-v --TRIBVN #311 June, 2014 . . ~

... at Gustave Roussy

at the heart of digital imaging

Pr. Jean-Yves Scoazec & Dr. Jacques Bosq Pathologists

Dr. Paule Opolon Pathologist Researcher

Irène Villa Digital Pathology Engineer

André Gavoille 1T Project Manager

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Customer testi mony

Gustave Roussy: developing advanced applications on the basis of an integrated digital pathology solution The leading oncology centre in Europe and a benchmark establishment in France, the Gustave Roussy (GR) bases its expertise upon innovation, personalized medicine and the quality of care. The GR Department of Biology and Medical Pathology is comprised of 7 services combining some thirty practitioners - biologists and pathologists - together with 75 medico-technical personnel. The department undertakes diagnostic operations, but also provides training and research facilities.

Pursuing a genuine strategy for innovation Endowed wit h a state-of-t he-art technical platform, equipped with an extensive range of automatic equ ipm ent and high-p erforma nce instrumentation, the department can undertake analyses in the fields of specialized bio logy, anatomy and pathological cytology, together with molecular biology. In this context, late in 2013, the department install ed a high-performance integrated imaging solution for diagnostics and clinicat research . "One of the primary objectives is to improve the management of patient records and enrich the results of examinations by exploiting the advances made available by digital technology for the acquisition , management and sharing of images" explains Professer Jean-Yves Scoazec, pathologist at GR. Accordingly, an integrated soluti on for the association of macroscopic and histological images with anatomie pathology records is the course of deployment. Links with other ava ilable image records for the same patient wi ll be exp loited in order to deliver genuine digital continuity in patient care, from radiological images through to microscopie images . Jean-Yves Scoazec goes on: "A second objective is the deployment of image analysis tools as a means of facilitating certain quantitative or semi-quantitative evaluations which are now an integral part of the diagnostic process, and the improvement of their reproducibility . A third objective is the participation of the department in the telepathology networks which are current/y in the course of development , and to meet the requirements of virtual expert networks: this is a necessity, in the light of the diversity of tumours treated within the department and the leve/ of specialized expertise required for certain of these tumours. This also provides us with the opportunity to evaluate the expertise of our pathologists , specifically in the field of rare tumours". Likewise, digital technology fulfils the object ives of the department in the clinicat research field: faci litating the participation of pathologists in multi- centre studies, accelerating and improving the exchange of information in the context of protocols and clinical studies, and enhancing the annotation of samples stored in biological resource centres. Finally, "Digital imaging offers unparalleled opportunities for education and training, whether through the constitution of image banks for consultation by trainee pathologists, the organization of non -campus-based training for the refreshment of knowledge and the development of anatomie and clinical consultations with our clinica l, radiological and surgical colleagues ".

Securing the production of macroscopic and microscopie images The soluti on adopted is based upon a CaloPix image network. In macroscopy, the Macro too l developed by TRIBVN permits the dire ct workbenc h integration of high-definition images of operative specimens. The department has aise acquired a a high-capacity slide scanner (the Hamamatsu Nanozoomer

scanner) for the production and management of ail digital microscopy services. Connected to the Laboratory Management System (LMS), this solution permits the rapid and straightforward acquisition and consu ltat ion of images , specifica lly through th e use of barcodes and automatic importing . Im ages are accessib le for consultation in CaloPix Workstation from any medical workstation in the department, and images can be shared throughout the department using the CaloPix Pocket full-web solutio n. "The integration of the TRIBVN Macro tool with our LMS (Diamic, Jnfologic) is a key point" according to André Gavoille, 1T project manager. "This ensures a strong link between images and the patient record in the LMS (for technical and reporting purposes) . For the deployment of the various components - works tati ons and servers - we have assessed the impact of the quality of bath operators and documents upon th e relevant prerequisites . This has allowed us to proceed with a well -managed deployment operation, providing our two teams with everything required for their collaboration" . Image analysis mod ules have aise be insta lled for the quantification of tissues, and specifically for immun e-ma rked slides . As Paule Opolon, a researc her at GR, exp lains "This allows dedicated research teams to complete their work on the basis of virtual slides, thereby accelerating the production of their results".

Promoting effective communication between teams Image-sharing has been a key contributory factor to th e acquisition of this system. Pathological images must be accessib le in the pathologist's office during th e dictation of reports, in meeting rooms during the conduct of staff consu ltations, and with in the establishment for RCPs and discussions w ith clinica l services. Extensions of the system to include PACS are envisaged in the medium term, and the intention is to provide an integrated radio logica l and patho logical diagnostic imag ing tool in the interests of personalized medicine. This point is confirmed by Jacques Bosq, patholog ist: "The consultation of images and the automated quantification of biomarkers will enhance the understanding of the pathology concerned, and will be conducive to the deployment of a therapeutic strategy which is best-adapted to each patient''.

Developm e nt of collaborative tools and telemedicine Deployed in the spring of 20 14, t he soluti on is now operational wit hin GR. In itial considerat ions for t he end -to -end man agement of image production and distributi on have been expanded to include the more exte nsive deve lopment of app licatio ns for collaborative solutions. The integrated image network perm its th e association of macroscopic and microscopie images wit h patient records , together w ith the high -speed and reproducible analysis of virt ual slides using an auto mated counting f unction. Irène Villa , digital pathology eng ineer, describes the next stages : "Over and above this network, the department plans to develop a web platform. This platform will contribute to bath training and care. The training element will incorporate a collected resource comprised of annotated macroscopic images and virtual slides, together with background information on the pathology concerned. Training and evaluation modules will also be included. For patient care purposes, this platform will permit the rapid and secure exchange of images, bath in-house and externally, for intra -operative telediagnosis operations , the acqui sition of second opinions, academic panel reviews and anatomie & clinical meetings, and as a resource for the conduct of subject-based seminars ".

Fu rther information - Trude l o., Desmeules P., Turcott e S., Plante M., Grégoi re J., Renaud MC., Orain M., Bairati !., Têtu B. Visual and automated assessment of matrix metalloproteinase-14 tis sue ex pr ession for the evaluation of ovarian cance r prognosis. Modern Pathology doi: 10.1038/ modpathol.2014 .32 . March 2014 .

- Jeremy Goc, Clair e Germain, Thi Kim Duy Vo-Bourgai s, et al. Dendritic cells in tumor-associated tertiary lymphoid structures license th e positive prognostic value of tumor-infiltrating COB+ T cells. Cancer Research doi: 10.1158/0008-5472 .CAN-13- 1342. Published OnlineFirst . 23 December 2013 .

- Favier Mathieu, Carcenac Carole, Drui Guillaume, Boulet Sabrina, El Mestikawy Salah, Savasta Marc. High -f requ ency stimulation of the subthalamic nucleus modifies the expression of vesicular glutamate transporters in basal gang/la ln a rat mod e/ of Parkinson's dlsease. BMC Neurosc ience 2013, 14: 152 doi:10.1186 / 1471-2202-14-152. Licensee BioMed Central Ltd. December 2013.

TRIBVN

Product Focus

Telemedicine in Paris area: in the service of continuous diagnosis for pathologists

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~~~ Web platfo rm - telepatho/ogy solution for laboratories

Simple and effective operation Requests for opinions and real-tim e anal yses are submitt ed directl y on-lin e via a web platf orm. These operation s are facilitat ed by th e availability of a tool for th e manag ement of requests and the tra ceabilit y of procedures. Specialized rev iewe rs th en respond to th ese requests within an agre ed tim e limit. Real-tim e tele-di agnosis demand s are handl ed imm ediat ely by a path ologist thr ough th e shar ing of th e medical fi le within a web-conference tool .

A first for French Laboratories The telepat hology demonstra t ion facil ity established in th e Paris ar ea allows th e conduct of real-tim e t ele-diagn osis and tele-experti se operati ons on- line, t hereby ensuring th e continuit y of diagnosis, and consequ entl y of care, thr oughout th e territ ory of Paris area. Thi s facilit y prov ides pat hologists with a request manag ement tool which ensures t he full tra ceabilit y of proce dur es and high-qualit y tele-dia gnosi s, even in emerge ncy situati ons. Ali data are hosted in a secure Cloud archit ectur e, in or der to meet stat utory requ irements for securi ty and t raceabilit y. Thi s projec t is subsidized by th e Regional Health Agency of th e Il e-de- France, and is sponsored by th e Cooperati ve Health care Consortium for th e Deve lopmen t of Shared Health care Informati on Systems in t he Il e-d e-Fran ce .

A forward-looking application for pathology The platf orm is cur rent ly in t he course of acceptance on some dedic ated pil ot sites. The real -tim e tele-dia gnosis fun ct ion is being eva luat ed by th e Diaconesses-Croix-Saint- Sim on Hospital Consortium, and by Saint Anto ine Hospit al (APHP). The tele-expertis e fun ction is being evaluated by th e René Dubos Hosp ital Centr e (Ponto ise), and by fou r specialized rev iewers. Fro m summ er 2014 onwards, th e soluti on wil l be subjec t to ge nera l roll- out and deployment on 17 sites, for an evaluati on period of 18 mont hs.

CaloPix Workstation, a daily working tool for pathologists

Optimum data management The CaloPix solutio n is based upon a uniqu e cent ralized databa se (SQL or Orac le) for the organ izati on of wo rkflow and the str ucturing of pati ent records, imag es and associated dat a. Macrosco pic and microscopie images are consolidated in an examinati on fil e .

Customized organization of cases A practiti oner can access cases using a customi zed wo rklist , based upon their profil e and t heir rights of access. The statu s of th e case fil e - pending , ready-to- read, validated - ind icates the state of progress in t he case concerned. The Laboratory Inf orm ati on System link ensures the optimum circulatio n of informati on within t he departm ent, and allows th e ret rieva l of case histor ies.

Optimum working convenience The ergon omie workstation design per mits a rapid swit chove r from case to case. The slide of interest is ta rgeted using th e virtu al platf or m. Viewi ng tools allow the effi cient opening of slides, flu ent browsi ng and instan taneous access to annotat ed regions. Regions of inte rest can be extr acted and saved by means of a single click .

My Toolbox

Effective processing of data A case can be consult ed fr om any workstation in the institu t ion concerned, using a dedicate d and secure env ironm ent , for consult ati on in staff meet ings or tum ou r board revi ews . A multi -c rite ria search tool permit s th e process ing of data at th e level of cases, images , annotati ons or the result s of quanti fi cati on.

Pocket: an easy facility for the remote viewing of images

Pocket application web interface for the view of s/ides on the move

*available on îOS and Androïd.

Associate d with a CaloPix database, Pocket is a new web-based image-viewing application . Thi s is a full web too l, which th erefor e requir es no inst allati on and runs on a simpl e we b browser. Pocket allows any CaloPix user t o access the ir images, not only from any computer on th e intr anet syste m, but also f rom t he int ern et . USB sti cks or Powe rPoi nt presentati ons are no longe r needed to show images. Thi s is an indi spens abl e applicatio n for the meetin g room, for your st aff meet ings or int er -departm ental consult ation meetin gs . This soluti on also delivers essential mobility in your everyday work .

Pocke t can display images and virt ual slid es, with the ir associate d annot ation s. A high-speed and intuitive browsing functi on in th e latest browsers delivers opti mum flu ency in the readout of images . Developed in HTMLS, Pocket is comp at ible w ith PCs and Macs, but can also be accessed on ta blets • : movem ent withi n the ima ge is st raightforwar d, w ith a click-t a-zoom fea ture . Using a t ext mode search functio n, images for a given pat ient or exa min ation can be ret rieved easily. Cont extua l inform at ion, with full security and traceability , can be displayed t o enhance t he unde rstanding of cases.

Pocket puts your images within hand's reach.

39, rue Louveau - 92320 Châtillon - FRANCE Conta ct us : info@tribvn.com - +33 (0) 155 580 520 Read m ore bout us: www.tribvn.com - www.teleslide.fr