Digital Pathology in a
Web-based System to Study
Renal Disease in Animals
Worldwide
George E. Lees, DVM, MS
Small 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
Background
The 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
Background
The 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 Initiative
Strategies
• 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 Initiative
Strategies
• 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 Initiative
Strategies
• 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
Implementation
Key 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)
Implementation
Key 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
Implementation
Key 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)
Achievements
Our 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.
Achievements
Our 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
Achievements
Have 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
Acknowledgments
Many Contributors
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The organizing committee
The sponsoring organization
The financial sponsors
The Prelude Dynamics team
The Aperio team
The TVRPS team
Veterinary Renal Pathology Initiative
The Sponsoring Organization
The World Small Animal
Veterinary Association
http://www.wsava.org
WSAVA Renal Pathology Initiative
The Financial Sponsors
• Hills’ Pet
Nutrition
http://www.hillspet.com
• Bayer Animal
Health
http://www.bayer-ah.com
Veterinary Renal Pathology Initiative
The Prelude Dynamics Team
• Richard Tieken
• Alicia Browner
www.PreludeDynamics.com
Veterinary Renal Pathology Initiative
The Aperio Team
• Mark Wrenn
• Many others
http://www.aperio.com
Veterinary Renal Pathology Initiative
The TVRPS Team
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George E. Lees
Brian R. Berridge
Fred J. Clubb, Jr.
Mary Sanders
And many helpers
Questions?
glees@cvm.tamu.edu