SUNY researcher issued patent for virtual telemicroscope and actor-robots 'staff' part of new simulation training centre at Johns Hopkins Outpatient Center

Brooklyn, Baltimore 27 March 2008After nearly ten years of research and development, scientists at SUNY Downstate Medical Center in Brooklyn and Peking University in Beijing were awarded a United States patent for their virtual telemicroscope. This patented software permits off-site pathologists to diagnose cancer or other diseases in patients living in remote locations around the world. And in East Baltimore, a medical student places a chest tube in a patient lying on an operating table, while another student conducts a colonoscopy. Everything is just as it would be in a real OR or treatment room, except that the patients won't be harmed or complain if mistakes are made - they're robots. These high-tech, electronically outfitted mannequins are equipment in the new $5 million medical and surgical simulation training centre at the Johns Hopkins Outpatient Center that opened in March.

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Virginia M. Anderson, MD, associate professor of pathology at SUNY Downstate, and Jiang Gu, MD, PhD, dean and chairman of pathology at Peking University, developed the virtual microscope system, the only one of its kind capable of e-mailing electronic slides. Using their patent, the Chinese company Motic - a global expert in microscope manufacturing - created a microscope with a robotic stage that scans whole slides at various magnifications and then creates compressed images that can be e-mailed all over the world.

In China, where the device is being tested as a diagnosis instrument, 600 hospitals do not have an on-site pathologist. The system was developed with that fact in mind. "Enormous voids in pathology services exist. Virtual slides are definitely going to improve diagnostic accuracy and health care", stated Dr. Anderson.

The Motic telepathology system utilizes a computer and microscope, which enables interactive communication on a user network. A robot scans the whole tissue sample on the microscope. Subsequent images corresponding to the selected area of the specimen are linked at higher magnifications. The patented software turns an ordinary computer into a virtual microscope. High magnification images are compressed and linked to the low power scanned glass slide that is stored as a virtual slide file. Images can then be e-mailed and analysed by pathologists at remote locations. Once received, Internet independent images can be stored and viewed as part of the electronic medical record or medical student teaching file.

"The virtual telemicroscope is designed the way pathologists think and work", Dr. Anderson stated, adding: "A pathologist would never scan an entire histopathologic section at high power. This is inefficient and unnecessary. Slides prepared by an experienced pathologist will focus on important areas to make a diagnosis."

Clinical trials showed that Motic's virtual telemicroscope is "as good as or better than the competition". The system is also teaching-friendly, allowing professors to manipulate existing digital slides and create new slides for students to study. The next generations of medical students and pathologists are being taught through interactive technology. The virtual telemicroscope will save time and money, improve medical education, and provide insight into the pathogenesis of disease. Microscopes will be used to prepare whole slide images for analysis on a big screen or laptop computer.

The SUNY Downstate system produces the only virtual slides that can be e-mailed around the world. Moreover, it is also the least expensive, Internet independent solution for expert consultation. Clinical trials published in the journal "Human Pathology" in February 2008, confirm the diagnostic accuracy of virtual slides as compared to traditional methods.

At the Johns Hopkins Outpatient Center in East Baltimore, the "sim" centre contains two fully operational operating rooms, two intensive care units (ICUs), high-fidelity computerized mannequins that mimic physiologic and behavioural response to procedures, and 12 examination rooms where students practise routine exams on actors posing as patients with particular complaints and symptoms.

The mannequins have breath sounds and heart tones, palpable pulses, and a monitor that displays vital signs as students, physicians, nurses and other health care professionals practise everything from bag-mask ventilation, intubation, and defibrillation to chest tube placement and endoscopies. Computer programmes test decision making skills and knowledge on topics such as advanced cardiac life support and trauma management.

"The idea is to get it right before they treat real patients", stated the centre's director, Elizabeth Hunt, M.D., M.P.H., assistant professor in the Department of Anaesthesiology and Critical Care Medicine. The troupe of paid professional actors who are trained to portray patients submit themselves to trainees who practise taking histories, performing physical exams, breaking bad news and communicating in a compassionate manner.

"Students can learn the science of medicine in many different ways, but there is only one good way to learn good bedside manner, and that is with real people", stated Dr. Hunt. Each of the 15 simulation rooms in the centre is equipped with adjustable cameras, microphones, one-way glass for observer viewing, and large flat-screen monitors so students and staff can quickly review their performance while it's still fresh in their minds.

In addition to training students and staff, Dr. Hunt stated that the centre also will be used to train medical staff on new equipment, and for teaching emergency medical technicians and paramedics. Outside groups may also be welcome during continued medical education seminars.


Leslie Versweyveld

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