March 2006


Coming soon to a screen near you - Malaria TV

Watching a live wriggling malaria parasite ominously make its way across the screen, wreaking havoc within an innocent blood sample may not be everyone's idea of must-see television, but "Malaria TV" is poised to become a hit in the world of medical diagnostics.



From left, Dr. Ian Crandall, Dr. Peter Pennefather and Dr. West Suhanic of the University of Toronto's LCD

Using their connection to ORION, Access Grid collaboration software and generic PCs, researchers at the University of Toronto's Laboratory for Collaborative Diagnostics (LCD) have introduced an IP-based application which provides Canada with a new national, collaborative malaria diagnostic capability. While malaria is the initial target, the ultimate goal is to provide a national, collaborative parasite diagnostic capability.

Their project, nicknamed "Malaria TV", allows physicians and clinical lab workers anywhere in Canada to link their lab's digital microscope to an on-line microscopy network and facilitate consultation with colleagues in determining if any malaria parasites are present in suspect blood samples.

Although the system is still in development, the lab provides a live digital video feed of a malaria parasite from its Collaborative Digital Microscope (CDM), accompanied by a live audio feed that permits a collaborative diagnosis to be developed. All of this content is made globally accessible via the use of Access Grid client software and the lab's Access Grid Venue Server all running on inexpensive personal computers.

"Having access to ORION helps make this possible," says Dr. West Suhanic, the Executive Directory of the Laboratory for Collaborative Diagnostics, who is working with Dr. Ian Crandall, a parasitologist and an assistant Professor in the departments of Laboratory Medicine and Pathobiology and the Department of Medicine at the University of Toronto, and Dr. Peter Pennefather, a Professor in the Leslie Dan Faculty of Pharmacy and the Academic Director of the Laboratory for Collaborative Diagnostics.

"This is a powerful new tool that can make a genuine difference in the way we diagnose and confirm the presence of infectious disease, when speed and time is of the essence," says Dr Crandall.

"Malaria can kill within 72 hours. It's important to be able to access diagnostic resources and expertise very quickly so that malaria can either be ruled out or treated before disaster strikes," he explains. Malaria is relatively rare in Canada, and most physicians or researchers are not trained in what to look for. "Using the CDM allows someone with expertise to look over your virtual shoulder and consult with in real time. This is crucial to effective patient management."



Sample LCD malaria image (10 MB file) - Red and blue in a erythrocyte (human red cell) spells trouble since it indicates that malaria parasites may be present. Malaria can be a medical emergency and needs to be treated promptly, however antimalarials come with potential side effects. When accuracy and speed are of the essence it never hurts to get a second opinion, and in the case of this blood film treatment is definitely required since it contains the most deadly form of malaria, Plasmodium falciparum. - Photo by Dr. James Flick

The need for the CDM was highlighted recently by cases where patients presented severe Malaria-like symptoms in New Brunswick after traveling to the Dominican Republic, where a malaria outbreak was known to be taking place. It took five days to determine, using traditional mechanisms, that Malaria was not present. However if the local team had access to a CDM and an opportunity to consult with a Tropical Disease expert like Dr. Crandall a conclusive diagnosis would have been reached much faster.

"The Laboratory of Collaborative Diagnostics (LCD) is using internet-enabled digital diagnostic microscopes to combine collaborative communication technology with cytometry to deliver diagnostic tests that are open, transparent, adaptable, economical and participatory," says Dr. Pennefather.

Part of the urgency that drives the development of these new technologies is the fact that trained and experienced parasitologists or researchers familiar with specific but rarely encountered diseases are retiring, or are scattered across the country and not readily accessible for consultation.

The team is also behind the development of the new "BIOTIFF" image format. BIOTIFF is based on the industry standard TIFF image format and was inspired by the GEOTIFF standard. The new format provides the framework needed to hold not only the digital image but the necessary meta data required to support the diagnostic conclusion.

The team demonstrated the use of the technology at a recent ORION workshop in Windsor, where participants were able to view a live sample broadcast in real-time from the lab's location in downtown Toronto. The team in Windsor was able to receive the Malaria TV signal by installing Access Grid software on a generic PC (running Windows) and installing the X509 security certificate from the Laboratory for Collaborative Diagnostics.

Through the LCD's basic setup process, anyone in Canada or around the world could easily access Malaria TV with a one-time setup of approximately 20 minutes.

Malaria is only the first target. The LCD is now investigating how to best use the technology for HIV/AIDS and Tuberculosis.

The first goal, however, is to get Malaria TV up and running as a seven-day-a-week digital disease signal, giving researchers around the world a reliable digital malaria signal. It will also act as a training and quality assurance mechanism for physicians and clinical laboratory workers.

In the long run "Malaria TV" will become "Parasite TV". Reruns of Parasite TV could be significant training tools as they would allow parasitologists to hone their skills in identifying unusual or rarely encountered perpetrators of infectious diseases.

The researchers are keen on having other applications take advantage of these new capabilities enabled by ORION and advanced networks, and open source collaborative platforms like Access Grid. The team is quick to note that Malaria TV was developed using inexpensive, off-the-shelf commodity equipment and should therefore be easily adopted by labs across the province and the country.

"This is just the beginning. Once we demonstrate how these technologies can lead to faster and more accurate diagnoses of parasites and other pathogens and can help save lives, we can expect that it will introduce new and more exciting innovations," says Dr. Suhanic. "It will have a snowball effect."

Learn more about the team's research at http://hub.lcd.utoronto.ca.


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