Army's 'virtual' microscope brings images to docs around the world

'It creates this virtual microscope. This is a way to move images and not people.'

'Army Maj. Keith J. Kaplan

Henrik G. DeGyor

In Army Maj. Keith J. Kaplan's office at Walter Reed Army Medical Center in Washington, water runs from a fountain, music CDs like Billie Joel, Herbie Hancock and Eric Clapton hang from a rack, and a picture of the skyscrapers in Chicago'his hometown'hangs on a wall.

But the microscope that sits on his desk is what really gets the hospital's medical director of telepathology and cytopathology excited.

A robotic microscope controlled by a mouse lets Kaplan share and discuss slides with other pathologists miles away via the Internet. By digitizing slides, the medical center's doctors can more easily get second opinions on difficult diagnoses, Kaplan said.

The innovative system last year received a Technology Excellence in Government Award from Post Newsweek Tech Media of Washington, the parent company of GCN.

The system'which uses standard microscopes and PCs running a custom Microsoft Windows application'works like a two-headed microscope through which two doctors can analyze a slide at the same time. But the robotic microscope goes a step further, Kaplan said, by letting numerous doctors at remote locations across the world view a slide simultaneously via TCP/IP. 'It creates this virtual microscope,' Kaplan said. 'This is a way to move images and not people.'

The system works better than photographing a slide and e-mailing it to a pathologist, Kaplan said, because it offers more flexibility. With the robotic microscope, doctors can enhance the magnification, contrast and focus of a slide, similar to what can be done with a standard microscope.

The system has been installed at five Army hospitals: Walter Reed; Fort Knox, Ky.; Womack Army Medical Center, Fort Bragg, N.C.; Tripler Army Medical Center, Honolulu; and Landstuhl Regional Medical Center, Landstuhl, Germany. Kaplan said in the next six months, microscopes will be sent to 12 additional sites in Germany and South Korea and at medical centers in Washington state, Texas and Georgia.

'Here, you have the ability to look at the same slides at the same time,' Kaplan said. 'Here, you have the ability, as opposed to a mail-in service, to consult with other pathologists in real time. We are able to arrive at a diagnosis faster because of transmission time.'

The faster transmission can cut the time needed to make a diagnosis from days or weeks to minutes, said Tom Bigott, senior program manager for the North Atlantic Regional Medical Command Telemedical directorate at Walter Reed.

The system showed off its advantages in a recent case, Bigott said. A patient from Landstuhl was having severe problems with his spleen, and a pathologist sent a slide to doctors at Walter Reed. The patient was flown to Walter Reed, where he underwent an operation that may have saved his life, Bigott said.

'This really extends the reach of the pathologist,' Bigott said.

Fewer pathologists

Over the past decade, the number of Army pathologists has steadily declined, mostly due to retirements and the closing of several residency programs, Kaplan said. Currently, there are 102 pathologists on active duty. The ideal number would be 180, he said.

Kaplan also works as a consulting pathologist at the Military Academy in West Point, which currently does not have the robotic technology. So, Kaplan said he has to drive to West Point whenever he's needed. If the technology were installed at West Point, that would eliminate the trips.

The robotic microscopes, developed by MedMicroscopy, a product of the Trestle Corp. of Newport Beach, Calif., cost $60,000 apiece. In May, the Army Surgeon General's Office approved funding totaling $750,000, which will pay for the 12 additional sites, Kaplan said. As more funding is approved, other sites will be added.

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