Brig Dr Arvind Lal
Executive Chairman
Dr Lal PathLabs Ltd.

Instrument modernization

With intensifying pressure on laboratories to deliver high quality, faster, and affordable tests that also reduce manpower costs, automation has become an inherent part of operations and technology of a modern laboratory. Accurate and faster turnaround time has high value for physicians, as the results aid in more than 70 percent of clinical decisions. Last year we tested nearly 2 crore patients in our 216 laboratories all over India. 32 of our labs have NABL accreditation.

Therefore, our recent and future investments in instrumentation are largely ruled by lab needs and technological advancements. Over the last year we have built total lab automation on track systems for our regional hub labs and the national reference laboratory at Delhi. The integrated track systems provide world’s best automated lab equipment that allows highly skilled operators to help focus their attention on more important lab tasks. This helps to de-duplicate tasks, remove non value added activity, cut sample processing time and enhance quality improvement.

This results in higher throughput per square meter and has been achieved with the help of world famous companies like Seimens, Roche, and Beckman. Delivery of controls and calibrators to multiple analyzers from an onboard refrigerated compartment allows the quality control (QC) and calibration tasks to be automated.

We are always facing challenges to design and develop new tests that we can offer for better patient diagnosis. We have achieved world class total lab automation that includes Atellica systems from Siemens integrated with Aptio track automation, Cobas 8000 series from Roche, integrated with Cobas infinity and track, and AU 5800 series with the DXI 800 from Beckman connected with track and Remisol solution. Multi-camera vision system with 360° view is designed to reduce bar-code reading errors, exception. handling, operator intervention and providing a multidisciplinary total lab solution.

As the largest histopathology center in the world, with processing close to 1250 biopsy samples a day, it was natural that we lead the way in digital histopathology also. We were the first lab in India to install the high throughput Philips Whole Slide Image (WSI) digital scanner. This tele-pathology platform holds the key to making histopathology future ready, more efficient, scalable and to connect Tier II and III town labs. We have been able to unchain our pathologists from their (physical) labs, allowing them now to practice anatomic pathology anywhere, independent of the physical location of the biopsy, the glass slide and the patient. We are the second largest kidney biopsy processing center in the world and have done India proud by installing the first electron microscope in a private lab in South Asia to diagnose complicated kidney diseases.

We are using the computational pathology algorithms for the quantification of breast cancer immunohistochemistry panel making reporting more accurate and more reproducible. This has helped us integrate our reporting with genomic profiling in oncopathology. The technology allows easy review and to give second opinion from expert pathologists. This has hugely helped to educate the new generation of pathologists getting trained in our national reference lab for DNB Pathology course.

In order to have more focus on the cutting edge technologies spanning molecular diagnostics, we have recently launched a separate division within Dr Lal PathLabs in the genomics segment called Genevolve. We are also partnering with IGIB, a Government of India’s CSIR lab, which has developed a number of new technologies to reach the masses at affordable rates. Our latest molecular and gene technologies include the 3500 Dx capillary electrophoresis system which is being used to perform tests to diagnose Spino Cereberal Ataxia and Beta Thalassemia using Sanger sequencing. Using the same equipment for fragment analysis we can perform tests for Duchene muscular dystrophy and spinal muscular atrophy for both pre-natal as well as post-natal cases.

We have procured next generation sequencers (NGS) to cater to increasing focus on personalized medicine for precision diagnostics. Using these systems, we can look at thousands of genes and the mutations therein at one go. They can elucidate the mutations, copy number variations, insertions-deletions as well as fusions which occur in various chromosomes. These could be somatic changes leading to cancer or other diseases which one acquires later in life. We can thus look at these variations in a comprehensive way. Similarly, we have standardized exome and clinical exome sequencing using NGS technologies to look at germline mutations i.e. those mutations which a person inherits. These are responsible for a host of genetic defects spanning all fields of medicine.

Using the same next generation sequencing, it is also possible to predict and detect numerical changes in the chromosomes of the fetus by analyzing the maternal blood. This non-invasive prenatal testing or NIPT is revolutionizing the way trisomies like downs syndrome, Patau syndrome, and Edwards syndrome are diagnosed. Advanced forms of the same test can look at a number of microdeletions as well.

The time tested real time- polymerase chain reaction (RT-PCR) systems have become the work horse of any molecular lab. By optimum utilization of these 96 well and 384 well systems, along with automated extraction systems, we have been able to serve the country by doing close to 350,000 COVID tests during the current pandemic.

In cytogenomics, automated detection and classification of banded chromosomes help clinicians diagnose cancers and other genetic disorders at an early stage more efficiently and accurately. In order to improve the performance of automated chromosome classification and recognition of disordered chromosomes, Artificial Intelligence (AI) and Machine Learning (MR) methods have been widely used in the computer-assisted chromosome detection and classification systems. Our lab is fully integrated with a range of fully motorized and automated instruments namely Hanabi PIII metaphase harvester, Hanabi PV Auto minispreader, Olympus VP-2000 G banding and Leica GSL 120 metaphase slide loader and automated scanner.

The automated instruments have proven to be beneficial as now we can process more workload with minimum involvement of manpower. Also, it has minimized the chances of variability of results and errors that generally can occur during manual analysis. The use of integrated computer hardware and software have smoothened the job as it provides automatic process control and data processing. In totality, introduction of automation has led to reduction of workload, less time consumption per sample processing, more number of samples handling, decreased chances of human errors, and high accuracy and reproducibility. The advent of such motorized and automated instruments have provided a platform to become the lab of future.

Aside from the investments in high end esoteric testing, we continually improve upon the available technology and automation for routine reporting. As an example for urine routine analysis, we have installed fully automated urine analyzers from Suyog diagnostics-Urised. This has an advantage of fully automated microscopic reading and removes the subjectivity of microscopic evaluation. The microscopy examination is performed on urine sediment by taking several images of each sample through its built-in microscope and evaluates them using the auto image evaluation module, which is high-quality image processing software. This automated image processing allows the detection of the urine particles in the sediment with high accuracy. The new test also has more than 20 additional parameters. It covers three physical, nine chemical and 26 microscopic parameters including all cell types/casts/crystals, bacteria, yeast etc.

Improvisation of current features for our high ended labs have helped incorporate automation in pre-analytical and post-analytical phase of testing with rerun and reflex testing, closed tube sampling facility and rapid STAT testing. This along with integrated QC software for four level quality management, bi-directional interfacing capability and modular systems with expandable test menu incorporating routine clinical biochemistry and immunoassays has helped us to stay ahead of other labs. 

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