1
|
Rojansky R, Jhun I, Dussaq AM, Chirieleison SM, Nirschl JJ, Born D, Fralick J, Hetherington W, Kerr AM, Lavezo J, Lawrence DB, Lummus S, Macasaet R, Montine TJ, Ryan E, Shen J, Shoemaker J, Tan B, Vogel H, Waraich PS, Yang E, Young A, Folkins A. Rapid Deployment of Whole Slide Imaging for Primary Diagnosis in Surgical Pathology at Stanford Medicine: Responding to Challenges of the COVID-19 Pandemic. Arch Pathol Lab Med 2023; 147:359-367. [PMID: 35802938 PMCID: PMC9904534 DOI: 10.5858/arpa.2021-0438-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Stanford Pathology began stepwise subspecialty implementation of whole slide imaging (WSI) in 2018 soon after the first US Food and Drug Administration approval. In 2020, during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services waived the requirement for pathologists to perform diagnostic tests in Clinical Laboratory Improvement Amendments (CLIA)-licensed facilities. This encouraged rapid implementation of WSI across all surgical pathology subspecialties. OBJECTIVE.— To present our experience with validation and implementation of WSI at a large academic medical center encompassing a caseload of more than 50 000 cases per year. DESIGN.— Validation was performed independently for 3 subspecialty services with a diagnostic concordance threshold above 95%. Analysis of user experience, staffing, infrastructure, and information technology was performed after department-wide expansion. RESULTS.— Diagnostic concordance was achieved in 96% of neuropathology cases, 100% of gynecologic pathology cases, and 98% of immunohistochemistry cases. After full implementation, 8 high-capacity scanners were operational, with whole slide images generated on greater than 2000 slides per weekday, accounting for approximately 80% of histologic slides at Stanford Medicine. Multiple modifications in workflow and information technology were needed to improve performance. Within months of full implementation, most attending pathologists and trainees had adopted WSI for primary diagnosis. CONCLUSIONS.— WSI across all surgical subspecialities is achievable at scale at an academic medical center; however, adoption required flexibility to adjust workflows and develop tailored solutions. WSI at scale supported the health and safety of medical staff while facilitating high-quality patient care and education during COVID-19 restrictions.
Collapse
Affiliation(s)
- Rebecca Rojansky
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Iny Jhun
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Alex M Dussaq
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Steven M Chirieleison
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Jeffrey J Nirschl
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Don Born
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Jennifer Fralick
- Anatomic Pathology and Clinical Laboratories (Fralick, Hetherington, Macasaet, Young), Stanford Health Care, Stanford, California
| | - William Hetherington
- Anatomic Pathology and Clinical Laboratories (Fralick, Hetherington, Macasaet, Young), Stanford Health Care, Stanford, California
| | - Alison M Kerr
- Clinical Operations (Kerr), Stanford Health Care, Stanford, California
| | - Jonathan Lavezo
- The Department of Pathology, Health Sciences Center, Texas Tech University, El Paso (Lavezo)
| | - Daniel B Lawrence
- Information Technology (Lawrence, Shoemaker, Waraich), Stanford Health Care, Stanford, California
| | - Seth Lummus
- The Department of Human Physiology and Nutrition, University of Colorado, Colorado Springs (Lummus)
| | - Ronald Macasaet
- Anatomic Pathology and Clinical Laboratories (Fralick, Hetherington, Macasaet, Young), Stanford Health Care, Stanford, California
| | - Thomas J Montine
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Emily Ryan
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Jeanne Shen
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Jonathan Shoemaker
- Information Technology (Lawrence, Shoemaker, Waraich), Stanford Health Care, Stanford, California
| | - Brent Tan
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Hannes Vogel
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Puneet Singh Waraich
- Information Technology (Lawrence, Shoemaker, Waraich), Stanford Health Care, Stanford, California
| | - Eric Yang
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - April Young
- Anatomic Pathology and Clinical Laboratories (Fralick, Hetherington, Macasaet, Young), Stanford Health Care, Stanford, California
| | - Ann Folkins
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| |
Collapse
|
2
|
Greco JA, Wagner NL, Jensen RJ, Lawrence DB, Ranaghan MJ, Sandberg MN, Sandberg DJ, Birge RR. Activation of retinal ganglion cells using a biomimetic artificial retina. J Neural Eng 2021; 18. [PMID: 34768254 DOI: 10.1088/1741-2552/ac395c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/12/2021] [Indexed: 11/12/2022]
Abstract
Objective.Biomimetic protein-based artificial retinas offer a new paradigm for restoring vision for patients blinded by retinal degeneration. Artificial retinas, comprised of an ion-permeable membrane and alternating layers of bacteriorhodopsin (BR) and a polycation binder, are assembled using layer-by-layer electrostatic adsorption. Upon light absorption, the oriented BR layers generate a unidirectional proton gradient. The main objective of this investigation is to demonstrate the ability of the ion-mediated subretinal artificial retina to activate retinal ganglion cells (RGCs) of degenerated retinal tissue.Approach. Ex vivoextracellular recording experiments with P23H line 1 rats are used to measure the response of RGCs following selective stimulation of our artificial retina using a pulsed light source. Single-unit recording is used to evaluate the efficiency and latency of activation, while a multielectrode array (MEA) is used to assess the spatial sensitivity of the artificial retina films.Main results.The activation efficiency of the artificial retina increases with increased incident light intensity and demonstrates an activation latency of ∼150 ms. The results suggest that the implant is most efficient with 200 BR layers and can stimulate the retina using light intensities comparable to indoor ambient light. Results from using an MEA show that activation is limited to the targeted receptive field.Significance.The results of this study establish potential effectiveness of using an ion-mediated artificial retina to restore vision for those with degenerative retinal diseases, including retinitis pigmentosa.
Collapse
Affiliation(s)
- Jordan A Greco
- Department of Chemistry, University of Connecticut, 55 North Eagleville Road, Storrs, CT 06269, United States of America
| | - Nicole L Wagner
- Department of Chemistry, University of Connecticut, 55 North Eagleville Road, Storrs, CT 06269, United States of America.,Department of Molecular and Cell Biology, University of Connecticut, 91 North Eagleville Road, Storrs, CT 06269, United States of America
| | - Ralph J Jensen
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, United States of America
| | - Daniel B Lawrence
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06032, United States of America
| | - Matthew J Ranaghan
- Department of Molecular and Cell Biology, University of Connecticut, 91 North Eagleville Road, Storrs, CT 06269, United States of America
| | - Megan N Sandberg
- Department of Chemistry, University of Connecticut, 55 North Eagleville Road, Storrs, CT 06269, United States of America
| | - Daniel J Sandberg
- Department of Chemistry, University of Connecticut, 55 North Eagleville Road, Storrs, CT 06269, United States of America
| | - Robert R Birge
- Department of Chemistry, University of Connecticut, 55 North Eagleville Road, Storrs, CT 06269, United States of America.,Department of Molecular and Cell Biology, University of Connecticut, 91 North Eagleville Road, Storrs, CT 06269, United States of America
| |
Collapse
|