Editors: Raymond D. Aller, MD, & Dennis Winsten
Smart microscope evokes look and feel of the traditional instrument
August 2024—Aravindhan Sriharan, MD, is a supporter of digital pathology, but when it comes to assessing images, he prefers the feel and speed of a microscope. And his conversations with colleagues indicate many of them do too.
“If I’m scrolling around a digital image, I can’t get the kind of speed, accuracy, and dexterity that I can on a physical microscope,” says Dr. Sriharan, dermatopathologist at Dartmouth Hitchcock Medical Center and assistant professor of pathology and laboratory medicine at Dartmouth Geisel School of Medicine.
To address this issue, Dr. Sriharan founded the startup PixCell and developed SmartScope, a patent-pending smart microscope for viewing whole slide images that is operated like a traditional microscope. His goal is to eventually market SmartScope as an easier and more user-friendly way to use artificial intelligence and machine learning algorithms in a clinical setting and to work remotely.
SmartScope looks like a microscope, and it mimics the feel of a traditional medical microscope by providing pathologists with a mock slide they can move around a microscope stage in the same way they would maneuver a slide containing a tissue specimen. Pathologists simply touch a thumbnail on a tray-like touchscreen to open a high-resolution image. They then move the mock slide to view the desired portion of the image through the microscope eyepieces. SmartScope tracks the movement of the mock slide and translates the movement to manipulate the whole slide image in real time. This process is more intuitive for pathologists than the slower process of repeatedly clicking and dragging a mouse to move an image on a computer screen, Dr. Sriharan says. The images being assessed are downloaded from the cloud to SmartScope via a secure connection, he adds.
To zoom in and out of an image, a SmartScope user moves a notched wheel below the microscope stage, which can be easily maneuvered with one finger. The wheel mimics the rotating carousel of lenses on a traditional laboratory microscope but is designed to be easier to reach and turn than a lens carousel, Dr. Sriharan says.
A gastrointestinal pathologist from Dartmouth Hitchcock tested SmartScope to compare diagnostic times for 59 routine GI biopsies. The test showed that the average diagnostic time was 65 percent less using SmartScope than a computer screen (43.7 versus 68.2 seconds), Dr. Sriharan and colleagues reported as part of a poster presentation at the 2024 annual meeting of the United States and Canadian Academy of Pathology. A similar study conducted with dermatopathologists showed a 52 percent reduction in diagnostic time using SmartScope.
The SmartScope development team is continuing to fine-tune SmartScope for ease of use and hopes to reduce the mean diagnostic time by another 15 seconds, Dr. Sriharan says, so the time required is essentially identical to that for completing the same task using a traditional microscope.
An added benefit is that, as with a traditional microscope, SmartScope’s use of eyepieces to view images allows pathologists to concentrate on the tissue without peripheral distractions, he notes.
To prototype SmartScope, Dr. Sriharan partnered with Digital Applied Learning and Innovation Lab, an engineering and design firm at Dartmouth College.
PixCell has a formal contract with DALI Lab, which employs engineering students who range from undergraduate to PhD level.
PixCell (using DALI Lab as a subcontractor) is developing AI algorithms in partnership with the Department of Pathology and Laboratory Medicine at Dartmouth Health. “These focus exclusively on making work easier for pathologists,” says Dr. Sriharan. “Moreover, many colleagues want to be able to sign out remotely without sacrificing diagnostic time. We think we can indeed do both.”
The DALI Lab team, working with others affiliated with the project, has so far built seven SmartScope prototypes. One is currently being tested at Dartmouth Health. The DALI Lab team constructed all the prototypes using 3D printing, and the devices are now entering the design for manufacturing, or DFM, process.
One of the bigger engineering challenges the team encountered in building SmartScope was programming the motion tracking of the mock slide, Dr. Sriharan says. The motion tracking had to be sensitive enough to allow pathologists to move an image one cell to the left or right (an almost imperceptible adjustment) but also fast enough to quickly capture a larger move of the slide, such as a shift of several centimeters from one part of a tumor to another. The DALI Lab team is currently working on making SmartScope so intuitive that pathologists will not need a tutorial, he adds.
While PixCell owns the intellectual property related to SmartScope’s design and hardware, the AI and ML diagnostic pathology algorithms that the PixCell team and Dartmouth Health researchers are jointly developing will be co-owned by the hospital and PixCell.
Together, both entities are also applying for a National Institutes of Health grant to support further work on SmartScope and AI algorithms, Dr. Sriharan says.
“One goal is to effortlessly deploy AI and ML algorithms developed by other researchers and third parties,” Dr. Sriharan explains. “Discussions with some third-party developers have already begun,” he adds. “In the meantime, the DALI lab team is continuing to study design refinements that would ensure SmartScope’s compatibility with a variety of AI and ML algorithms and provide maximally easy ways for pathologists to access and use them.”
“The goal is for SmartScope to be a conduit to get a lot of this amazing AI research that’s being done by people all over the world in pathology out into the clinical setting to not only improve patient care but to make life better for pathologists,” Dr. Sriharan says. “Both can be done.”
—Renee Caruthers