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Automation In Diagnostics: A New Beginning

Developing countries are faced by unprecedented challenges of rising costs, increased workload demands while managing a limited workforce. In view of the rising growth rate and ageing population needs, the diagnostic sector in India needs harmonization of best practices in lean work processes and IT support using skilled manpower or robotics which can perform more value-added-work such as quality monitoring, evaluation and setting up of new tests with reduced turn-around-time. Advantages: 1. Process standardization, decreasing frequency of outliers and errors. 2. Better accuracy and consistent quality results. 3. Ameliorate processing times with better TAT 4. Occupational safety. 5. Enhances productivity. 6. Cost-efficient Clinical laboratory automation can be ranged from automating only a few laboratory processes, partial or local automation, to total laboratory automation, which can include quantitative chemical and microbiological tests together with the majority of preanalytical processes. Expansion or upgradation of existing automation systems in a laboratory is usually considered based on the laboratory’s needs, the specimen volumes, infrastructure requirements, performance indicators like productivity, turn-around-time and quality; and finally cost jurisdictions. Phazes of Laboratory Automation in Clinical Laboratories: A. Pre-Analytical Automation in pre-analytics is the key to flawless barcoding, accessioning and transportation of specimens. The same is achieved through implementation of standardized specimen transfer tube or pneumatic tube systems, mobile robots to transfer specimens and an AutoSort that can sort specimens by analytical needs and transport specimens to an automated centrifugation station for processing. Samples are segregated specific to each analytical rack. B. Analytical Laboratory automation using robotics in the analytical phase is aimed at traditional manual analytical steps (such as mixing, reconstituting, pipetting, dissolving before measurements can be made) and the subsequent measurement step. Manual data transfer at the beginning and end of the run has now been replaced by bi-directional data integration and laboratory information system (LIS) with wireless transmission of results. Advances have been made to develop areas of analytical automation unique to their respective disciplines. Clinical Chemistry The need for automated platform in clinical chemistry can be based on the sample size to be analyzed, and the capability for connectivity into instrument clusters or larger laboratory automation system. Regardless of the initial installation and equipment costs, these automated systems for large-volume laboratories improve efficacy by handling more tests per hour with a larger volume for both specimens and reagents. Along with routine chemistry analyzers that perform traditional photometric and potentiometric measurements, automation in clinical chemistry also includes specialized instrumentation for specific clinical needs. These Point-Of-Care (POC) systems are useful to near-patient testing, including electrolytes, coagulation profile, glucose, ionized calcium, lactate, pH, hemoglobin or hematocrit. Immunochemistry and Immunology Automated immunoassay platforms are predominantly based on antibody-based detection methods, along with other systems like microplates and microwells, including ELISAs, cell-based immunofluorescence assays, Western blots and immunoblots. Finally beadbased multiplex systems allow for detection of multiple analytes in the same reaction mixture. Such systems can decrease the specimen volume required for parallel analyses. Urinalysis Urinalysis by automation is primarily based on reflectometry reading of test strip, as well as analysis of sediment, particles, or cellular elements using flow cytometry or microscopic analysis. Hematology Automation in hematology has exploited the principles of cell conductivity, light scatter, flow cytometry and digital microscopic analysis. Integrated hematology systems may include automated slide makers and slide stainers to limit the manual intervention involved in creating and labeling slides. Also, automated digital imaging allows electronic storage of slides needed for further review by clinicians and pathologists. Transfusion Medicine Blood banking and Transfusion Medicine can be automated at blood collection sites, through apheresis donations that help to maximize the yield of specific blood component donations, and automated component processing systems at blood banks. RBC molecular typing or genotyping may further refine automation of donor and recipient screening. Microbiology Total laboratory automation microbiology solutions with track systems have been designed to include pre-analytical, analytical and post-analytical steps like specimen decapping and recapping, petri dish bar code labeling, plate inoculation and streaking, grams stain preparation, automated incubation (O2 and CO2), high resolution digital imaging of plates, colony sampling for biochemical identification, antibiotic susceptibility testing and seeding of plates for subsequent matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometric analysis. Molecular Diagnostics Automation has impacted the process of sample preparation, liquid handling, target amplification by PCR and data analysis in the field of molecular diagnostics. An automated fluorescence in situ hybridization (FISH) enumeration system is a device consisting of an automated scanning microscope and image analysis system designed to detect and enumerate FISH signals in interphase nuclei of formalin-fixed, paraffinembedded human tissue specimens. These systems aid in the detection, counting, and classification of cells based on recognition of cellular color, size, and shape. Automated nucleic acid extractors coupled with closed system PCR technologies like TrueNat/ CBNAAT are fully automated systems that employ chip-based PCR molecular diagnostic technology to look for and quantify minute amounts of microbial nucleic acid. These platforms apart from providing faster results are also consistently sensitive, and as such, increasingly becoming the preferred methodology to carry out confirmatory tests for many PCR based assays including Covid-19. C. Post-analytical Automated selection and reporting of test results based on set algorithm minimizes interlaboratory personnel variations. This in turn reduces the number of test results that require manual checking; granting laboratories time to focus on ambiguous results. Also, postanalytical automation can help locate, store, retrieve and archive or discard samples after a specified date. DISASTER ROBOTS!! Role of Robots amidst Covid-19 Pandemic – Thermal imagery to help identify infected citizens – Measure blood pressure and oxygen saturation for patients on ventilators – Disinfection of workplace and public places – Serving dietary supplements to quarantined patients – Drones to ferry test samples to laboratories – Monitor safe-distancing protocols – Phlebotomy procedures and performing mouth swabs. Robots/ Artificial Intelligence Vs Humans… – Automated systems like robots can detect inefficiencies that a human manager never would. Along with a low error rate, these technologies have an inspiring precision, accuracy and speed, resulting in swift and efficient rate of task completion. Robots can be made to work in hazardous environments and in emergencies where humans cannot assimilate the unanticipated tasks. Also they free up health care workers to handle the increased workload during emergencies. – Higher costs involved in software and equipment development along with its maintenance are the main hindrances for developing nations as compared to human resources.

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5/5
Good service in a cost effective manner. Doctor consultation was very good, she explained my test report one by one in detail and suggested for having healthy diet and exercise. The person who collected the sample was also very good, he came on time, collected the sample with cleanliness and in a good manner. Overall nice experience. Keep up the good work Saral team!
Kumari Nutan, 10/01/19, Google Review

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