Hello everyone, welcome to another episode of Vet Chat, the UK's leading veterinary podcast. We're very fortunate today to have Kerry Friel on the line. Kerry is a veterinary anatomical pathologist who works at Nationwide Labs.
We're gonna be talking today all about new technology, how it can really help us as vets in practise. We've also, if you're listening to this as a podcast, we've also made a little demo of some of the cool things that, some of the technology can do, and that will be available on YouTube. So do go and look at the link below.
If you're watching it on our website, of course, you will be watching it as a video podcast and you'll be able to see these things anyway. So Kerry, great to meet you. Tell us a little bit about yourself, how have you found yourself at Nationwide?
I, I graduated from Glasgow Vet School in 1999. And I went straight into a mixed practise job and a very mixed practise job. So cats, dogs, cows, sheep, pigs, horses, fish, birds, reptiles, small furries, the occasional invertebrate, random wildlife.
So it was a bit of a a trail by fire, and I was there for about 3 years. And then, a 6 ft tall police officer, encouraged me away, not in a custodial capacity. And I moved to Lanark.
He was based in at that time, so I moved to Lanark and took up a position here as a small animal veterinary surgeon with a focus on surgery. So I, I don't know if I was just one of these kids who always said, but why, but why, but why, and as endearing as that is, as a child, when you become an adult, you kind of need to go and find out, but why for yourself. So the more I did with surgery, the more I wanted to know why things were happening, not just how to fix it.
And that was how I ended up taking up a residency at the deck vet, in about 2005. So I was there for 3 years, and at the end of that, I did my, RCV, RCPA exam. And then I spent another 2 years doing part-time lecturing at Glasgow vet school pathology department, part-time emergency and critical care medicine in Edinburgh, and part-time working in my friend's practise.
And then after another couple of years of doing a bit of all of that, I did my fellowship with the Royal College of Pathologists, and I started with Nationwide Labs full-time in 2010. Fantastic. I, I share your same fascination with the question why, cos why is, as my mum used to say when I would continue to ask her this question, she would say, cos why is a crooked letter and you can't straighten it, which would perturb me for a minute before I ask the next question.
To be fair, that that's probably a very good summary because I would say pathology is a bit like that. When I went into pathology, I thought, oh great, I'm gonna get all these answers and we're gonna find out and actually all it ever does is throw up more and more and more questions. And I think it's also fascinating, you know, I've spoken to Trevor a lot as well, Trevor Whitbread, and it is that partnership, isn't it, that if you try and do this on your own as a pathologist without actually talking to the clinician and vice versa, where we're the poorer for it, so actually developing those relationships where.
Obviously there's straightforward cases where you can see what's going on, but if there's something where, what the pathologist said doesn't seem to match what the clinician has seen, it's really important to email, get on the phone and discuss in more detail, isn't it? Yeah, absolutely. We, we're more than happy to take emails and calls from clients where things just don't quite marry up.
Sometimes it's something as simple as the, the lesion itself in an attempt to get the best sample, they may have tried to go in the periphery or, or the opposite gone in the middle, and it just so happens that that they've got doesn't tell us exactly what's going on, and it's. I, for instance, you're, you're, you know, you're sort of pegubogarri in the mouth, it's a nightmare to get samples from that. I know I have tried in clinical practise myself, and you'll take it 67 biopsies, and one will have the piece in it that gives them the answer.
And yeah, it's the more you talk to each other and the more information we have clinically. The more the better our interpretation can be of what we've got in front of us, because it might be that we don't have that classical lesion, but given what we do have, the clinical history, the progression, its response to treatment or, or lack of, you know, thus far, can obviously help us say, look, there isn't the precise evidence to say that's definitely what's going on, but given everything you've told me and what I can see, I would be highly suspicious that that that is the situation. And I think this is where we give you a better chance if we send you 16 millimetre punch, biopsy of the skin, and that's all you get, then it's really, really limited.
If we're sending you 5 or 6 samples as you just said, the chances of you making a diagnosis are much better, aren't they? And as accurate as possible as well. And, and the way things are going, everything, everything is being graded.
And, and, you know, categorised into boxes and streams so it can sort of better advise where to go clinically with it and what options for treatment there are. And in a lot of these cases, a lot of the grading schemes and things that have been developed have have always been based almost from institutional research, and they have the whole tumour. They often have the whole animal, never mind the whole tumour to look at.
And these gradings are all based on that. And if we only have a little tiny piece of a tumour, even with the best will in the world. We can guess what grade it might come up, but we really need the whole thing.
And, and I think that's another thing as well. It's, it's getting the size of the samples so that we can give you not only the diagnosis, but if there is a grading application that will make a difference clinically, then we can actually give you that all at the same time without any extra surgery, without any extra, you know, implications for the pet at all. Yeah, I know, brilliant, Kerry.
It's interesting, you know, from about 2015, I was talking to the profession a lot and saying, you need to be a digital business. You know, every business needs to be digital, be it you need a Facebook page or you need better ways of booking appointments, because millennials don't want to hang on the phone for 20 minutes to get an appointment. They want to go onto the internet, sign up and see there's 20 past 10's free and bang it's done.
And to a degree, I would say I was probably ignored. Maybe a tiny bit of, yeah, maybe he's got a point. The tiny little virus that attacked us, 2 or 3 years ago really encouraged us all to digitally transform and suddenly grandmas were were experts at zoom and things, .
And I think it's happening in all businesses, and I know Nationwide has always been, you know, thinking about how can it do things better, but tell us about the new scanner and what excites you about it. So basically, obviously for those not knowing, nationwide now have gone very much digital with their ability to. Show slides, if you go and have a look at the demo on YouTube, you'll be able to see, but also it does haematology, biochemistry as well, so sorry cytology as well.
So maybe explain to us what this brand new machine is and why it's so fancy. Yeah, that this is the, the new baby, the new addition to the family is the big tech scanner, . She's, she's lovely.
She's huge. She's absolutely huge. But she's a, she's a high capacity scanner.
She can get through 100 slides an hour, and she can get through about 2000 in a day. And that's cytology, haematology, and, and histology. She, the, the, the she.
The, the images that are produced, are, are top notch, and the, the scanner itself also has the ability for what's called water immersion, which means that, one of the, the few machines actually in the UK that offers water immersion, outside of research facilities, it means that we can achieve the same level of magnification that you would get with oil immersion when, and particularly in cytology and haematology, when looking at samples. The images that produces are, are phenomenal. It really is fantastic.
But it's the, it's one of these machines where it's automated right from the get-go. The guys in the lab can load up the slides and walk away, and it does everything else for them. And it's all downloaded into the system, and then the pathologists come and select cases for their folder.
It's, it speeds up work efficiency, unbelievable. Having something like the digital scanner just means that instead of, at the moment, the way things work, as we're moving to digital, because we're all doing our standardisation and our validation protocols. But normally the tissue would come in, you would get it on a glass slide, and, and that's kind of been the stalwart of pathology for forever.
But it's getting that glass slide to the pathologist, whether it's a remote pathologist or a pathologist in, in one of our different sites, or even sending it to a specialist somewhere else. That has always been the, almost like the, the, the limiting factor with pathology. Having a digital image means that, and, and one where you can literally, unlike just a photograph, we can zoom in and out, you can go right up to very high power magnification.
We can send these images. Anywhere, anywhere in the world. As soon as it's scanned, it can be sent anywhere, and that it speeds up actually reporting times as well.
Second opinions are great, teaching, it's fantastic for, we actually have a, a sort of resident member of staff at the moment and, his, his whole workflow will be based around using the images from the digital scanner. So as I've been so excited about getting this machine. It's that I think I've I've been a bit like a parrot in the corner of the room for quite a few years.
We need to get this. Yeah, yeah, well, I mean, to be, to be fair, at the beginning, I think just progressing to digital was really all I was really looking for, but as a company, it had to be, it's a huge investment and it is a massive reworking of the workflow and rejigging the whole of the lab, but it's not just a oh you buy a machine and stick it in and that's it done. It has to be integrated with our limb system for reporting.
So it's, it's not just a, you know, plug in, plug it in and play. And with that amount of, of upheaval and investment, it had to be something that was good enough for histology, cytology, and haematology. And this is one of the first machines where when we've reviewed different demos, everybody was happy with the images that they could get.
They were happy, they were diagnostic, they were happy, they could work through them just as they would the normal glass slide. So, this is our, our, our baby. And I, I think it, you know, what it means, I think for pathologists is using digital tools saves time and we are short of vets, we're short of pathologists.
Anything that sort of helps with that allows us to do more work. Suddenly, you know, we as a pathologists don't need to get that slide and look at it under the microscope, see the bits that are interesting. You can scan it so much more quickly, so presumably you could see more cases per hour than when you were doing it in a manual setup.
It even even just on a case by case basis, even on our lowest power on the microscope, you, you can never get that full, the full image size and with with the digital now, we can see the whole thing all at once before we even start and that you can orientate your section better. You've, you've got a better idea of what's going on all the way around the periphery. Instead of zooming around and working your way, you know, it just, the, the time that it takes out is, is unbelievable.
It is fantastic. And, and the other things it offers with measuring margins, all of these things are all little, little extra few minutes in the day that will all be cut out by just being able to do it in seconds on a machine. Yeah, and, you know, I have a friend at the moment who's had a biopsy done waiting for results.
And of course that's incredibly worrying times and it can be weeks, particularly in the NHS. If you can have a sample which is sampled quickly, gets back to the veterinary practise, they're able to ring up the client, you know, within 2 to 3 to 5 days, whatever it is, that is amazingly quick and you know, how many times have I heard a client say, gosh, your service is better, you know, than the than the NHS's. And, and I remember obviously doing my dermatology clinics, I would often see a report, look at the dog and say these two things don't make any sense.
And the first thing I would do is I'd ring up the lab and say, can you send these slides to Trevor cause I'd like him to have a look at them, Trevor Whitbread. Of course that was pack them up, stick them in the post. It's then a .
You know, it's special delivery so you worry do they get there and everything, so hopefully they get there, but again it it is all time, isn't it, and I think for me using tools like this, obviously a very expensive tool. But when you consider the amount of time that it's starting to save and the amount of ability to do more, you know, probably it's gonna pay for itself in a, you know, a reasonably short time, isn't it, the payback period. But absolutely, and to be fair, .
We're, we're not going to be just looking at H&E sections for much longer. The world is definitely changing. I mean, already in histology and pathology in general, we've, we've moved from just looking at H&E slides originally.
To immunohistochemistry, to molecular, diagnostics, it, it's the world is changing all the time, and as is as is pathology and digital imaging opens up a whole new avenue of diagnostics, which it is, it's where it's gonna go. It's all AI and it's all deep learning, which for a lot of us. Little bit frightening, you know.
Well, I think, I think that's the thing, where is tech going, you know, change is happening quicker and quicker and you know, we want to be a part of that change rather than, you know, I, I know it's difficult, some people don't like change, but to continue to push against it is is no good. You have to hopefully be a part of it and, and influence the change in a good way to make sure that. You know, AI doesn't become something that's really horrible, but it's something that's positive and for the, for the common good.
Yeah, it's, I think, like you said earlier, that the pandemic itself, has pushed a large number of the, the NHS guys towards having to work in a, a sort of digital environment. And that's, that's almost helped it always does, the veterinary side. If human medicine is pushing towards that kind of goal, you know, we should be taking advantage and going to rather than being 20 years behind them like we normally are, we should be going along in tandem, because these, these diagnostic tools.
They they're applicable across species this sort of these sort of AI algorithms that will look for, mitotic figures. They can look for cell variations, you know, they can pick up things that we would normally spend a long time looking at a slide at to assess and grade a lesion. They can do it for us.
That information can be provided when we actually get the H&E slide. It can already have been done. And then it's just a case of us deciding what the cell is, what the pattern is, looking at the values, and then being able to categorise it again, speeding up time, more accurate diagnosis, you remove a lot of that into observer variation, when you have something that can be standardised and and quantified, and that it, it all helps in the long term of moving towards.
Quick, accurate, and reproducible diagnosis. So, you know, it, it does help it does help the clinicians at the day. It's not just the pathologists getting excited about something new.
Well, you know, as I've said, if we can quicken things up, that's a massive help throughout, isn't it? And, and, getting things back quickly is I think really important. How, how do you see the tech moving?
You know, with AI and things, in some ways I I look and I say, you know, we have been behind on the medics. Sometimes we look into the future is actually in the present moment, but just in another discipline, and obviously medicine has more money, usually gets these machines earlier. So, we, you know, if we can be 3 to 5 years behind, that's better than being 20 years behind because, you know, there is the cost implications of this.
So what is, I know you've talked a little bit about that, but what's some of the other things that we can look forward to? Well, as humans are already there. They're using deep learning for grading prostate biopsies.
They're using it for, breast screening. They're using it, for the, the new sort of biomarkers, and this is where it gets really exciting. This is the bit I actually really like.
This, this particular reference here is, is phenomenal. What they're, what, where they're taking it is that through deep learning, the, the, the, the AI systems can actually see things beyond what we can see looking down the microscope and H&E. And they are effectively able to predict, changes in the genome of a cell, towards sort of cancer changes.
Things that we would see like, variation in cell size, diameter, nuclear size and diameter. So we, an isocytosis, an isokaryosis, you'll have seen the words a 100 times in your reports. We can see that, but it can actually measure it to a level where it can predict what the actual genetic changes.
And these are what are called high-level labels. So we're a lot of things where we would have used, immuno histochemistry or, or needed additional molecular testing or staining to actually find that information out. The AI can find out just on the H&E section alone, which again, speeds up time, it reduces extra costs of having to do additional tests, and it can actually tell you the information without having to have anything more than a normal H&E section.
I'm, I'm interested to know, you have, categorised her from a sexuality perspective. Do you have a name for her? Well, I think you should, I think we should do a bit of a draw to decide on the name, because I, I remember as a child we always had names for our cars and cars tended in my family to be female.
Rightly or wrongly, that was what they were. So they all had names. I can't remember the names now because it's a long time ago, but I, I do think we should, have a webinar vet draw to decide on the best name for the 3D scanner.
I'll be getting in trouble for calling it a g. Well, it, it, you know, I, it's, it's intuitive and everything, so it probably is a girl, isn't it? I, I don't want anybody, male sort of having to go at me now.
I could now get into trouble as well, so we'll just have to get into trouble together. Yeah. So how do you think it's gonna affect.
That's in practise, we know it's gonna to quicken up time and there's gonna be other things and then the health, the one health in general. Yeah, well, that's, that's really where the the AI and the deep learning part comes in because, you know, very often we'll get a, we'll get a case in and we'll then say, oh well, this is gonna need I mean a histochemistry to confirm this is what it is, and then we've got to wait for that to be done. And then to be read and then to come back.
And the fact that this, these deep learning algorithms can do all that just on H&E means that we can say, all right, we don't really know what that is. Let's run the algorithm through it and see what it is, and it will tell us, and it will tell us accurately. And not only that, it'll probably tell us the grade and the likelihood of it metastasizing and everything else all at once.
So the It, it's gonna it will remove the costs to clients and to vets in the first place for having to do all these additional tests that, that will disappear. The need for a lot of these things are for these tests that we've relied on so heavily for such a long time, will diminish. And it, it just, it just means that for cancer in particular, you're gonna get a, a very in-depth and accurate diagnosis very quickly on a single sample, with nothing else having to be done.
And that for the client, for our clients, our clinicians, being able to just say to the client, right, your dog, your dog has a melanoma, it's, it's great, whatever. We're gonna have to do XYZ treatment wise, and to be able to tell them that straight away after the one biopsy, effectively within 2 to 3 days of having had the sample taken off, it is amazing, it's brilliant. I know we've gone over a few points a couple of times cause it's just to really just emphasise how important that is and.
You know, one of the things I love about digital, obviously we were the first company to digitalize learning in the veterinary space because nobody knew what a webinar was 13 years ago. My, my little tagline is, you know, we were planning for the pandemic for the last 10 years, we just didn't realise. But obviously when you digitalize you democratise and to some degree you demonetize because obviously, you know, the cost of all of those tests, as you've said, would have been really high.
And I think it also allows us, and we're talking a lot now, aren't we, about personalised medicine, you know, the 20 years ago we might have said that's a lymphoma, and that might have been as good as it got. Now we can really go into much more depth, we can talk about, you know, what type of CD sort of profile it has. Do we then have different treatments for that.
So actually, although we're talking about pathology at the moment, the, the treatment, possibilities. By being much more specific about what that tumour or what that particular condition is, allows for much more personalised medicine as well, doesn't it? Yeah, it's moving towards genomic medicine rather than it just being a kind of catch-all system.
And that is one of the reasons why all the sort of human work is going towards these types of programmes where They can pick up these minute changes that we just can't see, in an H&E section, and it can actually tell them exactly which part of the gene in the cell has gone wrong. And it means that, like you say, much more tailored medicine to specific diseases in specific patients, not even just the specific disease itself, which, yeah, that's, that's the way it should be. It's the way we should be going.
It sounds like exciting times and I can see how excited you are, and this is the thing, if we can have passion in our job, it keeps us in the job. I know there are challenges and everything, but I think if we can use tools. And be passionate at the same time at the job, it keeps us much more involved and excited and keeps us within the profession, doesn't it?
Yeah, absolutely, it encourages the, the younger, younger set in as well. They're, they're of a a very different generation. They've been plugged into digital media and streaming since the day they were born just about, and to.
To show to to show them what the capabilities are and where things are going, if it can inspire them and give them an interest in something that they really want to get into, then yeah, that's, that's the way forward definitely. I think as you say, digital natives, and it, it's interesting because again, if we go back 1015 years when I started with Webinar vet, it was very much the profession was very conservative and spent a lot of time navel gazing. I mean, whether you agree with corporatization or not, I think it's helped.
By bringing other people into the profession, us going and looking a little bit further, you know, we're not just looking at the veterinary papers, but we're actually going, as I did to an internet conference, heard about webinars, brought that back in. That sort of interdisciplinary effect, I think is, makes us a better profession, doesn't it? Yeah, absolutely.
But vets, vets have always been adaptive. That, that's kind of part of our nature. That there's there's never a time where you turn up on a farm to see the cow and the cow actually has what the farmer told you it's got.
So you need to be able to think on your feet and adapt. So it's something that I think is part of our nature anyway. I don't know if some of us get a little bit, like you say, navel gazing a little bit staid sometimes because it's easy to stay where you are.
But realistically, that, that never happens. The world's always going to change and it's always moving forward. And we certainly, there's no reason why vets shouldn't be doing it too.
We're more than capable of this, more than capable of this. Exactly, one of my favourite lecturers is Mike Willard, who's an ex professor. I think he's, I think he's more or less retired at Texas A&M, and he said everything I taught you 10 years ago was a lie.
I just didn't realise, you know, so the, the knowledge is expanding so quickly that. We have to stay up to date, but that's actually part of the excitement of the job as well, isn't it? Yeah.
Definitely, yeah, definitely. Kerry, it's been great to speak to you. I love the tool.
I do think we do need to christen her at some point, so any suggestions from people listening on the podcast, please do forward either to myself or or to Nationwide, and I'm sure we can hopefully come up with some really cool. Yeah, we've got some great gritters up here, in Scotland. So if we go down there if we go down that road, it could be very interesting what she actually ends up getting.
Thanks so much, Kerry, and thanks everyone for listening. This is Anthony Chadwick from the Webinar vet, and this has been another episode of Vet Chat. Don't forget, do go and have a look at the, the, The little demo at the beginning, it will be available on YouTube, so look below if you're listening on a a podcast channel and it should zoom you over to YouTube to, to have a little look at the demo.
Take care, thanks everyone, bye bye.
