Automation of Microscopic Tests for Cyto-diagnostics Using Custom-built Slide Scanner

Abstract

Optical microscopy is the simplest and the gold standard method adopted for the screening and subsequent diagnosis of various hematological and infectious diseases like malaria, sickle cell disease, tuberculosis etc. In addition to infectious disease diagnosis, its applications range from routine blood tests to the more sophisticated cancer biopsy sample analysis. Microscopy Tests (MTs) follow a common procedural workflow: (1) A technician prepares a smear of the given sample on a glass slide in a specific manner depending on the sample and the disease to be diagnosed; (2) The smeared slide is subsequently exposed to fixative agents and different histochemical stains specific to the diagnosis to be performed and (3) the prepared slide is then observed under a high quality bright- field bench-top microscope. An expert pathologist/cytologist is required to manually examine multiple fields-of-views of the prepared slide under appropriate magnification. Multiple re-adjustments in the focus and magnification makes the process of microscopic examination time consuming and tedious. Further, the manual intervention required in all the aforementioned steps involved in a typical MT, makes it inaccessible to rural/resource limited conditions and restricts the diagnostics to be performed by trained personnel in laboratory settings. To overcome these limitations, there has been considerable research interest in developing cost-effective systems that help in automating MTs.

The work done in this thesis addresses these issues and proposes a two-step solution to the problem of affordable automation of MTs for cellular imaging and subsequent diagnostic assessment. The first step deals with the development of a low cost portable system that employs custom-built microscopy setup using o -the-shelf optical components, low cost motorized stage and camera modules to facilitate slide scanning and digital image acquisition. It incorporates a novel computational approach to generate good quality in-focus images, without the need for employing high-end precision translational stages, thereby reducing the overall system cost. The process of slide analysis for result generation is further automated by using image analysis and classification algorithms. The application of the developed platform in automating slide based quantitative detection of malaria is reported in this thesis.

The second aspect of the thesis addresses the automation of slide preparation. A major factor that could influence the analysis results is the quality of the prepared smears. The feasibility of automating and standardizing the process of slide preparation using Microfluidics with appropriate surface fictionalization is explored and is demonstrated in the context of automated semen analysis. As an alternative to the mechanism of fixing the spermatozoa to the glass slide by smearing and chemical treatment with fixative, microfluidic chips pre-coated with adhesive protein are employed to capture and immobilize the cells. The subsequent histochemical staining is achieved by pumping the stains through the microfluidic device. The proof-of-principle experiments performed in this thesis demonstrate the feasibility of the developed system to provide an end-to-end cost-effective alternative solution to conventional MTs. This can further serve as an assistive tool for the pathologist or in some cases completely eliminate the manual intervention required in MTs enabling repeatability and reliability in diagnosis for clinical decision making