a cell-phone camera, and then transmit the photos to experts at medical centers. 

The total cost of the first prototype, built from off-the-shelf components, was $75. The current version provides its own sample illumination from cheap, low-power LEDs. The device comes in two versions: with a magnification of about 5 times, for taking images of moles and rashes, and with a magnification of about 60 times, for capturing the details of blood cells and parasites.

The scheme is to train local personnel and provide them with the necessary equipment to take pictures of patients' blood on special slides, and then phone in the images to specialists who can identify and count malaria parasites.

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My comments:

While the device for $75 is very interesting and allows for inexpensive imaging of clinical findings and microscope images, the concept has been around in dermatology and the clinical laboratory for years.  I have a previous posting about resolution with a low-resolution image (by todays standards) of malaria taken through a even lower resolution microscope objective.  This was from 2002. It was taken by an infectious disease fellow for the next days' morning conference.  It could have just as easily been used for consultation.  Is this P. falciparum? on a short e-mail or text message with image attached.  At the same institution dermatology was doing the same between primary care providers "in the field" and dermatology "at the main hospital".  Cameras were provided, web-enabled secure system stood up to upload, download and track who did what when, from where and who saw it when and where, what he/she said and ultimately patient disposition for this encounter. 

Ultimately, these types of consultations (posted as "schemes" above) fail becuase of lack of clinical champion, technophobia on part of consulting physician or an answer of "Yes, that looks like an atypical nevus, we should see the patient ", "You are right, that is a rash, I am not sure based on your history what it is", or "We really need to see the slide to make that diagnosis".  So referring physicians and pathologists go through this half a dozen times or so and think, I will just send the patient or slides and avoid these extra steps if ultimately no triage is going to occur (outside of referral which in some cases probably isn't warranted but remote diagnosis is out of the comfort level of consultant and they are unwilling to be associated with this without laying hands on the patient or slide themselves....).

Web-based tumor reporting system from University of Rochester

I first came across mention of this site at the USCAP meeting this past March. 

Disclaimer from their site:

This tumor reporting system is only intended to be a tool to facilitate the reporting process. The users are expected to use their judgment as to the accuracy and adequacy of information presented here. The owner of this site or its affiliated entities shall not be held liable for any adverse results from use or misuse of the material in this tumor reporting system.

IT Helping Vets Get Back on Feet

from www.eweek.com
By Deb Perelman
2008-04-14

A new program aims to help injured soldiers make a transition into the IT work force. The Department of Defense announced April 5 that a total of 36,082 members of the U.S. military had been wounded in action or killed in Iraq since the war began in 2003. Of these, nearly 4,500 were deaths and 31,950 were wounded. Once they return from the war zone, injured soldiers face a multitude of physical, emotional and professional challenges, the least of which is a startlingly high unemployment rate. In 2005, the jobless rate for veterans between ages 20 and 24 was 15.6 percent, more than triple the national unemployment rate of 5.1 percent, and a number that skyrockets for the injured. Carl Stephenson, coordinator of a training program at Walter Reed Hospital in Washington that helps injured soldiers at Walter Reed get back on their feet, said he has seen this unfolding firsthand. "When they're discharged, they've got the VA [Department of Veterans Affairs] on one side of them and the Department of Labor on the other and they're stuck in the middle. Some fell through the cracks. I wanted to know what we could do to help," Stephenson said. Walter Reed's EEOO (Equal Employment Opportunity Office) offers classes to help prepare injured veterans, individuals who may not have otherwise been able to go back to work, for careers in IT and tech support. The soldiers, Stephenson said, were more than ready for ways to use their time constructively. "Some of them had been at Walter Reed for close to two years, and they were bored to death. There was nothing to do but to heal," Stephenson said. The pilot program launched 18 months ago with 12 students who were using Microsoft-provided materials to learn to be entry-level desktop service technicians. However, Stephenson quickly realized that the students—many of whom had memory problems, post-traumatic stress disorder and other challenges—were getting lost and frustrated. "We knew if we were going to get them through the certification exam, they'd need more help. We had to redesign the course to accommodate the disabilities we had in the room—we put in more screenshots and went over points much more thoroughly," Stephenson said. The Walter Reed EEOO announced April 14 a partnership with Cisco's WebEx Communications, which is providing its Online Classroom application to continue veterans' education post-discharge. "These veterans were doing some of the coursework and then being discharged and couldn't finish up what they started. What Walter Reed is doing now [is] reaching out to these vets at home too," Bob Lee, manager of Learning Solutions at WebEx, told eWEEK. The program is now far more than a path to Microsoft certification. Injured soldiers can stay on and get as many certifications as they need. "Most members are retired officers who have little experience in a corporate environment, and are trying to survive on what little they do know. We're hoping to make this as easy as possible," Stephenson said.

CMS launches PHR pilot for Medicare beneficiaries

By  Richard Pizzi, Associate Editor  05/07/08  Healthcare IT News

The Centers for Medicare & Medicaid Services this week announced a new pilot project that encourages traditional Medicare beneficiaries to use an online Personal Health Record to track their healthcare services and better communicate with their providers.

The CMS pilot - which will take place in South Carolina - gives Medicare beneficiaries the ability to collect and access information about their health or healthcare services, such as medical conditions, hospitalizations, doctor visits and medications.

CMS claims that strict privacy and security safeguards will protect all beneficiary data, and affirmed that the PHRs would be under the control of patients.

"By using a PHR, patients with the pilot will have easy access to personalized medical information that will enable them to be more involved with their healthcare services," said Kerry Weems, CMS Acting Administrator."The steps we are taking today will help CMS understand how to best educate beneficiaries on the use of a PHR so that we can encourage use of these tools in the future."

Medicare beneficiaries participating in the pilot will be given an opportunity to use a PHR populated by their own claims data. Information from hospital and provider medical claims will be automatically entered into the PHR once the individual registers and requests the data. Each beneficiary will control who is able to see the information in the PHR, and can decide whether and with whom the information can be shared.

CMS representatives said prescription drug information, even for individuals who participate with a Part D Drug Plan, would not be automatically entered into the PHR, but individuals could choose to enter their own prescription drug and over-the-counter medications into the PHR.

The pilot project's PHR also allows individuals to look up information specific to their own personal health status and health conditions. CMS said that the PHR tool provides links to "carefully selected" Web sites with educational material on health topics, which would allow beneficiaries or other authorized users to do research on health issues and better manage their care.

The pilot began on April 4, 2008, and is expected to run for 12 months. CMS plans to use information gathered from the pilot to determine future steps with respect to PHRs.

The PHR tool selected for the South Carolina pilot is offered by HealthTrio, which currently offers PHRs to patients through employer contracts. The Medicare data will be provided through Palmetto GBA, a Medicare contractor serving the region. Gaithersburg, Md. -based firm QSSI is managing the pilot, which has been termed "MyPHRSC" ("SC" standing for South Carolina. ).

The South Carolina PHR pilot follows close on the heels of another initiative launched in June of 2007, where CMS is collaborating with seven health plans to test the use of PHRs for beneficiaries who are enrolled in a Medicare Advantage or Part D Prescription Drug Plan.

Currently, Medicare beneficiaries are able to receive some personalized information about their Medicare benefits and services at the MyMedicare. gov page on www.medicare.gov. However, CMS officials say a PHR can provide additional support for people with Medicare, because the technology provides access to a fuller, more comprehensive view of medical history, along with interactive educational resources.

Participation in the pilot is voluntary, and interested patients can enroll online at www.MyPHRSC.com and at local events in South Carolina.

The demand for lab scientists growing

03/10/2008
Fort Worth Star-Telegram - Online

FORT WORTH -- The economy may be sick, but laboratory-loving science types have never had it better.
Aging baby boomers are helping drive the demand for lab tests, and the programs that train people to work with the technology report a healthy demand.

'They're starting out at about $25 an hour,' said Sally Lewis, who heads Tarleton State University's clinical laboratory sciences department in Fort Worth. 'The salaries are incredible, and nobody knows.'

Tarleton's clinical laboratory science program draws students from as far away as California and Florida and graduates about 30 students a year. Classes start in July and January. It's one of only two such programs in North Texas.

Job possibilities for certified clinical laboratory scientists include instrument sales and service, and forensic, veterinary, research, hospital and reference laboratories. Qualified scientists can earn $70,000 with a few years' experience, Lewis said.

'Lab managers can be more,' Lewis said. 'The people who are very valuable are CLS people who go on to get a Ph.D. in molecular biology. If you want to continue, it's a great stepping stone.'

Many program graduates quickly move into sales positions because the people who sell high-tech lab gear need expertise in the field, said Karen Murray, Tarleton's Fort Worth-based assistant vice president for academic affairs and outreach coordinator.

The demand isn't limited to Texas. The American Society of Clinical Pathology's Web site showed openings from Berkeley to Baltimore, as well as jobs at the Centers for Disease Control and Prevention for senior laboratory experts willing to work with AIDS programs in places such as Nigeria and Vietnam.

About half the enrollees have degrees when admitted to the programs, but undergraduates can use program requirements to complete their Tarleton degrees. Students at other universities can also arrange to receive degrees through their schools after completing classes in Fort Worth.

Danielle LaVista, 22, was on the road to medical school but got put on the wait list after graduating from Tarleton with a degree in biomedical science last year. Now, she's in the clinical laboratory sciences program and loving it.

'This is the next-best thing,' LaVista said. 'It sounds like everybody who graduates is going to get a job.'

Altered Cytoplasmic-to-Nuclear Ratio of Survivin Is a Prognostic Indicator in Breast Cancer

Clinical Cancer Research 14, 2681-2689, May 1, 2008. doi: 10.1158/1078-0432.CCR-07-1760
© 2008 American Association for Cancer Research

Donal J. Brennan1, Elton Rexhepaj1, Sallyann L. O'Brien1, Elaine McSherry1, Darran P. O'Connor1, Ailís Fagan2, Aedín C. Culhane4, Desmond G. Higgins2, Karin Jirstrom4, Robert C. Millikan6, Goran Landberg4, Michael J. Duffy2,3, Stephen M. Hewitt7 and William M. Gallagher1

Authors' Affiliations: 1 UCD School of Biomolecular and Biomedical Science and 2 UCD School of Medicine and Medical Science, UCD Conway Institute, University College Dublin; 3 Department of Pathology and Laboratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; 4 Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts; 5 Center for Molecular Pathology, Department of Laboratory Medicine, Lund University, Malmö University Hospital, Malmö, Sweden; 6 Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina; and 7 Tissue Array Research Program, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland

Requests for reprints: William M. Gallagher, UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland. Phone: 353-1-7166743; Fax: 353-1-2837211; E-mail: william.gallagher@ucd.ie.

Purpose: Survivin (BIRC5) is a promising tumor biomarker. Conflicting data exist on its prognostic effect in breast cancer. These data may at least be partly due to the manual interpretation of immunohistochemical staining, especially as survivin can be located in both the nucleus and cytoplasm. Quantitative determination of survivin expression using image analysis offers the opportunity to develop alternative scoring models for survivin immunohistochemistry. Here, we present such a model.

Experimental Design: A breast cancer tissue microarray containing 102 tumors was stained with an anti-survivin antibody. Whole-slide scanning was used to capture high-resolution images. These images were analyzed using automated algorithms to quantify the staining.

Results: Increased nuclear, but not cytoplasmic, survivin was associated with a reduced overall survival (OS; P = 0.038) and disease-specific survival (P = 0.0015). A high cytoplasmic-to-nuclear ratio (CNR) of survivin was associated with improved OS (P = 0.005) and disease-specific survival (P = 0.05). Multivariate analysis revealed that the survivin CNR was an independent predictor of OS (hazard ratio, 0.09; 95% confidence interval, 0.01-0.76; P = 0.027). A survivin CNR of >5 correlated positively with estrogen receptor (P = 0.019) and progesterone receptor (P = 0.033) levels, whereas it was negatively associated with Ki-67 expression (P = 0.04), p53 status (P = 0.005), and c-myc amplification (P = 0.016).

Conclusion: Different prognostic information is supplied by nuclear and cytoplasmic survivin in breast cancer. Nuclear survivin is a poor prognostic marker in breast cancer. Moreover, CNR of survivin, as determined by image analysis, is an independent prognostic factor.

Kodak Posts $114M Loss

ROCHESTER, N.Y., May 1, 2008 -- Eastman Kodak Co. today reported a first-quarter loss of $114 million, or 40 cents a share, on sales of $2.09 billion. Total sales were up slightly -- one percent -- from the first quarter of 2007, and losses improved from the $175 million, or 61 cents a share, posted one year ago.

Kodak said its digital revenue was up 10 percent to $1.36 billion, while its traditional film-based revenues continued to decline, down 13 percent to $724 million, compared to $830 million a year ago. The company has posted profits in four of the last six quarters as it continues to make the transition from film to digital photography (See: Kodak Q4 Profits Rise). 

"Our first-quarter results are very much in line with our expectations, which included forecasted seasonality, and provide an early indication that Kodak is on a growth track," said Antonio M. Perez, chairman and CEO, Eastman Kodak. "We delivered strong performance across our major digital businesses, reinforcing our confidence in achieving our revenue, earnings and cash goals for the year."

The company's gross profit margin decreased from 20.6 percent a year ago to 20.3 percent, primarily due to increases in silver, aluminum and other raw material costs, as well as continued investment in its consumer ink-jet business, Kodak said.

Digital cameras and picture frames increased Consumer Digital Imaging Group sales for the quarter by 20 percent, to $554 million, over a year ago, but losses for the segment increased from $75 million in 2007 to $111 million. Kodak said the increased loss was driven by planned investment in the ink-jet business.

Sales in the Graphic Communications Group were $812 million, up four percent from a year ago, but the segment posted a loss of $1 million, compared to earnings of $9 million in 2007, primarily because of increased raw material costs and research and development costs for its ink-jet printing business, Kodak said.

The company said it expects total revenue for 2008 will be up as much as 2 percent, digital revenues to increase by seven to 10 percent and earnings from continuing operations in the range of $250 million to $275 million.

For more information, visit: www.kodak.com

Pathologists’ victory in fair compensation lawsuit to stand

The latest development in a lengthy legal battle concerning fair compensation for physicians is good news for pathologists—and marks another victory for the Litigation Center of the AMA and state medical societies.

A Florida court of appeals ruled last month that Health Options Inc. (HOI), a health maintenance organization (HMO) subsidiary of Blue Cross Blue Shield of Florida, must pay pathologists with Palmetto Pathology Services in a case centered on the reasonable value of their services. The ruling upholds a jury decision to award more than $1.5 million to the pathologists after HOI refused to pay them for professional clinical pathology laboratory services they performed at two hospitals within HOI’s network.

The Litigation Center assisted with the interpretation of various Current Procedural Terminology (CPT^®) codes at issue in the trial and joined the College of American Pathologists in filing an amicus curiae, or “friend-of-the-court,” brief in support of the pathologists during the appeal process.

The case is one of 14 different lawsuits, some of which were consolidated, in which 11 separate pathology groups sued three HMOs in Florida courts. At issue in the suits is whether Florida law requires HMOs to pay out-of-network pathologists based at in-network hospitals for hospital-based services. The Litigation Center is supporting the lawsuits because the AMA believes that physicians should be fairly compensated for their professional services.

Download (PDF, 66KB) a copy of the opinion.

First Diagnostic Test for Alzheimer's and Parkinson’s Disease Available Late 2008

First Diagnostic Test for Alzheimer's and Parkinson’s Disease Available Late 2008
A new blood test has been developed by a company that claims it can give an early diagnosis of neurodegenerative disease and distinguish between Parkinson’s and Alzheimer’s disease. The test, called NuroPro, comes from Power3Medical Products , an Oklahoma-based proteomics company.

Power3 Medical Products has identified and patented several blood proteins associated with neurodegenerative disease. NuroPro measures a suite of 59 protein biomarkers, the relative levels of which can help distinguish between Parkinson’s, Alzheimer’s and Lou Gehrig’s disease, or tell if a patient is disease-free. The company says the test is highly accurate, with a specificity and sensitivity in the high 90s.

“There is currently no diagnostic test for any neurodegenerative disease on the market—diagnoses are currently based solely on a clinical diagnosis of symptoms,” said Power3Medical CEO, Steve Rash.

Two clinical validation studies are currently underway at the Cleo Roberts Center of Clinical Research in Arizona in the United States and at the Research Institute of Thessaly in Greece. The U.S. clinical validation study includes one hundred Alzheimer’s disease patients, one hundred Parkinson’s disease patients, and one hundred controls. Power3Medical Products plans to sell the test when the clinical trials are finished. It should be available in Greece by Q3 of 2008 and in the U.S. market by late Q3 or Q4 of 2008.

According to the Alzheimer's Association, as many as 5.2 million people in the United States are living with Alzheimer’s. It is predicted that 10 million baby boomers will develop Alzheimer’s in their lifetime. Furthermore, the direct and indirect costs of Alzheimer’s and other dementias to Medicare, Medicaid, and businesses amount to more than $148 billion each year.

Pathologists and lab directors will want to monitor the arrival of this test in the clinical marketplace. It is an example of how multi-analyte assays, based on genomic or proteomic technology, promise to deliver new tools for diagnosing disease. Should the test demonstrate effectiveness in its clinical studies, there is likely to be significant demand for it. Because the symptoms of Alzheimer’s, Parkinson’s, and other neurodegenerative diseases are easily confused with the normal effects of old age, a test that can provide an accurate diagnosis is likely to be accepted and used by clinicians.

Related Articles:

First diagnostic test for Alzheimer's and Parkinson's disease on the horizon

Power3 Medical Initiates Three Hundred Patient Clinical Validation Study of Its Nuropro® Diagnostic Test for Alzheimer's and Parkinson's Disease

Study assesses blood test for Alzheimer’s and Parkinson’s

AMD Telemedicine Explores the Role of Telemedicine During Disasters

Noted Emergency Physician Richard Aghababian, MD, Discusses the Benefits of Telemedicine Use at Disaster Scenes.

N. Chelmsford, MA (PRWEB) April 23, 2008 -- Executives at AMD Telemedicine, the leader in telemedicine hardware and software solutions with over 5,000 installations in more than 72 countries, today announced that a discussion on the value of telemedicine during a disaster with noted emergency medicine physician, Richard Aghababian, MD, was now available on the AMD web site.

Unlike day to day (emergent) operations in which a whole team works together to save one life, in disaster medicine, there can be many more victims than one's immediate resources can handle. So that takes a different mindset. One has to switch from everything for one to best outcomes for the group   
Dr. Aghababian, a fellow of the American College of Emergency Physicians (FACEP), an Associate Dean for Continuing Medical Education at the University of Massachusetts Medical School (UMMC), past Chairman of the Department of Emergency Medicine at the University of Massachusetts Medical School and past president of the American College of Emergency Physicians (ACEP) explains that telemedicine can play a vital role in the triage process, which is often a critical tool at disaster scenes.

"Unlike day to day (emergent) operations in which a whole team works together to save one life, in disaster medicine, there can be many more victims than one's immediate resources can handle. So that takes a different mindset. One has to switch from everything for one to best outcomes for the group," said Dr. Aghababian. "(One has to determine) how to best allocate resources to do the greatest good for the greatest number. (In this process) triage is an important facet -- the ability to determine who, with immediate treatment will live, and who might not, and who can wait for treatment for a while. Telemedicine can be of great help here to identify and understand patterns of injury, as well as to access information and experience on treatment"

Noting that preparedness is the key to successful response, Dr. Aghababian also discusses how telemedicine training can be vital prior to a disaster and what that training would entail.

"Dr. Aghababian's considered opinion is another vote of support for the value of telemedicine," said Steven Normandin, president of AMD Telemedicine. " A true aid in the triage process, telemedicine can not only provide a critical, visual link between a disaster site and experienced medical personnel at a distant facility, but it can also be a conduit of vital patient data to enable life-saving treatment to begin right in the field."

To view Dr. Aghababian's comments on the role of telemedicine in disasters, visit the AMD Telemedicine web site at http://www.amdtelemedicine.com/DrA.html .

About AMD Telemedicine
AMD Telemedicine is the leading, worldwide supplier of telemedicine equipment and technology devices used in telemedicine with more than 5,000 installed sites in 72 countries. AMD hardware and software products offer clinically acclaimed, cost-effective solutions for the most challenging medical applications. AMD also provides complete technical support in program design, device integration, training, and remedial service to assure a successful program implementation. For more information on AMD Telemedicine, please visit http://www.amdtelemedicine.com/, email us at pr @ amdtelemedicine .com or call          866-511-0923       .