Matthew: [00:00:00] A lot of people don’t appreciate when you’re looking at just the end result, how much or how many of the specimens that are needing to be sent through the traditional workflow actually use logistics to make that happen. And what is the percentage of those that get lost, broken, damaged. They become unuseful and that patient’s got to go back.

And in some cases you have very limited ability to get additional specimens. So we’re eliminating a lot of those kind of functional risks with the workflow that I think both the pathology teams, the laboratory teams and the administrators are all going to appreciate.

Aleks: We are at the MUSE booth and I’m with Matthew Nunez.

He’s the CEO. Matthew. Welcome.

Matthew: Thank you. Thanks for having us.

Aleks: What is MUSE?

Matthew: It is the industry’s first direct-to-digital pathology imager. Fully integrated. So we can go directly to digital for the first time. Tissue right into the instrument [00:01:00] and come up with an H& E equivalent image in just minutes.

Aleks: I’m gonna show the instrument. And we were thinking, how do you call this instrument? That’s it? We’re going to do a little demo in a second, but yesterday with the team, we were thinking what do we call this thing? Because it’s not a whole slide image because there’s no slide. So we came up with a whole tissue image. So here is the device. Let’s show the device. Here is the cassette with tissue.

And, what are we doing, Matthew?

Matthew: The instrument will close the tray. It’s going to show the user the tissue in the cassette. The system, we can actually select an area if we’d like, of interest.

Aleks: Oh, so you don’t have to scan the whole thing if you know exactly where.

Matthew: No, you can see the little squares here.

You can pick any quadrant you’d like.  To scan or and confirm it, or there’s a mode where you simply can start imaging. [00:02:00]  The system has an onboard Cognex camera

And it’ll identify where the tissue is automatically.

Aleks: So it has tissue recognition without having to switch anything on?

Matthew: Right, Correct.

Aleks: Nice.

Matthew: That way pathologists have the confidence that the technician is capturing the entire tissue. They’re going to have the the entire image available to them, and they can navigate in their viewers anywhere that they’d like to be with on within that tissue.

Aleks: Because in this device, it’s a computer, right?

You can send this slide to wherever you want to send it,

Matthew: Right? It’s all the computing for the processing, the virtual staining capabilities, which we’ll talk about a little bit more. The stitching, the mosaic and all the Z layers are all on board.

Aleks: Yeah. So let’s start with what’s inside the device? We have an objective.

Matthew: Yep, we have an objective with an  [00:03:00] optical system. We have an obliquely lit lighting strategy, which is quite unique in microscopy. So it’s not like a confocal microscope or where we’re using dichroic mirrors or light through the objective or through the tissue. We’re using it from above to, to light it. We’re using…

Aleks: MUSE actually stands for Microscopy with UV Light Surface Excitation. So this is, with those UV lights, L.E.D.s, you excite the surface.

Matthew: Right. We use a very short wavelength, non visible to the eye, wavelength of light.

And it excites the tissue and generates a fluorescent response that we measure and we image with the camera.

This is the H& E image. But we also have a capability. So you’ll have the fluorescent image on the right. And you have the digitally converted H& E. So no stain required for that. We can look around [00:04:00] the physiology. The system automatically matches.

So the user can slide around and see anything that they would like in both the H& E and the native.

It’s just a push of a button.

Aleks: Okay, so let’s unpack the staining because this excitation with UV light generates a fluorescent. So it’s a, the native image is a fluorescent image, right? Correct. And what dyes are you using? Are you using anything?

Matthew:  We’re using a variation of a few dyes. Typically DAPI is very consistent especially for the human health markets that we’re going into. But things that are all readily available in the histology laboratory, non toxic,

And very easy to use.

Aleks: So the obvious benefit is It’s faster because you can skip the processing and yesterday when we were at the booth the main surprise when people were coming and seeing was [00:05:00]  that oh, so the first question was oh, so do you put an unstained slide?

And we are like no there is no slide Oh, so do you need a paraffin block you serve you image the surface of the paraffin? No, there is no block so, so you just put the formalin fixed tissue No, you don’t need to put it in formalin. It’s fresh. It’s fresh tissue. Basically it can go this is the plastic cassette that you put in the device.

You can put your specimen, whatever you want to diagnose. Fresh tissue goes into the imaging. So people were surprised because the main concept of pathology workflow is this. Everybody accepts that because this is how pathology is done. Yeah. And the main benefit. is okay. This is direct to digital.

You can have the result or the image in. Yeah. How long? How long does it take? We didn’t cover that.

Matthew: Depending on the size of the tissue specimen itself, [00:06:00] you can have a full image in between two and 10 minutes. It’s a range. It also we are stacking using a Z stack concept on the system where we can actually create a 3D image. So we can actually present in a very analogous format to what the pathologist is used to seeing with the glass slide. But for those that want to see further and more detail about the tissue in an undisrupted, un micro tome on altered state. We now have all those data.

Aleks: So I see several advantages here.

Speed is one, the obvious one. Second thing, the option. So what’s the depth of the imaging of the surface? How deep do you go with the

Matthew: We would say that the functional imaging depth of non-clarified tissue is, 30 to 50 microns.

Aleks: Okay.

Matthew: Okay.

Aleks: Compared to five in the classical [00:07:00] whole slide, classical just glass slide.

Matthew: Right.

Aleks: Okay, so we have this depth. One advantage that came to my mind when we were talking about it was, Oh, you could use this for stereology. So stereology being an estimate of of things in 3D structures. And it is super valuable scientific method and I’m looking at it from the image analysis, drug development veterinary discovery standpoint.

It’s a very valuable method, but it was kind of abandoned because it’s so time and resource consuming. You would need to have let’s take a heart if we wanted to estimate something in the heart. To do it in the traditional way, you would have to slice it at different levels, produce slides from all those levels and it takes a lot of time and then the heart is gone. [00:08:00]

Here, you can just Slice it and image the surface. Not only will you get the surface images of those slices, you can go deeper than a glass slide. What did we say? 5 microns for a normal slide. Here we have up to 50, so we would have 10 times more images. Not just estimates from the stereological equation, but images that we could have for this particular scientific project using stereology,

Matthew: Right, so on the back as the system outputs an image if you’re taking a file out off the system. Then transporting it to a viewer you can look at every individual frame Independently just like you’re describing with the traditional workflow. But then we can also present it like the images here that we’ve been showing today where they’re all in focus and you can see the topography of the tissue in an undisrupted [00:09:00] format.

So topographical data, 3D, thin sections, those are all things the system can do integratedly.

Aleks: So we have faster, we have, we can, we have more data for different applications.

Matthew: The big one, non destructive.

Aleks: Non-destructive, yes. And that was also a question that yesterday our pathologist that we were visiting the booth had was, “Oh, what if we need special stains?”

And that’s another thing we were, we said we were going to talk about virtual stains. But what if we need IHC on this tissue? And the, because it’s fresh tissue. So for how long does it stay fresh? Not too long, right? So what’d you do? You just take it out and you plop it in formalin, and you can do all the classical workflow if you choose to, if you wish to, immediately or in the future, right?

Be it molecular IHC stuff [00:10:00] sequencing,

Matthew: And since we are talking about the workflow and how simple it is to use, the system obviously lends itself beautifully to fresh tissue, but I do, I know that certain institutions do In every circumstance, go fresh out of surgery, even if pathology is just up the hall, and they do drop it in formalin.

There’s a workflow.

Aleks: And thats not a problem.

Matthew: And not a problem at all. So we can do formalin fix tissue we’ve done fixation studies. And does that affect imagery? Nothing.

Everything is very very amenable to being imaged.

Aleks: Amazing. I like it. So, where do you see it being implemented in the lab in the first place? Is it gonna be replacing something? Is it gonna be used in parallel? Do you already have an idea how it’s gonna be phased in?

Matthew: We’ve had an amazing journey being able to use it in a number of different situations to date [00:11:00] in a live setting.

We’ve used it in frozen sections very effectively and, that’s interesting because the frozen section obviously is completely destructive to the tissue and most people that read those images from the frozen section know that they’re riddled with artifact already.

It’s, in a lot of cases not as important just simply to get margins or something like that.

Aleks: And look up liver pathologists who visited yesterday. We’re excited about this, not having frozen artifacts, especially for the liver.

Matthew: The images are so much more telling, like when you when you see fat or you remove that traditional workflow artifact.

Yeah, it’s pretty exciting. But the frozen section would be one, for us as a company, we’re all about that diagnosis to care cycle. How can we get that to be as short as possible for the patient, for the physician? and get the patients under the care they need. So you can imagine going in for a breast biopsy today. On average, [00:12:00] I think that you’re waiting about 10 days for a result. Right now, using a system like this, a tissue biopsy dropped into here and you could have an image being read by a pathologist on site or remotely.

Aleks: Remotely.

Matthew: Remotely.

Aleks: Let’s Emphasize remotely because this can be sent basically anywhere.

Yeah. Digital image.

Matthew: Yep. And we can have that diagnosis for that patient while they’re in office.

That’s a huge change in the way that we take care of our patients. It’s also amazing because in the 20 percent of patients where we have a bad result, we then have the tissue totally intact for immediate IHC, for downstream analysis, and for molecular workup.

Aleks: Another thing that a pathologist mentioned yesterday was using this for assessing the viability of organs for transplants.

Matthew: Yeah, we have a lot of interest in that. Are incredibly interested in organ feasibility being done in minutes, very [00:13:00] innovatively. And we’re really excited about the opportunity.

Every, it seems that every time we get into a setting, there’s a new opportunity.

Aleks: There’s a new application because people realize what this is and they basically think of, okay, what am I doing in my workflow where this could be a game changer. And several pathologists came with different ideas.

Matthew: A lot of people don’t appreciate, I think. When you’re looking at just the end result, how much or how many of the specimens that are needing to be sent through the traditional workflow actually use logistics to make that happen? And what is the percentage of those that get lost, broken, damaged they become, you know, unuseful and that patient’s got to go back.

And in some cases you have very limited ability to get additional specimens, we’re eliminating a lot of those kind of functional risks [00:14:00] with the workflow that I think both the pathology teams, the laboratory teams and the administrators are all going to appreciate.

Aleks: Speaking of that logistics, yesterday we had a pathologist from Hawaii and we were talking how this could change the way pathology is done in remote areas or pathology is not done because basically there is no histology lab.

There is no option to send tissue for pathology evaluation. And this device could be somewhere where there are no pathologists. It’s not a problem at all.

Matthew: This is probably a bit extreme, but you could actually mount these in the back of a mobile clinic.

Aleks: Mobile clinic is a reality for veterinary medicine. That would be a perfect device to have in the mobile veterinary clinic. And it’s so interested that the path your company took is uniting veterinary and medical pathology, which I am super excited about because I think we’re, [00:15:00] we should be closer as specialties.

Matthew: Yeah I couldn’t agree more with that. Actually. It’s very interesting to us as a company our veterinary, you know, lead here, the person who’s really driven the largest transition and digital pathology globally actually was the chief medical officer at Antec, Dr. Edwards on our team.

We find that the veterinary pathologist and teams to be incredibly progressive, very ahead because they want that point of care. They’re very focused. People get concerned. Our pets, we all love them and usually they’re part of the family. They just have this ability because of the environment that they get to operate in to, to be very open minded.

They’re very adaptive. When you talk with Jeff when the scanners came on and you started looking at images on a viewer [00:16:00] rather than in a microscope. He allowed his teams to have anything both images at any time for six months. And he’ll tell you repetitively that within 60 days nobody, everybody had moved, to the door.

We think that’s gonna happen here. This is much like radiology. It’s much like any of the new modalities. It’s a new foreign concept to people, but when it clicks, you can see it in their eyes. They’re like, Oh, my gosh, this is great.

Aleks: And I’ve heard similar stories in deployments at hospitals where you basically give the pathologist the option to do whichever modality telling them, okay, we’re going to be phasing in this thing let’s get comfortable.

And like you said, within six months there is nobody using the old modality, but they always get the chance to ask for it if they decide it’s diagnostically necessary.

Matthew: Yeah, absolutely. It’s, we’re [00:17:00] looking at how to best equip the pathologist to make right.

So we think this is going to be something that helps them. Their confidence will build as that transition occurs very naturally. And I think that the patient experience is going to drive it as well. I think people are really going to be excited about that…

Aleks: Very much. If you…

Matthew: We all know we’ve had a loved one or somebody that’s waiting for a biopsy it’s a, terrible time.

You’re just sitting there waiting. We eliminate all that. More importantly, we get them, in some cases that time is very precious in terms of treatment. We can eliminate a lot of that weight.

Aleks: Two things for pathologist and patient. First pathologist is still in the driver’s seat.

These are the people that are, Interpreting the images, they can always request a different modality if they decide it’s diagnostically necessary. And I think this technology, because it can be done in office, it can, it will bring pathologists closer [00:18:00] to patients.

Matthew: Oh yeah.

Aleks: At the recent conference I visited, and there was Dr. Lija Joseph is a pathologist who actually organizes. pathology clinics for patients. She reviews their slides with patients. So imagine if this could be done during the visit. They don’t have to come for a separate clinic. They don’t have to call in. They have it done together with all the specialists that are being involved in their care.

I believe pathology is the gateway to care and to diagnosis and I believe that patients should get their diagnosis fast and that’s definitely going to help.

Matthew: Yeah, I think the portability and the transportability of the image sets and the integration of the way the system…

Aleks:  I was picking it up yesterday.

I, I will link to the post.

Matthew: Hugging it.

Aleks: Yes, I was hugging it. It’s small enough.

Matthew: But second opinions are going to be very easy. We have so many talented pathologists in the industry, but there is [00:19:00] a huge shortage. There’s a shortage of histo techs also, and qualified people to help us produce those slides.

This eliminates a lot of consternation in the availability of those resources in the markets.

Matthew: So we should see a significant improvement in patient care. And, as you said, that touch point with the physician or with the pathologist, I think, is going to become even more interactive.

Aleks: And that’s super important because now in the era of ChatGPT and AI, patient heads has, patients have the access to whatever medical information is out there.

And having, and doctor is becoming not really the information provider, but rather the guide in how to navigate it, what’s important. And it’s gonna be more of a discussion where patients. Patients are becoming more and more participants in the decision what kind of care [00:20:00] they’re going to receive.

Do you think this is going to be the future?

Matthew: The future’s here, Alex. The future.

Aleks: The future is…

Matthew: The future is here. Alex. It’s been a hundred years with this workflow or maybe more.

Yes. I’m honored to have the team that has helped develop this. It’s one of those things that’s, there’s very few places in healthcare that I think can be this transformative. And we see it as being here now. So we’re very excited. Okay.

Aleks: Thank you so much for joining me.

Matthew: Thank you.

Aleks: For explaining this to my digital pathology trailblazers.  And we talk to you in the next episode.

Matthew: Thank you.

Aleks: It was really educational for me to spend the time with the MUSE team at USCAP in Las Vegas. Finally, pathology will not need to lag behind radiology because now there’s an option for direct to digital pathology. After a conference is always before a conference.

So the next conference MUSE is going to be attending [00:21:00] is going to be USCAP. So if you are visiting USCAP as well, be sure to find their booth and check out this device. And if not PathVisions, there will be other conferences that they will be presented. And also we will create more content together.