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Publications total: 16
  Jun 1st,2016

Looking deep within: The exciting prospect of in vivo microscopy

Introduction:

Medical science is progressing at a tremendous rate and the trend that is currently generating a lot of interest is personalized diagnosis, treatment and disease management. Decisions that are specifically made on the basis of an individual's genetic or cellular makeup are far more effective when it comes to ensuring a favourable treatment outcome or more effective management of disease conditions. In vivo microscopy is such a technique that will offer real time information to the doctors at the cellular level and would facilitate highly time-sensitive intervention and decision-making. In simple words, in vivo microscopy is a modern technique that involves the use of endoscopic tubes inserted into the human body for the purpose of obtaining images in real time. In vivo microscopy is definitely on its way in emerging as a revolutionary technology for patients suffering from critical conditions who require immediate diagnosis and treatment.


Why in vivo microscopy:

Traditional microscopic sample evaluation is a time consuming exercise involving sample collection, preservation, processing and examination in a lab and would normally require at least 24 hours before any diagnosis or treatment decisions are made. In vivo microscopy on the other hand will allow instant diagnosis of the condition or conditions without the need for removal of any tissue from the body. There is no doubt that in vivo microscopy will completely change the way health conditions are diagnosed and managed and will herald a change from the current biopsy and histopathological practices to a paradigm that will allow instant decision making and immediate intervention. Traditional microscopy that involves retrieval of tissues and elaborate histological procedures such as creation of tissues sections and staining is definitely very accurate and has been indispensable for medical diagnosis but it has limitations that can certainly impede rapid decision making and intervention. Histopathological procedures require carrying out biopsies that are stressful for patients and meaningful conclusions can only be drawn when the right tissue is retrieved. In essence, the process of sampling is critical and accurate diagnosis is only possible when the most relevant sections of the biopsy samples are analysed. Another issue with traditional histopathological examination is the possibility of contamination during sample preparation. The samples may undergo significant morphological alteration and thereby provide very limited information to the pathologist on the underlying medical condition of the patient. In vitro microscopy negates all the issues associated with histopathological procedures and allow rapid evaluation of the medical conditions with excellent accuracy. This in turn will facilitate rapid intervention and can even lead to discovery of novel molecular findings that can greatly improve cancer therapy (Wang et al., 2007). In a way, in vitro microscopy also changes the way the healthcare providers interact with the care receivers because the evaluation of the condition is done immediately in real time and not after the procedure, as it used to be in case of traditional histopathological examination.


Clinical applications:

Different clinical application paradigms can be used to implement in vitro microscopy in a real world scenario. One paradigm could be independent functioning of the endoscopist who would carry out the microscopic procedure and the pathologist who would evaluate the data provided by the endoscopist. Both players will act independently and the microscopic images that are captured will be transmitted remotely in real time to the pathologist (Williams, Henricks, Becich, Toscano & Carter, 2010);(Weinstein et al., 2009). In this arrangement the endoscopist is responsible for managing the entire microscopic procedure as well as managing the patient. Another application paradigm for in vivo microscopy could be an arrangement where the endoscopist also acts as a pathologist. While this might be good in the sense that the care provider can avoid situations like network delays doubts are being raised on the efficiency of the endoscopist-cum-pathologist in carrying out both the roles (Liu et al., 2011). Irrespective of the paradigm adopted one apprehension that is being raised is that since the procedure is in situ and interpretation/evaluation of the data is done immediately, the patient might have to spend longer time at the clinic. This would eventually increase the stress on the patient and could also reduce the efficiency of the pathologist and the endoscopist. However, in front of major advantages such as real time assessment and treatment and potential reduction in hospital admission times every disadvantage of in vivo microscopy should appear as an acceptable trade-off (Liu et al., 2011). In vivo microscopic technology is not just poised to alter the diagnosis and treatment paradigms but also training of future doctors who will be able to understand and use real time microscopic information. Furthermore, the technology will also be extremely useful for other emerging treatment paradigms such as telemedicine. Healthcare services today are stressed to the limit and it has become a real challenge to provide high quality affordable care to one and all. In this context, in vivo microscopy can go a long way in reducing healthcare costs by facilitating rapid on site diagnosis and treatment and reducing hospital admission rates. Another factor that cannot be ignored when it comes to successful clinical application of in vivo microscopy is the ease of use. Medical technology is maturing at an amazing rate and with time it will become important that further design refinements are brought into in vivo technology to facilitate its integration with other medical intervention technologies. Techniques such as image-guided surgery could benefit greatly from in vivo microscopy when microscopes could be integrated with instruments such as tumour catheters to carry out image detection and treatment simultaneously. Another design consideration for in vivo microscopy could be their adaptation to fit in through the already existing endoscopes and catheters for image capturing. While in vivo microscopy is already generating a lot of interest further developments such as long application life and easy sterilization will go a long way in fast-forwarding the adoption of the technology in real clinical settings. Robotic surgery is another emerging sector in the field of medical science and the prospect of integrating in vivo microscopy with surgical robots in extremely enticing (Liu et al., 2011).


Limitations of in vivo microscopy:

While in vivo microscopy can improve diagnosis and intervention there are a few disadvantages of the technique that cannot be overlooked. While immediate diagnosis through the use of the technique is a good thing, medical interventions carried out in the absence of the more detailed histo-pathological lab examination is a potential risk. In the event that a diagnosis is not accurate and treatment procedures such as tissue cauterization or removal is carried out then there is no scope left for further histopathological examination in the event of the patient not getting the expected relief. As a result, the procedural errors will remain undetected and it will become a real challenge for the physicians to recommend alternative interventions. Also since in vivo microscopy is a relatively new technology it is important that proper quality control measures are in place to ensure the appropriate selection of the instruments and full competence of the practitioners using them (Liu et al., 2011). Pathologists have relied on laboratory histo-pathological examinations for decades to make diagnosis of disease conditions and they are well experienced to identify those artefacts in the samples. In essence, the pathologists are actually acquainted to see artefacts in the sample and absence of the same will actually appear very unnatural to them. In vivo microscopy will present in situ images that will not have any artifacts and the endoscopists and the pathologists will have to be adequately skilled to make correct interpretations. Lack of adequate exposure and training in this aspect could lead to the formation of incorrect image-to-disease correlations and care providers may end up giving wrong diagnosis and treatment.


Conclusion:

In vivo microscopy definitely has got the potential for application in a wide range of clinical scenarios facilitated by rapid developments in the fields of information and communication technology, electronics and fiber optics. A common hurdle that comes in the way of successful application of any new paradigm is the lack of connection or communication between the scientists who developed the technology and the practitioners who use it regularly in a real world scenario. With regards to in vivo microscopy, a careful evaluation of its application potential is crucial along with the identification of the technological approaches that will help in the realization of the same. There are chances that every form of clinical application of the technology will come with its own set of challenges, both in design and practicality and it will be prudent on the part of the practitioners to establish a proper connect with the developers to ensure complete and total expertise. There is no doubt in the fact that there are major challenges that will have to be overcome first to make in vivo microscopy a widely accepted technology in clinical settings across the globe but when seen in context of all the benefits that it can offer to the patients and the care providers alike, all the effort seems completely justified.


References

Liu, J., Loewke, N., Mandella, M., Levenson, R., Crawford, J., & Contag, C. (2011). Point-of-Care Pathology with Miniature Microscopes. Analytical Cellular Pathology, 34(3), 81-98. http://dx.doi.org/10.1155/2011/657403

Wang, T., Friedland, S., Sahbaie, P., Soetikno, R., Hsiung, P., & Liu, J. et al. (2007). Functional Imaging of Colonic Mucosa With a Fibered Confocal Microscope for Real-Time In Vivo Pathology. Clinical Gastroenterology And Hepatology, 5(11), 1300-1305. http://dx.doi.org/10.1016/j.cgh.2007.07.013

Weinstein, R., Graham, A., Richter, L., Barker, G., Krupinski, E., & Lopez, A. et al. (2009). Overview of telepathology, virtual microscopy, and whole slide imaging: prospects for the future. Human Pathology, 40(8), 1057-1069. http://dx.doi.org/10.1016/j.humpath.2009.04.006

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