Neuropathology Chief Saves Time,Gains a Valuable Teaching Tool with CapSure

SCOTTSDALE, Ariz. (September 9, 2010) — Barrow Neurological Institute of St. Joseph’s Hospital and Medical Center in Phoenix, Arizona, was established in 1962 under the auspices of John R. Green, M.D., the founding director. Dr. Green began performing neurosurgery in Phoenix in the 1940s and 1950s. Now led by Robert F. Spetzler, M.D., the institute’s director for the past 24 years, Barrow treats patients with a wide range of neurological conditions, including brain and spinal tumors, cerebrovascular conditions, and neuromuscular disorders.

Barrow was recognized in 2006 by U.S. News & World Report as one of the nation’s top ten hospitals for neurology and neurosurgery. The institute is one of the few centers in the United States that offers the CyberKnife, a non- invasive radiosurgery device for removing previously unreachable tumors and lesions. And Barrow was one of the first neuroscience centers to use Gamma Knife radiosurgery, a non-invasive alternative to traditional neurosurgery.

Problem
Much of the focus of the neurosurgeon is on tumors and knowing whether they are cancerous or benign. That determination falls to a physician that patients rarely see—the neuropathologist. Stephen W. Coons, M.D. joined the staff at Barrow after completing a Neuropathology fellowship there in 1989. Dr. Coons has been Chief of the Section of Neuropathology since 1996.
Barrow Institute shares the neuropathology laboratory with St. Joseph’s Hospital, on its sprawling campus in Central Phoenix. The hospital is also home to a residency program to train more neuropathologists. The busy lab is located on the hospital’s second floor, while Dr. Coons’ office is in the basement where he conducts research. His principal interest is in translating the results from basic research in the molecular genetics of brain tumors to clinical applications in the pathology laboratory.

In the past, when a surgeon would send the lab a specimen for inspection, the trip from his basement office to the second floor lab would take Dr. Coons between five and ten minutes, depending on the availability of a service elevator. The delay meant the surgeon, and the patient on the operating table, had to wait that much longer for the crucial information. After interpreting the fresh frozen specimen, Dr. Coons would then make the return trip—another five to ten minutes—back to his office. Depending upon the number of surgeries scheduled each day, the walks from the office to the lab and back could amount to an hour or more of lost time in Dr. Coons’ day.

The GlobalMed Solution
Working with Dr. Coons, GlobalMed Group, LLC, a telemedicine design, manufacturing and marketing company based in Scottsdale, Arizona, developed a system that allowed him to remain in his basement office and perform his interpretations there. The result was the CapSure® Image Automation System, specifically designed for microscopy and macroscopy applications.

“In my situation, and the situation of a lot of pathologists, we work in multiple laboratories, different offices, different suites,” explained Dr. Coons. “You can’t be in more than one place at the same time physically, but you can with the camera system. The transit time involved in walking from one lab to another amounts to a tremendous amount of time that can be saved by reviewing the images on screen, live or real-time, rather than spending that time walking back and forth.”
GlobalMed paired a robust iREZTMi2100c digital video camera with a powerful microscope which connects to a PC through a USB 2.0 connection. In the path lab, a neuropathology resident places the specimen under the microscope and alerts Dr. Coons that they have images to examine. The resident shares the live image he is seeing through the microscope viewfinder to Dr. Coons.

Then, GlobalMed’s CapSure®, a real-time image automation, collaboration and information management software, takes the split- beam from the microscope and sends it to Dr. Coons’ computer with EasyShare® VC, a complete visual communications solution for point- to-point and multipoint calls. In the time he normally spends walking to the path lab, Dr. Coons is able to develop his opinion and deliver it to the neurosurgeon, saving precious time for surgical staff and for his own work.

Benefits
Dr. Coons believes that GlobalMed’s telemedicine solutions are essential for training future neuropathologists. “One of the real problems academic pathology has with the training of residents is they don’t get opportunities to function independently,” Dr. Coons explains. “There are no…simple levels of things that they can do straight out of medical school that gradually get more complicated.”

Pathologists must have the right answer the first time. The CapSure ProLab system allows the student to sit at the microscope and operate it without an attending physician looking over his or her shoulder. Residents develop a sense that they are fully involved and have told Dr. Coons that “they like the opportunity to be the one person at the microscope.”

“The camera system plays a major role in resident training when it comes to this process,” said Dr. Coons. “It has to be performed by the attending pathologist, and yet, this is the absolute most critical skill that a practicing pathologist has to have and thus, that a resident must learn. I found that having a remote camera system is the next best thing to being there; I can be at a remote location reviewing the images that the resident is responsible for producing and generating. And the resident has the impression that he or she is operating independently. It’s really quite amazing how not having someone looking over your shoulder adds that burden of responsibility the residents need to feel. They’ve told me that it absolutely makes a difference in terms of what they learn.”

Dr. Coons sees other potential uses for the GlobalMed solution. He thinks that they can use the CapSure software to “rapidly document cases, particularly interesting cases, as they come in.” He adds, “We can then link them directly to the case, allowing us to easily retrieve that information in the future.” He believes that linking a full color digital image to the written report will make the report more accessible, both to the clinician seeing the report and to future reviewers.