Electron Micrographs:  Key to Diagnosis of Kidney and Lung Diseases

The series of electron micrographs displayed above represent two major areas where electron microscopy has had profound influence on diagnosis and treatment of disease:  renal or kidney pathology and lung pathology.  Images 1 and 2 are transmission electron micrographs of a component of the kidney known as the glomerulus.  Image 3 includes, in the left hand image, a scanning electron micrograph and energy dispersive x-ray spectrum of a fiber found in the lung;  the center and right hand images are energy dispersive x-ray images of the same fiber showing it to be composed of iron and silicon. Iron and silicon are characteristic of a type of asbestosis fiber called amosite. 

Intended Audience for the Diagnostic Electron Microscopy Program Web Site

• Pathologists
• Physicians/Clinicians
• Electron Microscopists
• Research Investigators
• Electron Microscopy, Histology, Cytology Technical Staff
• Pathology Quality Assurance/Quality Improvement Managers
• Residents, Fellows, Interns, Graduate and Medical Students Training in Pathology

Purpose of the Diagnostic Electron Microscopy Program

• To provide a specialized modality--Electron Microscopy (EM)-- for enhancement of clinical diagnosis and research through the study of tissue and cell ultrastructure.
• To resolve diagnostic problems which cannot be settled at the light microscopic level.
• To permit the development and rapid exploitation for patient care needs of the new diagnostic findings and techniques which are constantly being found through ultrastructural research.
• To permit training of residents, staff physicians, research investigators and selected technical personnel in the use of electron microscopy

The appropriate use of ultrastructural study adds a new dimension to diagnostic pathology. Its value in difficult diagnostic situations has been demonstrated repeatedly in VA hospitals, particularly when there is close coordination between the pathologists and the clinicians.

Quality Assurance through the Peer Review Process

 An important aspect of this Program is that the quality of all VHA Diagnostic EM laboratories (see Map and Directory) is reviewed annually by a national peer review process organized by John Shelburne, M.D., Ph. D., National Electron Microscopy Program Coordinator, and under the direction of William Triest,M.D., National Director of Pathology and Laboratory Medicine. A committee of pathologists (EM Ad Hoc Review Group) from within and outside the VA reviews at least five diagnostic cases annually from each laboratory. Members of the national review committee are typically also members of USCAP (United States and Canadian Academy of Pathologists) and usually meet to review the annual reports and clinical diagnostic cases in conjunction with the annual USCAP meeting/conference.

This review includes the following parameters:

•  quality of the fixation
•  quality of electron microscopy imaging
•  quality of the written report including literature citations
•  contributions to the medical and scientific literature

Critical comments are provided to each laboratory. Laboratories with serious deficiencies are required to take immediate remedial action.

The goal of this program is continuous quality improvement of all of the VHA diagnostic electron microscopy laboratories.