The Daily Scan

Aperio Webinar: Research and Clinical Applications of AQUA® Technology

True Quantification of Protein Expression in Tissue: Research and Clinical Applications of AQUA® Technology Thursday, March 18, 2010 8:00 am PST, 11:00 am EST, 3:00 pm GMT  or                    4:00 pm PST, 7:00 pm EST                       (8:00 am JST /10:00 am Australia EDT March 19)   Presenter: Mark Gustavson, Ph.D. Senior Research Scientist, HistoRx AQUA® technology is a standardized and quantitative measurement of protein expression in tissue using fluorescence-based immunohistochemistry, high-throughput digital imaging, and advanced image analysis algorithms. AQUA®  technology enables the development of robust research and clinical diagnostic applications. To register for the March 18, 8am PST session, click here. https://aperio.webex.com/aperio/onstage/g.php?t=a&d=485661415 To register for the March 18, 4pm PST session, click here. https://aperio.webex.com/aperio/onstage/g.php?t=a&d=489227332 You may also register by visiting the Aperio Events page. You will receive a confirmation email upon registration with a web link that will lead you to the online event. Simply visit the link at the assigned time. The session is secure and easy to access. If you have any questions or would like additional information, please contact the Aperio Events Team at events@aperio.com or 760.539.1192.

Bioscience Technology: Digitizing Pathology

Bioscience Technology ran a nice survey article on Digitizing Pathology.

Fundamentally digital pathology is the digitization of microscope slides into image files called “digital slides”—the histologic equivalent of computerized x-rays.  Yet according to Aperio CEO Dirk Soenksen, digitization is just the beginning.  Digital pathology, Soenksen says, “is much more focused on the management of information than on the scanning technology for creating the digital slide.”  Computer files can be analyzed, shared, archived, and compared in ways physical slides cannot.

At least 30 commercial systems exist, according to one 2006 study.  Available from such firms as Aperio and BioImagene, MetaSystems, and Genetix, most are essentially automated brightfield microscopes in a box, though some, such as 3DHISTECH’s Pannoramic 250 and Genetix’s Ariol, handle fluorescent slides, too.

Whatever the platform, users invariably can view the resulting slides remotely (an application called “telepathology”), typically via a browser-based client often compared to Google Earth (that is, the software sends a low-magnification image that the user can quickly navigate and magnify).  As a result, whether they work on a different floor in the same hospital or thousands of miles away, pathologists can make diagnoses and consultations as if in front of a microscope, all without endangering the glass slides themselves.

Readers of this blog are probably familiar with the technology and companies in the digital pathology market already, but this article gives a nice comprehensive overview.  It is great to see the market awareness of this technology expanding.

The road to positive R&D returns

McKinsey have published an interesting article, the road to positive R&D returns (PDF), which analyzes ways that biopharma companies can increase the efficiencies of their R&D activities.

As productivity in the pharmaceutical industry has fallen, calls for a new paradigm that would radically change pharmaceutical R&D have increased.  The trend has been to view diminishing returns as a science problem.  But while scientific innovation is certainly part of the solution, management should not overlook other, more familiar ways to create value.  Increased attention to costs, speed of development, and decision making could increase the internal rate of return (IRR) of an average small molecule from around 7.5 percent—less than the industry’s cost of capital—to 13 percent.

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Previous industry experience suggests that such goals are attainable: from 1997 to 2001, the return on the portfolio described above would also have been 14 to 15 percent, driven by a higher probability of success and shorter development times.  Although the current environment is tougher, managers are not yet fully exploiting the value creation levers described here, and moderate improvements could substantially increase returns.  An IRR of 14 to 15 percent on R&D might not sound like a jackpot, but over a large portfolio it would create considerable value.

In the current economic climate biopharma companies have increasingly outsourced R&D; finding ways to make it more efficient internally could reverse that trend.

Quintiles rolls out contract pathology service in China

The interestingly-named Outsourcing-pharma.com reports Quintiles rolls out contract pathology service in China.

Quintiles’ new service, which is based at its College of America Pathologist (CAP) accredited central laboratory in Beijing, is intended to support the development of personalized cancer treatments.

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While the global biopharmaceutical industry is expected to grow as a whole in the coming years, Quintiles' investment in China fits with the consensus opinion that the country will emerge as a key market in the near future.

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Working in concert with the CRO’s other laboratories in Scotland and the US, the Beijing lab provides both immunohistochemistry (IHC) and Fluorescence In Situ Hybridization (FISH), as well as a wide range of bespoke biomarker assays.

This project highlights the value of digital pathology for CROs like Quintiles, as it enables them to provide better and faster service to their biopharma customers around the world.

Tighter Integration of Nighthawk Reports into Hospital EMRs and RISs

Bruce Friedman posted an interesting analysis on his blog: Tighter Integration of Nighthawk Reports into Hospital EMRs and RISs.

"Nighthawk-type" radiology service firms, launched initially with the avid support of radiologists, have evolved to potentially be their nemesis.  Defined succinctly, they provide the diagnostic services of outside radiologists to interpret medical images at times when members of a local hospital radiology group are unavailable.  Such services were initially provided off-hours -- hence the name nighthawk.  However, "nighthawk" firms have quickly morphed to provide around-the-clock services, putting some radiology groups out of business and causing others to fight back...  Although the concept of telemedicine has been in existence for decades, the most commercially viable version of this approach to the practice of medicine today is clearly teleradiology.

Interesting...  and yet, Nighthawk companies employ radiologists, so the threat isn't to radiologists per se, it is to radiology groups as formerly configured.  Worth keeping in mind because some pathologists fear that the advent of digital pathology will cause a similar change toward outsourcing pathology.  My own view is that digital pathology is more likely to cause insourcing, at least from a U.S. perspective, given the relative shortage of pathologists outside the U.S. 

The main driver of Nighthawk services in radiology was the need for time-critical interpretations, and the main driver of outsourcing in pathology will likely be sub-specialization, the need for tissue- and disease- specific interpretations.

chalk tip #34: useful ImageScope keyboard shortcuts

Greetings all...  in today's tip I want to tell you about a few useful ImageScope keyboard shortcuts.

shortcut	action	toolbar icon
Control-O	Open Image
Control-F4	Close Image
Control-K	Keep Image Open	(none)
Control-A	Image Adjustments
Control-R	Rotate Image	(none)
Control-N	ANnotations Window
Control-G	Analysis AlGorithms Window	(none)
Control-D	Digital Slide Conferencing	(none)

That's it - you're welcome!

Oh, and if you want a complete list of all shortcuts, please see the ImageScope Quick Reference Guide (PDF).  It is just eight pages and tells you everything you need to know: opening images, the main window, toolbar icons, and *all* keyboard shortcuts!

Trastuzumab Approved for HER2 Gastric Cancer in Europe

MedScape reports Trastuzumab Approved for HER2 Gastric Cancer in Europe:

Trastuzumab (Herceptin, Roche) has been approved for use in the treatment of HER2-positive gastric cancer by the European Commission.  This is the first approval in the world for this label extension for trastuzumab, which is already marketed for use in the treatment of HER2-positive breast cancer.

This marketing authorization is effective immediately in all European Union countries, and in Iceland, Liechtenstein, and Norway, according to the manufacturer.  Similar approvals for this label extension in other regions of the world are expected to follow soon, says Roche.

Approval for this new indication is based on the results of the international ToGA trial, headed by Eric van Cutsem, MD, PhD, from University Hospital Gasthuisberg in Leuven, Belgium.  The results showed that trastuzumab added to chemotherapy significantly prolonged survival — from a median of 11.8 months with chemotherapy alone to a median of 16 months.

When the results from the ToGA trial were first reported at last year's annual meeting of the American Society of Clinical Oncology (ASCO), data were hailed as "practice-changing."  ASCO later listed the study as one of the major advances in cancer in 2009.

Wow, this is great, sounds like an important new treatment option for gastric cancer, which is the second most common cause of cancer-related death in the world, and is the fourth most commonly diagnosed cancer with more than 1,000,000 cases diagnosed each year.

Apple iPad in Healthcare: Pros and Cons

The ScienceRoll blog considers Apple iPad in healthcare: Pros and Cons.  Please click through to read the whole post, but here are the bulleted Pros and Cons:

Possible cons:

• No camera: it means it cannot be used in telemedicine
• No flash: several medical websites use Flash
• No mouse support: it’s not a disadvantage if there won’t be click-heavy applications
• Battery life: It is somewhere around 10 hours which is enough for a doctor working on the hospital but what happens when the iPad gets handed off to the next person? Dying battery can be swapped out for a fresh one in other tablet solutions. Here there won’t be enough time to re-charge iPads.
• It’s too big to fit into a doctor’s pocket.
• iPad is not ruggedized while other healthcare tablets are drop resistant from about a meter.
• No Multi-tasking: it makes it impossible to write a patient report while consulting with a collegue (there are hundreds of examples why multi-tasking is crucial)
• No barcode scanner: it’s used for checking and uploading drugs, among others.
• Such a device should be water-proof and easily disinfected. iPad wasn’t designed for this.
• The iPad has a capacitive touch screen on which gloves won’t work.

Possible pros:

• If there is a company that can get the best out of such a device, that is Apple.
• Probably there will be more and more medical applications designed exclusively for iPad just like there are so many medical apps for iPhone.
• It’s cheaper than other healthcare tablets.
• It was designed to be as user-friendly as possible (a nice advantage of Apple products) so elderly people will also be able to learn to use it easily.
• One scenario might be having an iPad in the hospital as the central database where doctors can upload the information from the iPhones.

Although the screen resolution is modest (1024x768) it does seem like the iPad might be useful for digital pathology.  The completely untethered nature of the device is compelling.  We'll have to see when they become available, stay tuned!

College of American Pathologists unveils patient website MyBiopsy.org

The College of American Pathologists have unveiled a new patient-centric website MyBiopsy.org.  From the FAQ:

1. What is MyBiopsy.org?  MyBiopsy.org is a free resource developed by the College of American Pathologists for people who have been diagnosed with cancer and their loved ones to help them better understand their illness.
2. What information can be found on MyBiopsy.org?  Visitors to MyBiopsy.org can find accurate and credible information on more than 40 of the most common cancers and cancer-related conditions, including those affecting the breast, lungs, colon, prostate, and skin.  Each page on www.MyBiopsy.org has been developed by a pathologist, and includes:
   •  Answers to questions about a specific type of cancer
   • A list of available treatment options
   • Questions patients should ask their doctors
   • A glossary of key terms
   • Pictures of normal and diseased tissues and cells
3. Who developed the information on MyBiopsy.org?  All the patient information sheets developed on MyBiopsy.org were developed by pathologists — the doctors who diagnose cancer and other diseases by examining tissues and cells. If cancer is diagnosed, a pathologist will work collaboratively with a patient’s health care team to assist with treatment plans.

Very cool, a great resource.  We can hope that over time it will contain whole-slide images, I know Aperio would be delighted to help!

KGH Pioneers New Telepathology Technology

From "Stories in the News", from Ketchikan, Alaska: KGH Pioneers New Telepathology Technology:

Imagine looking through a microscope in Bellingham, Washington, and viewing a slide in Ketchikan, Alaska, and you have the idea behind the new telepathology service that now links the two cities. The new service allows surgeons in the operating room at Ketchikan General Hospital real time consultation with pathologists at Northwest Pathology in Bellingham. The pathologist can change focus, illumination, magnification, and field of view at will as he or she uses an online interface to examine a frozen tissue slide prepared in Ketchikan.

Ketchikan General Hospital (KGH), in partnership with the PeaceHealth Laboratories and Northwest Pathology, is among the first hospitals in North America to use telepathology in an intraoperative setting. This technology has been used for research, academic instruction and general pathology consultations but KGH is pioneering this use of the technology, which is especially beneficial to smaller, rural critical access hospitals where technical experts may not be readily available.

The use of this technology will improve patient care and reduce travel costs. Here is how it works: a surgeon at KGH submits tissue for pathology review during a procedure. A histotechnologist at the Ketchikan lab will freeze the tissue, prepare the slide and scan it. In Bellingham, one of the pathologists will log into an online site to review the whole slide image and call the surgeon directly in the O.R. to discuss the results.

How cool is that?  The technology of digital pathology has such value in remote locations like Ketchikan, to bring the required expertise to each case when needed.