Path Diagnostics is a mid-sized diagnostics lab based out of Phnom Penh, founded by the enterprising Dr. Vitou. It is run by a 10 member team and provides H&E, Cytology and IHC services, handling 30+ cases per day.
In the year 2020, Dr Vitou decided to move to Paris for a year for an assignment. However, he didn’t want to stop work on his pathology business in Cambodia. His interest was to continue applying his competency in Histopathology and keep up with his practice. Therefore, even after hiring a pathologist to take his place in the lab, he wanted to continue providing opinions on the pipeline of cases at his lab. This scenario got him curious about possible ways to carry out diagnoses remotely. Making weekly trips from Paris was definitely not an option.
The closest option with some level of feasibility involved pairing a lab microscope with a smartphone camera, and carrying out the diagnoses on a live video call with the help of a technician . While it may have a high element of frugality, this solution had some considerable drawbacks.
First, pathology is a matter of extreme importance for the patient, and the pathologist has to be empowered with all the tools to perform the diagnosis in a satisfactory manner. This includes the ability to see the full slide as clearly as possible. However, in a video call, the image quality over a smartphone can be questionable, even if one ignores the internet connectivity issues. It certainly can’t compete with the raw experience of the human eye on a microscope.
Second, to maintain good quality, Dr Vitou would have had to maintain real time communication with the technician with clearly defined markers on the microscope. Navigating an un-demarcated region with directional instructions can be a real challenge. It would not be very different from guiding an Uber driver with a bad phone line!
Third, the Paris and Phnom Penh time zones are a full five hours apart! Hiring good talent is often a devious task. Getting and retaining well trained technicians for operations in such circumstances can be a costly affair, in terms of money and/or time.
Finally, and probably the most important reason: with such a precarious process, the chances of missing a region on every slide could become a significant risk. This could lead to mis-diagnosis and pose significant health and life risks to the patients.
To avoid the above mentioned risks and challenges, Dr. Vitou decided to explore the option of getting a whole slide scanner and reached out to Morphle Labs. Fortunately, Morphle scanners seamlessly solve the above mentioned problems.
First, with AI-assisted scanning, scanned images have crystal clear quality. Second, the entire slide is available with magnifications ranging from as low as 0.3x to as high as 80x , eliminating the need for real time communication between Dr Vitou and the technician. Third, the slides are stored in the same computer that drives the scanner, and on an average less than 500 MB thanks to Morphle’s proprietary loss-less compression technology. Dr Vitou could access them remotely anytime he wishes to. Also, the entire slide doesn’t need to be downloaded, and only a small amount of internet bandwidth needs to be used. Finally, with the whole slide available on a screen with an intuitive user-interface and several software tools for things like measuring depth of invasions and nuclear diameters, demarcating regions to add comments and a heat map that tracks the seen regions, it is improbable that a region on the slide would be missed.
After a virtual demonstration of our scanners in September 2020, Dr Vitou opted for the 6-slide Optimus 6T. At the time of this writing, his lab handled an average of 30+ cases a day, and a 6 slide scanner fit perfectly into the operational requirement as well as within the lab’s budget.
Owing to the pandemic, we couldn’t visit Phnom Penh to install the scanner. So, we adapted to the situation and developed a process to fulfill the installation remotely and virtually. We shipped an Optimus 6T to the lab and ran the installation of the machine through remote control. In other words, the support team got the scanner up and running remotely in Phnom Penh within 45 minutes of unboxing! More details of this part of the story can be found here.
As of today, the lab workflow is as follows: The technician scans all slides by the end of the day by Phnom Penh time, and is stored on the image server. . Dr Vitou logs into the server and runs through them, provides an opinion and passes it on to the local pathologist in his lab. It is afternoon for Dr Vitou in Paris, when he has just finished his lunch. The local pathologist cross-checks and signs off on the final diagnosis.
Apart from that, an unexpected benefit appeared for the lab. Dr Hav Monirath, a specialist in Cytology and a colleague of Dr Vitou expressed interest in providing her opinions on the existing cases. Because the slides are now available in digital format, Dr Monirath could also give out sub speciality opinions on the cases.
In summary, the Morphle Optimus 6T has enabled successful collaboration across 3 continents with 3 different time zones!
At the time of this writing, the Morphle scanner has completed 9 months of hassle-free operation at Path Diagnostics with a total support time of 18 mins excluding installation support, again remotely. Dr Vitou is in Paris and plans to continue there till Oct 2021.
Would you like your lab to start tele-reporting too? Get in touch with us!