VisionTek live digital microscope

Transcription

1 VisionTek live digital microscope User experiences; live routine microscopy enters the digital world SMART Automation, maximizing productivity

2 This new technology provides the perfect solution to the current limitations in the acquisition, processing and sharing of information: a revolution in histopathology similar to the one experienced by radiologists a few years ago when digital images were replacing X-ray films. In conclusion, in our department there is an era before and after the introduction of the VisionTek. This system is so flexible, simple and robust that we can no longer do without it. Prof. Pierre Brousset, Head of the Department of Pathology, Institut Universitaire du Cancer (IUC)

3 USER EXPERIENCES; LIVE ROUTINE MICROSCOPY ENTERS THE DIGITAL WORLD Bringing live routine microscopy to the new digital world, Sakura Finetek proudly introduces the VisionTek live digital microscope, the first of its kind. With this collection of interviews, various user experiences from European pathologists are highlighted. We would like to give you the opportunity to take a closer look at laboratories that have integrated the VisionTek in their daily routine. The VisionTek is specifically designed with the routine workflow of the pathologist in mind. As a result of this focus, the VisionTek fits the needs of all pathologists. The logical, user friendly software offers the most important features for daily use; diagnosis, sharing, consulting and archiving are made easy. The pathologist is in complete control. The VisionTek is a perfect hybrid solution, where all the true benefits of digital imaging are being combined with the excellent live view of the regular light microscopy. The high-end motorized, digital microscope captures real-time images, for live viewing and precise measurements, all within seconds. The live multiview mode is perfect for complex cases, displaying multiple slides and stains on one screen. This not only optimizes the workflow, but can significantly decrease diagnostic time. Live sharing of images has never been easier; the large, high-definition screen displays extensive details, which can be viewed alone or together. The snapshot option is a powerful tool for creating instant, high resolution pictures of single slide or multi-views, which can be used directly in presentations. The perfect digital solution for consulting or informing offsite colleagues. The VisionTek is a live digital microscope including scanner capabilities, for scanning whole and partial slides. The pathologist now has complete control of the entire recording process, and decides what, where and how to scan. The perfect diagnostic tool for the pathologist.

4 VisionTek DIAGNOSE For precise and expert diagnosis a detailed, crystal sharp image is essential. Through the high quality Carl Zeiss objectives and high resolution cameras, a superb live image is created and presented on the widescreen monitor. Contrary to current scanners, all displayed images are live and digital and do not need to be stored in advance. With live images diagnostic tools, like real-time annotations such as distances and area measurements, can be used, without the need to save the image first. In addition to a detailed single live image, there is the possibility to show a multi-view of several live images, together in one screen. This unique feature provides the possibility of presenting different stains, of the same tissue, in one overview. Of course live superimposing can be done within seconds. As a result of this direct comparison, live diagnosis of complex cases is simplified and the time to diagnosis is dramatically reduced. VisionTek SHARE The large high definition monitor provides an amazing live image for diagnosis. The widescreen image can also be used for other purposes. The image can be viewed by all participants on the same high resolution, making face-to-face education direct and more personal than using a multi-head microscope. High resolution snapshots of single or multi-view screens are made, just by the click of your mouse. These are instantly usable, which significantly reduces preparation time for presentations. It is also possible to make a live connection with the VisionTek, presenting the cases live instead of recording them first. VisionTek CONSULT Some difficult and complex cases need an expert or second opinion. When this colleague is within the premises, consulting is easy: the high definition screen makes discussing and diagnosing cases together extremely easy. In many cases the expert colleague will not be in the same department. With the VisionTek, live images can be shared with remote colleagues anywhere: on another floor, building, city or even continent, providing direct access and control of the case to both pathologists in a fully secured, digital way. Due to easy access, tumor boards will benefit optimally from sharing the real-time live slides and cases. The live mode prevents the need for sending physical glass slides by regular post, which is unnecessarily time consuming. All cases can be viewed live and real-time, there is no need to scan the slides first, and sending the extremely large digital files to the receiving party. This will immediately save digital storage capacity for both sender and receiver. The images are also immediately accessible, due to reduced upload and download time.

5 VisionTek ARCHIVE With the VisionTek, the pathologist is in full control of the archiving and storing process. As the VisionTek is a live digital microscope, there is no need to store all the slides before viewing. Every case can be diagnosed live, without wasting scanning time and server space. The pathologist decides if there is a need to archive and if so, which slide or specific area of this slide is important to digitally archive. Current scanners need to scan all the slides in advance, before diagnosis is possible. This process creates an enormous amount of data. With the VisionTek the pathologist decides exactly why and what to scan, therefore the recorded images stay small, always in focus and manageable. There are several options that can be used to record the desired area of interest: screenshots, high resolution snapshots, mini-, whole- or partial- and even z-stacked scanned images. The pathologist decides what, when and how to archive.

6 LIVE DIGITAL MICROSCOPY EMPOWERS THE PATHOLOGIST IN ONCOLOGY Prof. Han van Krieken is Head of the Department of Pathology at the Radboud University Nijmegen Medical Centre in the Netherlands. He is President of the European Society of Pathology and a highly reputable professor and innovator. As an experienced VisionTek user he recognizes the opportunities this recent innovation provides to pathology. Prof. Van Krieken explains why the implementation of this digital microscope is essential for both present and future pathology. The user-friendliness of this digital microscope is one of the first things the professor notices. The VisionTek is unique because the digital microscopic images are shown in real time. The traditional image seen with a light microscope is totally identical to the image appearing on the VisionTek screen. The pathologist is still able to focus within the digital microscopic image in contrast to the image of a scanner which makes this technique also excellent to evaluate cytology. Many applications Certain features of the VisionTek result in an image that is much more similar to the ordinary microscope than a scanned image. Because samples are different everywhere, it is very important that you can adjust the focus. Furthermore, it is very easy to compare different images from the same case, which is something you cannot do with an ordinary microscope. It is very easy to make pictures and measure lesions digitally. I can go on and on about the benefits, he says, smiling. VisionTek use during congresses The digitalization of pathology is still in progress and digital technology is not yet applied everywhere. However, because of its user-friendliness the VisionTek is a great tool to use during congresses and presentations. Prof. Van Krieken illustrates this with his experience on a video conference at the ECP congress 2014 in London, at which live microscopy sessions were discussed using the VisionTek. Initially some pathologists where apprehensive, but each user was able to work with it almost immediately. This proves again that the VisionTek is very easy to use.

7 The Department of Pathology at the Radboud University Nijmegen Medical Centre in the Netherlands delivers 60,000 pathology reports per year and employs 16 pathologists and 16 physician assistants. It is one of 54 pathology laboratories in the Netherlands, 8 of which are based in academic centers. Emergency consultation At the Radboud University Nijmegen Medical Centre, the most widely used application in pathology is emergency consultation. The VisionTek is very useful for live consultation with a colleague. You can discuss on the phone while looking at the exact same live microscopic image. I do that a lot in emergency consultations or in very special clinical cases. For example: today I am alone my colleague has a day off so if I need a consultation, I can call him briefly. He then logs in and observes the image directly. This is very convenient, because we have many urgent requests; often in the evening and on weekends. A clinical case Another case with a lifesaving outcome involved a child with impending paraplegia who was suspected to have an osteosarcoma. The pathologist on call needed immediate consultation from a colleague, but the pathologist specialized in cases like this, lives far away. Now we could quickly do this consultation live with the VisionTek. And with success, for the paraplegia has absolutely been avoided because of this fast consulation. Great prospects for pathology Prof. Van Krieken explains how he sees the role of the pathologist now and in the future. With the new techniques, pathology can be even more valuable than it already is. Through the use of new technologies, such as the VisionTek, the pathologist can solve a problem quickly, which makes it more interesting for surgeons to involve pathologists. Our role is becoming increasingly important in decision-making processes as well. In that role, the strength of the pathologist lies in the fact that he communicates directly with many different clinicians; especially for complex clinical cases. I see great prospects for pathology through digitalization, but also through molecular pathology and liquid biopsies. Our knowledge is very important with regards to test results, because the results have become so complex that clinicians often have trouble to interpret them. As a pathologist, we must take up this challenge. Some pathologists continue to focus on all of histopathology, but they cannot offer the clinician what is needed, nor meet their demands. The VisionTek is unique because the digital microscopic images are shown in real time The strength of the pathologist lies in the fact that he communicates directly with many different clinicians In summary, prof. Van Krieken experiences the use of the VisionTek as a supplemental tool in the rapidly developing world of oncology. In addition to new technologies, such as molecular pathology and tumor genetics, digitalization of pathology is an irreversible process: a fact. The digital microscope provides the pathologist many possibilities. It undoubtedly is a new development that in the near future will become indispensable in the pathology laboratory.

8 THE VISIONTEK AS A REMARKABLE NEW ASSET IN DIGITAL PATHOLOGY Dr. Lise Grupe Larsen is one of the three pathologists working at the Naestved section of the Department of Pathology in Region Sjaelland, 90 kilometers east from Copenhagen, Denmark. She has participated in a study on the role of real-time digital microscopy in consultations. The university was convinced by the results of this study and the proven benefits of the VisionTek, representing a completely different approach and added value to digital pathology. At the request of the Department of Pathology at the Rigshospitalet in Copenhagen University Hospital, Dr. Grupe Larsen was involved in a study that aimed to find how real-time digital microscopy can contribute to the workflow of a consultation. The results of the study were remarkable. Not only because the live digital images were of very high quality, but also because the VisionTek provided a lot of convenience and speed compared with a consultation using physical slides. high quality of the images on their screen and the possibility to refocus, due to the fact that the VisionTek is a live microscope. Everyone was very confident to give their diagnosis based on this digital image. They did not doubt for one second. Dr. Grupe Larsen also found that cytological specimens are diagnosed very easily using the VisionTek. Logistics around revision of specimens The project, aiming to improve the logistics around consultation for urological specimens, started with a collaboration with Prof. Ben Vainer, pathologist at the University of Copenhagen. Dr. Grupe Larsen: The main goal of this study was to evaluate whether real-time digital microscopy for urological cancer specimens can substitute physical slide referral and re-assessment. In our hospital we treat many patients with bladder cancer, so that is why it was obvious we were included. When I received a specimen that was suitable for this project, I contacted Ben Vainer via . He then logged in and we discussed the specimen by phone. Working with the VisionTek is very fast: if you want to look at another slide, it literally only takes a few seconds to do this. When we agreed on the diagnosis of a specific specimen, I described our discussion in the report of the patient and finished it. Digital diagnosis with confidence When Dr. Grupe Larsen presented images of the VisionTek to new colleagues in Copenhagen, they were surprised about the

9 Emergency consulting The Danish pathologist is impressed with other uses of the VisionTek as well. For example, in case of emergency consulting, the VisionTek has been of great value to the patient. Dr. Grupe Larsen illustrates this by two clinical cases: A few weeks ago we had a frozen section of a tumor in a testicle of a young man. I thought the tumor was benign, but I was not sure. I asked the surgeon to wait ten more minutes and called my colleague in Copenhagen. We used the VisionTek to quickly share the image, and he agreed with my diagnosis. Thanks to the VisionTek this young man could keep his testicle. Another case involved a woman with rapidly growing bladder cancer, growing into the uterus. It was Friday morning. Consulting was necessary and would take more than a day without the VisionTek. I consulted a colleague and we agreed this was a type of cancer suitable for chemotherapy. In this case, where the patient was very ill, our fast diagnosis allowed the doctor to see the patient the same day instead of after the weekend, three days later. The VisionTek is especially indispensable in a small department with very few pathologists, like in my situation. This new way of working gives me more satisfaction and joy in my work New way of working Dr. Grupe Larsen sees many opportunities for this innovation in order to better organize pathology services, especially in light of the shortage of pathologists in Denmark. Besides; the use of the VisionTek in case of emergency allows for quick consultation when necessary. Moreover, it is also a very pleasant way of working. It is very nice to work with the VisionTek. For example, my work has become a lot more social. To use the VisionTek you have to be more open minded and discuss your opinion. I do admit that, in some cases, it is fine with me that I do not see the expression on a colleague s face when I give my opinion (laughs). I found this new way of working challenging and this absolutely gives me more satisfaction and joy in my work. The Department of Pathology in Region Sjælland, with laboratories at Naestved, Slagelse and Roskilde Hospital in Denmark processes 15,000 pathology reports per year and employs 20 pathologists. It is one of 13 pathology departments in Denmark, with 4 pathology departments in academic centers.

10 LIVE IMAGING: AN IMPORTANT NUANCE IN MULTIDISCIPLINARY ONCOLOGY TEAMS Dr. Arnaud François is pathologist at the University of Rouen in France. He has embraced the diversity of the VisionTek and has integrated it into his daily routine. Many new users emphasize their positive experience with the VisionTek in consulting other pathologists in the diagnostic process. Dr. François sees this as a promising trend. Dr. François: In everyday use, the VisionTek is ideal for multiviewing. It provides a lot of benefits because you can see the different staining techniques side by side on the screen. This allows for a quick assessment and facilitates discussions with colleagues. He illustrated one of the benefits with a specific case where multi-viewing with the VisionTek proved its value: Using the multi-view, we could analyze a biopsy of a child with colitis much more accurately. A histological slide was positive for Epstein-Barr virus (EBV), but we could not localize it on the hybridization. By showing various staining techniques (histology, immunohistochemistry, and in-situ hybridization) side by side, we could pinpoint the cells that had been marked for EBV on the sample. That helped us find the exact location of the infection at a cellular level. The VisionTek made our diagnosis much more precise, allowing a better understanding of disease mechanisms. Small but important advantage Due to the development of many subspecialties within pathology, Dr. François notices a greater need for quick second opinions from specialist colleagues. The VisionTek delivers high quality and convenience: I was used to sending a selection of the digital pictures to a colleague for a first impression. The next day, I would send the actual samples. With the VisionTek, the specialized pathologist can see the entire tissue sample immediately at a remote location. This is a small but important advantage, because it eliminates the risk to miss crucial areas of the lesion. Now the expert can point them out to me, because the whole slide is on a live image.

11 Simplifying logistics The VisionTek also allows for a lot of progress in simplifying the logistics around the analysis. Dr. François illustrates one of the logistics benefits in case of a frozen section: Currently, a frozen section from an external location is brought to the laboratory with an emergency service. This transport causes a delay of about 45 minutes for the sample to be analyzed, while the patient is still in the operating room. With the VisionTek, a technician from our department would be able to work at the hospital where the operation takes place. He could first discuss the macro-resection area with the pathologist by sending him a digital image. The technician could then process the tissue to lightmicroscopy slides and send the full digital images to the pathologist, using the VisionTek. We would then be able to assess the entire region, not just a micro area on a picture, and make a diagnosis without having to travel. This would be a huge time saver, without any quality loss. Added value for logistics and other specialties Dr. François is also very pleased with use of the VisionTek for presentations, both to students as well as to colleagues from other specialties. It is a useful tool for preparing and giving lectures. I find it very pleasant that the scanned files are The Department of Pathology at the University of Rouen is located 140 kilometers west of Paris, France. The department with 19 pathologists (including partial time) processes 25,000 histological samples and over 6,000 cytological samples per year from the university hospital, regional clinics, and hospitals. It is one of 32 pathology laboratories in France that are based in university hospitals. small - less than 150 MB instead of an average of 1.5 GB - which is faster and requires less storage. Besides convenience for my lectures, I also frequently use it in multidisciplinary consultations with other specialists. For example, in our hospital many renaltransplant biopsies are performed. The tissue is delivered to the pathology laboratory in the morning and I send the digital images to the nephrology team in the afternoon. With this approach, the medical team is able to interpret the images themselves while I discuss the specimen with them by phone. This way the pathologist can contribute more accurately to patient care. This new approach also saves a lot of time and makes it easier to make the right decision. Because the clinician now receives the specific images, he knows exactly what I am referring to. This also emphasizes the work of the pathologist as a vital link in the multidisciplinary team of specialists. I find it very pleasant that the scanned files are less than 150 MB instead of an average of 1.5 GB, which is faster and requires less storage This is a huge time saver, without any quality loss

12 NEVER UNDERESTIMATE THE IMPORTANCE OF A SECOND OPINION Digital microscopy is on the rise. Pathologists who work with these novel microscopes, found that assessing compositions by means of a screen is different. Prof. Hermann Herbst, pathologist in Berlin, sees that digitalization is the solution to a major problem in clinical pathology in Germany: the shortage of pathologists. In his experience, digital microscopes are even a necessity for oncopathology, the specialty that is essential for making a correct diagnosis in cancer diagnostics. Prof. Herbst shares his experience working with the VisionTek live digital microscope. Within seconds, the microscopic images that normally are seen through the eyepieces are translated into a three-dimensional digital image, in which the pathologist himself is pushing the buttons. The pathologist stays in control. This innovation offers a range of novel possibilities. Prof. Herbst s experience with using this new live digital microscope illustrate that this innovation opens many doors to necessary development in the work of the pathologist. A quick second opinion The VisionTek is a very important tool in a setting such as, in our case, a network of pathologists. The institute Vivantes Klinikum Neukölln in Berlin works with eleven pathologists at five locations, every location is equipped with its own VisionTek. Each pathologist in this chain is specialized in a different component of pathology. On average, two pathologists are working at each location. The importance of a quick second opinion by a colleague should not be underestimated. If a colleague at his or her location is not available and there is no possibility for consultation, this can lead to loss of quality. The digital microscope resolves this problem because you can instantly share live images with a colleague at a different location. This is the type of standardization I deemed necessary to ensure the quality of our service. Time savings Prof. Herbst found that the VisionTek provides added value to the work of the pathologist: The time you need to load and share a slide is negligible compared with the time savings you get because, for example, you do not need to travel to assess a frozen section or send a microscopic slide to another location. With the VisionTek, it is also possible to remotely access patient cases, so you do not have to travel to diagnose. I do this just from my own office. Furthermore, the images I have viewed for a frozen section are being recorded on video. I keep this video until I have seen all paraffin slides of the patient s tissue. After that, the digital images or video can be deleted. I find that a great advantage of this live digital microscope as well.

13 In Germany there are 1,700 pathologists, 718 in private practices and 596 in hospitals. Prof. Herbst is the director of all Pathology departments of Vivantes in Berlin: the network of all citizen Hospitals in Berlin, East and West. He leads 7 Pathology institutes, including the Center for Stains and Innovation. All 9 departments are CAP accredited since Berlin Serving 9 Vivantes hospitals and 3 external hospitals samples from patients, 400 autopsies 1/3 of the Berlin hospital market It works effectively, efficiently and is beneficial for the workflow Workflow This live digital microscope is the best for consultation, emergency preparations, and second opinions. It works effectively, efficiently and is beneficial for the workflow. I do not need to scan all of my slides, but I would use the VisionTek scanner function for example for immunohistochemistry. The distribution in the workflow of immunohistochemistry used to take half a day. Now scanning takes place at the workplace, the results can directly be distributed to different pathologists through satellites. Security and convenience It is clear that Prof. Herbst experiences the use of the VisionTek as a great benefit. An innovation that not only guarantees quality, but also gives the pathologist a lot of security and convenience. Convenience in the form of time savings and extension of local services. Security because the VisionTek, with its many user benefits, provides liberties within the microscopic world of cancer diagnostics. It is clear that this way of working is an extremely cost effective way, in which the pathologist can remain faithful to the light microscope.

14 THE INDISPENSABLE ROLE OF LIVE IMAGING AT THE RESEARCH CENTER INSTITUT UNIVERSITAIRE DU CANCER The Department of Pathology at the Institut Universitaire du Cancer (IUC) in Toulouse, France is one of the biggest in Europe, employing up to 35 pathologists and 70 technicians and engineers. The IUC is currently setting up a slideimaging platform for the comprehensive cancer research institute located at the Oncopôle, Toulouse. Digital pathology offers enormous potential in increasing the level of service and supporting development of pathology as a specialty. In this article, Prof. Pierre Brousset, Head of the Department of Pathology at the IUC, explains the added value of the VisionTek in research, teaching and routine pathology. His colleague Prof. Emmanuelle Uro-Coste, Deputy Department Head, illustrates this with a few examples of how live imaging contributes to achieving the great ambitions of this prestigious institute. The slide-imaging platform is a joint venture of the Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), the Institut Claudius Regaud (ICR) and the Centre de Recherches en Cancérologie de Toulouse (INSERM CRCT). The concept is based on virtual microscopy, in which the images created by the VisionTek can be perfectly integrated. Prof. Brousset explains that the partnership between these institutes is a breeding ground for a highly effective approach to translational research. This allows a continuum between basic science and health. It has the potential to greatly improve the quality of cancer treatment. The added value of live imaging in digital pathology Prof. Brousset continues: The VisionTek is the most convenient system to increase our expertise. Working with this digital microscope is very intuitive and fast, and the image resolution is more than excellent. By using Microsoft Lync and a remote control software the users can directly assess the remote slide. This system saves a lot of time because it is not necessary to scan the slide. The VisionTek is also very useful for teaching and research meetings. Interesting cases, typical lesions and new markers can be shown consistently in meetings at the pathology laboratory. Expert networks meet every week to discuss difficult or didactically interesting cases. Pathologists can bring their slides and submit them instantly to their colleagues and to other clinicians. Conventional scanners do not provide this facility. Lastly, the VisionTek is frequently used for research meetings. Human tumors, but also animal tissue sections, are presented during joint meetings with physicians and scientists involved in collaborative research projects. Besides the time saved by presenting slides live, the added value of VisionTek is the capability to provide high-quality scanned slides as well.

15 The Department of Pathology at the Institut Universitaire du Cancer (IUC) in Toulouse, France processes 60,000 pathology reports per year and employs 35 pathologists and 70 physician assistants. It is one of 32 pathology laboratories in France that are based in university hospitals. Frozen sections The department operates from three locations; a central laboratory with all facilities and two small laboratories that are mostly in contact with the operating rooms in the two main surgical hospitals in Toulouse. Dozens of frozen sections are processed and interpreted on a daily basis. This requires the pathologists to have broad expertise. To guarantee quality, a VisionTek is installed at every location. Prof. Uro-Coste: On two of the three sites, the pathologist occasionally works alone. We have developed a system that allows us to see which colleague is present at his workplace; it works like a spy. It is reassuring to know you have the possibility of direct consultation with a colleague, so that when you are in doubt, you can still give a good diagnosis. This improves the quality and gives the pathologist more confidence when working alone. Prof. Uro-Coste shares an example where the VisionTek again proved its value: I had a difficult case of a brain tumor. The question was whether it was a metastasis of prostate cancer or a malignant glioma. The slides of the primary prostate cancer from a previous resection were in the central laboratory at the other location. The VisionTek could send the entire sections to me live and digitally. Now we could compare the slides and confirm that it This system is so flexible, simple and robust that we can no longer do without it was a high grade Gleason prostate carcinoma. It was perfect to examine this case this way. It was also a very special case, because it did not look like prostate cancer at all, but the digital slides from the previous resection allowed us to see it was the same tumor after all. And I also do believe that the VisionTek is a good starting point for a smooth transition to digital pathology. New era Prof. Brousset: This new technology provides the perfect solution to the current limitations in the acquisition, processing and sharing of information: a revolution in histopathology similar to the one experienced by radiologists a few years ago when digital images were replacing X-ray films. In conclusion, in our department there is an era before and after the introduction of the VisionTek. This system is so flexible, simple and robust that we can no longer do without it.

16 Apply for a live VisionTek demonstration now Bringing live microscopy to the new digital world, Sakura Finetek proudly introduces: The VisionTek live digital microscope, first of its kind. The VisionTek captures real-time images, for live viewing and precise measurements, all within seconds. The live multi-view mode is perfect for complex cases, displaying multiple slides and stains on one screen, also offering the possibility to (z-stack) scan whole and partial slides. VisionTek optimizes live digital microscopy: Facilitates accurate diagnosis Share live images Direct consultation User determines what and when to archive Are you ready to bring your diagnosis to the digital era? Apply for a live demonstration via visiontek.sakura.eu. Sakura Finetek Europe B.V. B.V. visiontek.sakura.eu