Keeping up with technology in medical diagnostics

Dr Th Dhabali Singh MD *

Diagnostic tests are, today, an essential component of the health care system, providing the much-needed vital information that impacts decision making of the health care providers in relation to the overall diagnosis, treatment, prevention and management of diseases and other health conditions.

The last few decades have seen several advances in technology with the result that diagnostics have become even more integral to the practice of medicine today enabling a more personalised and many practical treatment options. For professionals in a clinical laboratory, every day can be an adventureand every day holds the potential for unrelenting challenges and remarkable achievements.

While testing capabilities continue to evolve rapidly through new cutting-edge technologies, there are many concepts used to measure the trueness and effectiveness of diagnostic tests that are fundamental and unchanging.

In-vitro and in-vivo testing

Most diagnostic tests today, are performed on fluid and tissue samples after they are removed from the body. This is called in-vitro testing. Research is under way for using techniques of testing that will enable health care providers to take measurements of various biological parameters directly from inside the body.

In other words, the testing will be performed on the whole living organisms, or cells as opposed to tissue or body fluid extracts. This is called in-vivo testing. When the testing shifts from in-vitro to in-vivo, it will mark a dramatic change in diagnostics and care since it will eliminate the major sources of errors in diagnostic testing. The change will push in new opportunities for applications of technologies for the whole diagnostics sector and for monitoring human health.

New paradigms in diagnostic tests

With the growth in the knowledge of the human biology, there has been a corresponding expansion in the scope and definition of the term, diagnostic tests. The conventional definition of the term that refer to tests for identifying illness in a person is changing. Today, rapid advances in molecular testing have opened up a new sphere of diagnostics that enables health care providers to evaluate even the likelihood that someone will develop an inheritable disease potentially many years in the future.

Understanding the rationale behind diagnostic testing

All diagnostic tests require a desirable level of accuracy and precision, and sensitivity and specificity in order to demonstrate they are effective. This is regardless of the role they perform in patient care or the technology used. A layman’s understanding of the term “diagnostic tests” is mostly in-vitro diagnostics.

There is a need for acknowledging the complexity of the process of in-vitro testing. What the patient sees of the process and what the referring doctor sees, is just a small part of a complex process that involves many steps. Because of the many steps involved, errors do creep in occasionally. Errors in testing typically are not due to the quality of the test or technology employed. These errors mostly occur during the pre and post analytical phase.

Of the two, the vast majority of testing-related errors occur in the pre-analytical phase that involve registration of the patient details and the tests ordered, collection of fluid or tissue sample from the patient, labelling, transportation and other such steps in the tracking system. Although automation has eliminated many of the error-prone steps to a great deal, there are still manual steps involved and the human errors have not been completely removed.

Elimination of pre-analytical errors and in-vivo testing

One of the major areas of research in medical diagnostics is in the elimination of pre-analytical errors. A great deal of research is under way in the in-vivo testing area that would enable analysis of the body fluids through devices that are worn on the skin or implanted in the body.

When these tests develop and evolve and are approved for wide-scale use, we will see the elimination of the need to collect, transport, process and store the patient test samples. Wearable and implantable devices currently in development will allow for constant monitoring of body chemistry and collection of previously inaccessible data.

Benefits of real-time monitoring

The benefit is that of real-time and continuous monitoring within a time period. A 72-hour continuous glucose monitoring system, for instance, allows the physician access to hourly blood sugar level scores, which helps in formulation of a unique drug regimen for the patient.

As the anticipated massive volume of data is analysed for the individual and in aggregate, a range of possible benefits to care emerge – identification of disease-causing infections and new treatment for chronic conditions.

The new technologies, apart from reducing diagnostic errors by eliminating pre-analytical sampling, handling and preparation, are likely to have significant health impacts in specific areas, further expanding the role of diagnostics as instantaneous test results allow for faster data-gathering and better-informed decision-making.

Conclusion

Medical diagnostics is a constantly shifting landscape. Driven by technology, new techniques and methodologies come up every year to replace the old ones for providing fasterand more accurate results and that are more convenient for the patients.

Dramatic changes are also seen in the radiology or imaging diagnostics withincreased automation; imaging and software systems are becoming more intuitive for faster exam times and workflow. One of the biggest challenges of a diagnostic centre is to keep up with the fast obsolescence of equipment and techniques of testing.