-0 TRIBVN at the heart of digital imaging

Editorial

Digital pathology in the service of diagnostics

I am happy to present this newsletter for your attention and, at the same time, to wish you an excellent 2016, full of projects, success and happiness.

This new issue includes concrete evidence of the everyday use of digital pathology at hospital level. In the Paris-Sud AP-HP Hospital Consortium, these applications are extensive, as they incorporate macroscopy, remote frozen section examinations, the presentation of slides at staff consultations and multi-disciplinary consultation meetings, and research work undertaken in conjunction with teams at the INSERM (national institute of health and medical research). The use of digital imaging in all these applications not only enhances the efficiency of work undertaken, but reinforces links and communications between pathologists, surgeons and researchers. To a large degree, these new practices are now commonplace.

While increasing numbers of studies are demonstrating that the use of digital pathology for primary diagnosis is a reliable option, and that the transition from microscope to screen offers fresh potential for the profession, I believe, more than ever, that pathology departments will expand their systematic use of our solutions in response to cancer diagnosis issues. Rapid, accurate and documented diagnosis serves the interests of optimum patient care .

Indeed, we hope that 2016 will see the realization of projects for the adoption of digital pathology, and will be a successful year, in terms of the deployment of these solutions for our clients. In pursuit of these projects and this success , we are proud to work with you. As for happiness ... it doesn't appear to corne to those who sit waiting for it. In the light of forthcoming projects and our ambitions, we should be able to achieve that tao.

Happy New Year and happy reading '

Jean-François POMEROL Director of Medical Operations

Find out more

#5. January, 2016 ~ .

Encounters with

The Paris-Sud AP-HP Hospital Consortium. pathology transforms everyday laboratory practices.

How digital

The Paris-Sud University Hospital Consortium is comprised of three hospitals: Antoine-Béclère, Bicêtre and Paul-Brousse. These hospitals provide a wide variety of specialized medical and surgical services for children and adults, with a total of 2035 in-patient beds and 197 day case beds. These hospitals are major players in the innovation of patient services in the south of the Ile-de-France, and are benchmark centres for the treatment of numerous conditions, specifically in the fields of hepatobiliary medicine, gynaecology, nephrology, neurology , immunology and haematology. In tandem with these care services, the Hospital Consortium is also a leading training and research centre.

A highly-valued migration process A faithful client of TRIBVN , the Paris-Sud Hospita l Consortium completed its migration t o CaloPix 3.0.0 in the spring of 2015. We now have feedback from this major development in imaging practices . Users of the new vers ion of this software have been impr essed by bath its performance and its ease of use. Thi s software has allowed the unification of pathological imaging services in all three hospitals, together w ith the development of applications and exchanges . Thank s to its redesigned v iewe r and wo rkflo w functions, CaloPix is not only fast, but is also more simp le and more efficient. According to Professor Catherine Guett ier, Head of the Patholog ical Anatomy & Cyto logy Serv ice of the Bicêtre/Paul Brousse Hospi tal s : "This migration to CaloPix 3.0 .0 has delivered genuine added value to our services". She goes on: "Whether in macroscopy, the conduct of remote frozen section examinations or the use of virtual slides, CaloPix is an everyday tao/ for the medical team. The straightforward incorporation of macroscopic photographs into reports is also high/y appreciated by our clinical colleagues". This migration has been undertaken in the context of the pooling of the information system at Hospital Consortium level, between the Paul Brousse and Bicêtre Hospita ls on one side, whic h have had a single Pathological Anatomy service since 2008, and the Antoine Béclère Hospita l on the ot her. Eric Adnet, Techn ical Director of the Information System Division of the Paris-Sud Hosp ital Consortium, was responsible for th e management of this project, assisted by Eric Poullier, manager of Pathological Anatomy in the AP-HP CCS-SI (patient information system centre of expertise). He acknowledges that "the deployment of this solution was straightforward, wit h the merging of databases and effec tiv e integration in the Diamic LMS".

Remote frozen section examinations The Paris-Sud Hospital Consortium has deployed a remote frozen sectio n exam ination solution in order to obviate the movement of practitioners between the Paul Brousse and Bicêtre Hospitals, thereby saving time. In the Paul Brousse Hospital , operational functions have been entire ly assumed by a technician, and frozen section examinat ions are conducted by telemedicine. Using the Macro solution by TRIBVN, the practitioner can guide the technician in the samp ling process. The slide produced is then scanned and undergoes direct remote inte rpretat ion in CaloPix. Diagnoses are transmitted in the OR and ente red in Diamic. Catherine Guettier is pleased to point out that "This practice has

permitted the reorganization of work between the Paul Brousse and Bicêtre hospitals, thereby freeing-up practitioner time. Since this solution has been in place, over 500 examinations have been completed, with response times of the order of 30 minutes - these times are entire ly acceptable for surgeons''.

CaloPix Pocket revolutionizes the sharing of anatomopathological images in the hospital The CaloPix Pocket full web application allows a user to consult their images remotely on a co mput er or a tablet , using a simple web browser w ith no pre-installation . Th e application incorporat es a search tool and a we b viewer , allowing the rapid retrie va l by the user of images and information for a given patient or exa minat ion, in an entir ely secure and traceable arrangement .

This solution is specifically used du ring staff consultations or multi-disciplinary consultation meetings outside the pathology service, during which the sharing of macroscopic imag es and v irtual slides is particularly useful. "Pocket increases our efficiency and saves time: we no longer need to prepare case images in PowerPoint beforehand, and exchanges with clinicians are enhanced" .

Resea rch works In collaboration w ith th e Paris- Sud Faculty of Medicine, the Hospi ta l Consortium pursues an active research policy, which is specifically structured on the basis of INSERM units and research platforms. CaloPix is used by a number of research teams in quantification operations. For example, the Paul-Brousse U1193 INSERM team regularly uses CaloPix in its research work on hepatic pathology. Hélène François, research physician at the combined health research unit UMRS 1197, acknowledges that "the use of image quantification in CaloPix has allowed the acceleration and standardization of our research work in renal fibrosis", and that "the renal fibrosis so~ware has been validated in fundamental research, and has been the subject of a recent publication (Lecru et al. Kidney international) and of a thesis on the c/inical evaluation of renal fibrosis" . Since its deployment , the CaloPix solution has been used for the analysis of fibro sis slides, bio-markers and TMAs in th e context of research works, and has been an indispensable tool for a numbe r of scientific publications.

Pr. Catherine GUETTIER Head of the Pathological Anatomy & Cytology Service, Bicêtre Hospital

Pr. Hélène FRANCOIS-PRADIER Research physician at the UMRS 1197, Paul Brousse Hospital

Eric ADNET Paris-Sud Hospital Consortium IT Engineer

Eric POULLIER AP-HP ces-sr IT Engineer

Pr. Sophie PRÉVOT Head of Pathological Anatomy & Cytology Service, Antoine-Béclère

- Cannabinoid receptor 1 is a major mediator of renal fibrosis. Kidney International, 2015. L. Lecru, C. Desterke, S. Grassin-Delyle, C. Chatziantoniou, S. Vandermeersch, A. Devocelle, A. Vernochet, A. Durrbach, . .. & H. Franço is.

- Full organ reconstruction in 3D, an automatized too/ for deciphering the complexity of /ymphoid organs. Journal of Immunologi cal Methods, 2015. A. Sergéa, A-L. Bailly, M. Aurrand-Lionsa, B-A. Imhofb, M. Irlac

- Characterization of the Microenvironment in Positive and Negative Sentine/ Lymph Nades from Melanoma Patients. PLoS One, 2015. M. Messaoudene, A. Périer, G. Fregni, E. Neves, L. Zitvogel, I. Cremer, J. Chanal, X. Sastre-Garau, L. Deschamps, E. Marinho, ... & A. Caignard.

TRIBVN

• Prad uct Foc us

TeleSlide 3.10: a challenge met

TeleSlide MultiMedia - Case-sharing page in the context of post-university education

In September 2015, TRIBVN added new functionalities to its dedicated TeleSlide platform for th e sharing of content in telemedicine and education in pathology and biology . These functionalities have been conceived for the delivery of optimum responses to the requirements of pathologists and teachers, but also to meet the requirements of expert networks .

The MultiMedia module Constantly developing in the interests of satisfying the increasingly stringent demands of pathologists and teach ers, simplifying the practices of the various users involved and fulfilling an expanding range of applications, the MultiMedia module has been substantially improved :

• Display of a miniature version of each virtual slide. • Review of the e-CaloPix v iewe r presentation function:

inclusion of contextual case and workshop references in slide information, list of all rules of procedure, full-screen actual display mode.

CaloPix 3.1.0

• Automatic retrieval of slide names in the index field for display in all interfaces.

• Downloading of PDF files of up to 40 Mb. • Review of workshop parameterization options. • Option for the downloading of metadata only, rather than

the entire slide, further to a review protocol. • Creation of web conferences in a given workshop, by th e

int egration of the Webex API in order to simplify th e establishment of a virtual post-university education environment, involving remote participants.

TeleMedecine module In addition to the beneficial deve lopm ents in MultiMedia, this module also incorporates additional functionalities for th e satisfaction of the workflow requirements of expert networks:

• Generation of indi v idual and general tracking charts for the attention of co-managers, in order to permit the accurate monitoring of operations and user statistics.

• Integration of Webex API for the initiation of a web conference directly from TeleSlide, and the tracking of all web conferences conducted.

• Automatic retrieval of snapshots recorded during the viewing of slides in CaloPix for subsequent inclusion in the discussion of requests for opinions.

• Management of digitization request forms on a TeleMedecine platform operated in conjunction with a slide digitization service provid er, and th e deferral of requests for opinions during digitization.

• Modification of notifications: option for the complete interruption of SMS messag es, concealment of mobile numbers, automatic notification of a user upon re-appro val.

• And many other functionalities ...

A comprehensive ergonomie redesign of TeleSlide version 3.12 is scheduled for mid-2016 .

a version with better performance features than ever Apre-premier presentation of CaloPix 3.1.0 took place at the "Ca rrefour Pathologie 2015" conference, with a market launch scheduled for mid-January 2016. This latest version includ es a series of remarkable functional and technical developm ents in response to the changing practices of pathologists , in the interests of furth er facilitating their everyday work.

Specifically, these developments include the following :

• Redesign of th e presentation of image analysis results . • Deplo yment of a library of analysis protocols which have

been validated for network application. • Redesign of the virtual slide automatic import function

using bar codes. • Improvement of requests. • A faster e-CaloPix full web viewer, w ith a facility for the

management of annotations. • Improv ement of the centralized updating tool.

My Toolbox

These developments are highly significant, and will ensure the further enhancement of th e performance and reliability of this solution.

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CaloPix 3. 1.0 - Redesign of the presentation of image analysis results

Discover the new TRIBVN image analysis tool, the Random Forest Tree

CaloPix RFT - Discrimination of different tissue types by the learning of 2 classes in the DAB layer.

A classifier integrated directly in CaloPix The Random Forest Tree (RFT) is a tool which permits the discrimination of different tissu e types within a sample, or the generation of an object learning function on the basis of different imag es. The RFT tool operates wi th all histological colouring methods , and permits the identifica tion of tissues prior to quantification, or the learning of a given cell type for the purposes of quantification.

An ergonomically simple and effective tool Directly integrat ed in CaloPix, the RFT classifier permits the definition of tissue classes by learning, with the automatic segmentation of imag es. Although easy to use, the algorithm invo lved is complex, and permits the effective processing of images: isolation of a tumour from surrounding tissue, segmentation of diff ere nt tissue structures, identification of certain cell types, etc. - the RFT classifier permits the extraction of the correct information prior to quantification.

Contact us: info@tribvn.com et 01 55 58 05 20 39, rue Louveau - 92320 Châtillon - France Read more about us on: www.tribvn.com et www.teleslide.fr