Circle of Life – Annual Celebration 2024

Imagine a world where pathologists can diagnose cancers, anywhere on the planet, right from a digital screen. This is the future of pathology, Digital Pathology!

My name is Dr. Christopher Ma (Pathologist, Medical Director & Chief of Laboratory Medicine); I am here today to share with you how a vote for a digital pathology slide scanner will completely revolutionize the way we practice pathology here at Guelph General Hospital (GGH) and allow us to become early adopters of this exciting technology. 

But first, who remembers vintage radiology before diagnostic imaging went completely digital?

You would have to put the physical X-ray plain films up against a lit background to make a diagnosis. Once completed, you would be left with stacks of films to be filed and stored.

Traditional pathology is comparable to vintage radiology; pathologists use a microscope to examine stacks of physical glass slides that are heavy, take up space, prone to breaking, and difficult to manage, file and store.

We are currently living in a transformative era of digital innovation, where technology and pathology are converging in unprecedented ways. Just like how radiology completely went digital many years ago; the time is now for a digital revolution in pathology.

So, what exactly is Digital Pathology?

Digital pathology is the utilization of modern technology to eliminate the need for a microscope and stacks of physical slides. A digital pathology slide scanner is used to convert traditional glass slides into a high-resolution digital image. This digital image is then examined using an image viewing software with advanced machine learning features and functions, empowering the pathologist to make diagnoses more accurately and faster.

How does digital pathology improve quality?

Quality in pathology is defined as providing accurate and precise diagnoses in a timely manner. Accuracy, precision and turn-around-time.

When every millimeter or percentage makes a difference; digital pathology improves accuracy by:

• More accurate tumour staging measurements
• More accurate distance to margin measurements
• More accurate tumour quantification (as %age)
• More accurate index / intensity interpretations (as %age)
• Ability to view multiple slides and zoom simultaneously
• Directly annotate and mark-up the digital images

Precision is repeatability, reproducibility and consistency. Digital pathology improves precision by:

• Standardizing imaging and digital reproducibility
• Consistent reproducible measurements and quantifications
• Enhanced collaboration between pathologists and multi-disciplinary teams
  • Ability to share desktop screen or digital images
  • Ability for pathologists to view single cell nuclear details simultaneously
• Allows for advanced automated image analysis and artificial intelligence (AI) applications

Digital pathology improves turn-around-time by:

• Improving efficiency and workflow
• Studies show pathologists can complete digital pathology cases faster than traditional pathology
• External consultations can be digital
  • Cost savings and time savings shipping out physical slides
• Remote work (not wasting time travelling + more flexibility)
• Allows for advanced automated image analysis and artificial intelligence (AI) applications

Other benefits of digital pathology include:

• Free up physical office space in the department
• Decreased work-related injuries and fatigue
• More attractive for pathologist recruitment and locum coverage
• Better work-life balance and maintaining staff
• Each patient will now have a digital pathology health record, which can accessed by the patient or clinician
• Better data management, archiving and retrieval

GGH would be early adopters of digital pathology in Ontario / Canada (one of only a few hospitals). Going digital would allow us to utilize, build and expand on previously invested technology, our PACS cloud system. Furthermore, GGH anticipates a significant increase in surgical pathology specimens in the coming years; with the expansion of endoscopy / gastroenterology, off site diagnostic imaging center and lowering of breast cancer screening age. Digital pathology would put GGH in a position, not only to accommodate the anticipated program expansions, but to maintain high quality while doing so.

So, Circle of life members, who is ready to help revolutionize the way we practice pathology here at GGH, one pixel at a time!?

Introduction:

Good evening everyone, I am Bob Clayborne, the Administrative Director of Laboratory Medicine and Medical Device Reprocessing.  It is my pleasure to be able to present to Circle of Life members. This evening, I am here to talk about Core Laboratory Automation—a transformative advancement in modern diagnostics.

The lab at Guelph General is faced with two conflicting realities. The growing population in Guelph means that hospital utilization is increasing. That means there are an increasing number of laboratory examinations being requested. We are also facing recruitment challenges as a result of a national shortage of skilled laboratory workers that has been decades in the making. This shortage is the result of a retiring workforce, a shrinking number of accredited training programs, and a competitive environment where there are a high number of full-time jobs available. Laboratories like ours are challenged to retain staff, particularly in part time positions.

Given the importance of lab results in helping guide most clinical decisions, the laboratory must continuously advance our ability to deliver quality results. The GGH Lab is under increasing pressure to deliver faster, more accurate results. Automation will revolutionize how we meet these demands and help mitigate the impact of the national shortage of skilled workers

What is Core Laboratory Automation?
Core laboratory automation involves the integration of advanced technologies—analytical equipment, robotics, software, and data analytics—into the diagnostic workflow of the laboratory.

Key components include:

• Automated sample processing: Robotic systems handle repetitive tasks like sorting, centrifugation, and specimen delivery, significantly reducing manual intervention.
• Integrated analyzers: Instruments that consolidate multiple tests, such as hematology, chemistry, and immunoassays, into a single, connected system.
• Data management systems: Middleware connects instruments, enabling seamless data transfer, real-time monitoring, and streamlined reporting.

Current State:

Currently, we use standalone analyzers and data management software.

• Prior to analysis, samples are handled and prepared manually, including sample reception, assessment, centrifugation, and delivery to the testing area.
• Analysis is performed on standalone analysers, in other words, not integrated into a single workflow.
• Data management software, or middleware, is used to assess sample results and determine if auto-validation can proceed.
• Post analysis, specimens are manually racked and eventually moved into cold storage for 3 days, following which they are manually discarded.
• The current state is susceptible to fluctuations in staffing, resulting in inconsistent turnaround times, and potential delays in reporting lab tests.

What is the Future State with Automation?

Automation transforms the lab from a collection of standalone instruments into a unified, high-efficiency system.

• Specimens will arrive in the lab as they do today; hand delivered or by pneumatic tube system
• Specimens will be loaded into a bulk loader that will sort the samples, read the barcode on each sample and determine that the correct tube has been taken and that there is sufficient volume for testing.
• Specimens requiring centrifugation will be automatically loaded into the centrifuge.
• Pre-analysis, sample inspection, sample assessment, identification of interferents is completed automatically
• Samples are loaded onto a robotic track system.
• Samples are delivered to the integrated analyzers for analysis.
• Post-analysis, samples are moved along the track and into cold storage and catalogued.
• Should the sample need to be retrieved for further testing, it will be automatically retrieved from storage, re-warmed, and re-tested.
• After 3 days in storage, the system will automatically discard the samples.

What will be required for Automation at GGH?

• New analytical equipment. We are currently in the process of implementing the latest technology in chemistry, hematology and digital morphology.
• Lab will be renovated to accommodate improved workflow and improved ergonomics. A renovation plan has been developed for the lab to improve workflow and accommodate automation.

Why Is Automation Critical to Patient Care?

• Efficiency Gains: Automated systems work continuously and at high speeds, increasing throughput, and require minimal supervision.
• Accuracy and Consistency: By reducing manual handling, automation eliminates variability and human errors, ensuring more reliable results with more consistent turnaround times.
• Scalability: Automation enables the lab to be able to handle surges in sample volume, such as during a pandemic, without sacrificing turnaround time.
• Cost-effectiveness: Though automation requires an upfront investment, it reduces long-term costs by lowering labor expenses, minimizing reagent waste, and optimizing resource use.
• Effective use of Scarce Human Resources: Automation allows for MLT time to be focused on tasks commensurate with their knowledge, training, skill and judgement by automating routine tasks.

Conclusion
Core laboratory automation is no longer a luxury—it’s an essential component of modern lab operations. By adopting automation, our lab can meet the growing demand for fast, accurate, and scalable testing. The benefits are clear: efficiency, precision, and a path toward the future of diagnostics and discovery.

From improving efficiency to minimizing human error, core laboratory automation is a necessity for sustainable lab operations and contributes to excellent patient care.

Your support for this project will help take GGH into the future of Laboratory Medicine.

Thank you for your time, and I’m happy to answer any questions.

Have you or a loved one had the unfortunate experience of having to wait weeks or months for an appointment for important diagnostic imagining like an MRI?

With a rapidly expanding and aging population, the demand for diagnostic imaging services in Guelph-Wellington has never been higher.

Currently, Guelph is grossly underserviced in access to diagnostic imaging services like MRI and High Risk Ontario Breast Screening (OBSP) which is creating a strain on GGH and surrounding hospitals. The average wait for patients in 104 days for a Priority 4 MRI imaging versus the provincial target of 28 days, although higher priority cases are seen much more quickly.

A community-based Diagnostic Imaging Centre will provide a fully integrative location for hospital quality imaging tests, reported by GGH radiologists, in a comfortable and accessible community hub as an alternative to the traditional hospital setting, which can be a barrier for some.

My name is Dr. Joy Banerjee, I’m a Physician in Diagnostic Radiology here at GGH.

And my name is Erin Lane, I’m the Administrative Director of Diagnostic Imagining at GGH.

Today we’re here to talk to you about GGH’s Diagnostic Imaging Centre project and its anticipated benefits for you, your loved ones, and other community members across Guelph-Wellington.

Project Overview:

This new centre will be anchored by GGH’s second MRI. Ultrasound and X-Ray will expand services from the hospital into the new centre, while Mammography and Bone Density services will fully relocate. Our Mammography and Ultrasound support the Ontario Breast Screening Program (OBSP) and the expansion and relocation allows us to support our growing community. This centre will also have access to parking as well as public transit routes. Imagining services will be fully integrated into GGH’s cloud-based picture archiving and communications system (PACS). This will ensure that your imaging records can be reviewed by GGH physicians regardless of the location an image was captured from.

The Ask:

With over 70% of funding raised, and operational funding for the MRI secured, we still need help raising funds for additional equipment. We invite Circle of Life – Inner Circle to help fund an X-Ray, a critical piece of imaging equipment for the centre. Your collective support will be acknowledge by having the Circle of Life – Inner Circle appear on the centre’s donor wall and by having named recognition within the X-Ray space.

What are the anticipated benefits for the community?

There are many anticipated benefits for our loved ones and community members, including:

• Increased Capacity: X-ray volumes have increased by approximately 20% in the past several years. Currently there are three x-ray rooms at the hospital. With the new facility, we will be able to add a fourth room, ultimately with two rooms at each site.
• Efficiency: With improved x-ray machine software and better machine design, exams can be completed in less time, allowing for greater throughput.
• Safety: Newer machines are able to provide diagnostic imaging quality with less radiation exposure. This is beneficial to both the patients and the radiology technologists.
• Accessibility: The location of the facility will be more central to the larger Guelph community which will allow a second option for those requiring imaging. This will also address the current parking space shortage at the hospital.
• Reduced wait times: By expanding access to diagnostic imaging services like X-Ray, MRI, Ultrasound and Mammography, will be better able to address the ongoing issue of increasing wait times.
• Cascading benefits across GGH: Improving patient flow throughout the hospital, better access to parking for hospital visitors and patients, increasing the capacity for other innovative in-hospital technologies, and improvements to the efficiency of the Emergency Department.

With a series of anticipated benefits that will help us enhance patient care here in Guelph, a community-based DI centre will enable GGH to respond to current and anticipated demand in a way that meaningfully builds toward the future of our community hospital!