VHA Diagnostic Electron Microscopy Program
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Art Captures Science as an electron microscope and operator are interpreted in the Industrial Machine Age style from post-World War II 1940's. Titled 'The Electron Microscope', by artist Thornton Oatley, this watercolor, gouache, and charcoal painting was commissioned by the National Geographic Society and published in National Geographic Magazine, December, 1945, p. 747, Figure XI, with the caption "Electron Microscope Opens Even the Secrets of the Molecule." The physical principles of electrons and lenses in Electron Microscopes parallel those of photons and lenses in Light Microscopes, but magnifications of over a million times are feasible.
Dr. Bezhad Najafian, Associate Professor of Pathology and Director, Electron Microscopy, Department of Pathology, University of Washington, Seattle, presented his studies of Quantitative Electron Microscopy in Fabry Nephropathy on 5/15/18 as part of the Benchmarks for Quality in Ultrastructual Pathology series . If you missed this excellent presentation, link to the recording at http://va-eerc-ees.adobeconnect.com/py11pznl4jt5/.
Contact VHA National EM Program QA/QM Coordinator Ann LeFurgey, Edoris.LeFurgey@va.gov, to be placed on the mailing list for future programs in the 'Benchmarks' series.
Highlights of the FY13-FY17 Benchmarks for Quality in Ultrastructural Pathology Live Meeting Series[Note: Links to images are embedded in the description for presentations by Weidenheim, Turbat-Herrera, Miller and Lockhart]
Dr. Sergey Brodsky, Ohio State University, Columbus, Ohio, discussed multiple aspects of Anticoagulant-Related Nephropathy: Clinical and Pathology Considerations as it relates to ultrastructure, nephrology and clinical presentation and treatment. If you missed this excellent presentation, link to the recording at http://va-eerc-ees.adobeconnect.com/py11pznl4jt5/.
The Role of Electron Microscopy in the Diagnosis and Causation of Asbestos-Related Diseases Among US Veterans was broadcast by pulmonary diseases expert Dr. Victor Roggli, Department of Pathology, Duke University Medical Center, Durham, NC. This presentation included a discussion of the role of electron microscopy in the diagnosis and causation of asbestos-related diseases among US Veterans. A link to the recording of the webinar is now available: http://va-eerc-ees.adobeconnect.com/p7s3qc8u1a8/.
Mark Haas, MD, PhD, Cedars Sinai Medical Center, Los Angeles, CA, spoke in detail about his work on the Value of Electron Microscopy in Evaluation of Renal Allograft Biopsies. The audio/video capture of this detailed presentation with outstanding images is available at http://va-eerc-ees.adobeconnect.com/p30jdwas3m6/.
Cynthia Goldsmith, CDC/OID/NCEZID, Atlanta, GA, presented a timely webinar on viruses such as Zika, Chikungunya, Ebola and case studies describing the clinical and environmental settings in which they occur in March, 2016. VHA EES has provided a link to its excellent audio/video recording of this webinar at http://va-eerc-ees.adobeconnect.com/p4tr8bcdqa2/.
Karen Weidenheim, MD, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, gave an excellent presentation on Successful Handling of Skeletal Muscle Biopsies in the General Pathology and Electron Microscopy Laboratories. An audio/video recording of her talk is now available through VHA-EES at http://va-eerc-ees.adobeconnect.com/p81b2tjtzfi/. Dr. Weidenheim defined the role of the pathologist in the diagnosis of muscle disorders such as muscular dystrophy, rare genetic myopathies, congenital and toxic myopathies, with emphasis on employing correlative methodologies from ultrastructural morphology to molecular genetics.
Sherif R. Zaki, MD, CDC, Atlanta, GA, focused on Pathology and Pathogenesis of Ebola and Marburg Viruses during his April 2015 presentation. He described how a combination of diagnostic pathology modalities including electron microscopy have increased our understanding of Ebola pathogenesis.
The June, 2014 Quality Live Meeting was presented by Professor Elba Turbat-Herrera MD, LSU Health, Shreveport, LA. Her topic was Making a Mountain Out of a Molehill: The Amazing Use of EM for the Diagnosis of Cytologic Samples. Dr. Turbat-Herrera has provided the images from the webinar/live meeting for review or initial viewing for those who could not participate.
For the December, 2013, Benchmarks for Quality presentation, VHA Pathologist William Clapp, MD, Malcolm Randall VA Medical Center, Gainesville, FLA, described The Glomerular Filter: Layers and Lesions with emphasis on the ways in which electron microscopic studies have increased our understanding of glomerular structure, function and disease.
Renal pathologist Guillermo Herrera, MD, LSU Health, Shreveport, LA, discussed the role of Serum-Free Light Chains in the Evaluation of Renal Biopsies in May, 2013, and provided information on recent research findings on light chain protein configurations which are pertinent in the clinical setting.
Virologist and electron microscopist Sara Miller, PhD, Duke University Medical Center, Durham, NC presented Electron Microscopy in Diagnosis of Viruses and Other Diseases Plus Traps and Caveats in January, 2013. Her talk compared electron micrographs of viruses with those of other infectious organisms which may be confused with viruses. Dr. Miller's images are accessible in four segments: Part A, Part B, Part C, Part D.
Evelyn Lockhart, MD, Durham VA and Duke University Medical Centers, presented in early FY13 on Diagnostic Platelet Electron Microscopy with illustrations of normal platelet ultrastructure as well as platelet pathology. In her discussion she cited Canadian pathologists who have examined Proficiency Testing as a Component of Quality Assurance in platelet dense-granule deficiency diagnostics with promising results (Am J Clin Pathol 131:671-675, 2009); she noted that participation in this type of quality program is available through the North American Specialized Coagulation Laboratory Association ( NASCOLA).
Check with your local Clinical Coag lab regarding membership. Previous lectures in the FY12 series included Primary Ciliary Dyskinesia by Eric Wartchow, Colorado Children's, Denver; Electron Microscopy in the Diagnosis of Non-neoplastic Renal Disorders by David Howell, MD, PhD, Durham VA and Duke University Medical Centers; Skeletal Muscle Biopsies by Barbara Crain, MD, PhD, Johns Hopkins, Baltimore. For the series to date, two category 1 ACCME continuing medical education credits have been available for each live meeting for all physician participants and ACCME-NP or general credits for all other staff. Meetings are sponsored by VHA Patient Care Services, Pathology and Laboratory Medicine Service (P&LMS) and by VHA Employee Education Service (EES).
FY2017 annual activity reports and cases for peer review for all VHA Diagnostic EM Facilities have been received and reviewed by the Ad Hoc Peer Review Committee. VISN, Medical Center and Facility Directors will receive annual summary review letters in July, 2018. The Diagnostic EM SharePoint site has migrated SP2013; it is available soon for all VHA EM Facilities and all VA EM Ad Hoc Review Committee members who are VA employees for electronic submission of reports, data and electron micrographs. EM facility directors have been pre-registered for access to the site. Support staff who may be uploading reports or images can also be given access to the site. Feedback and comments welcomed. Contact EM QA/QM Coordinator for access or questions (Edoris.LeFurgey@va.gov).
The Microscopy Society of America (MSA) Certification Board has announced dates for 2018 Certified Electron Microscopy Technologist (CEMT) Exams. Individuals with the requisite educational and/or occupational qualifications can attain certification by completing an application and passing both written and practical examinations. Successful candidates are awarded an official numbered MSA Certificate and a Certification Pin. Two examination cycles are offered each year. For more information and exam schedule, contact CEMT. Electron Microscopy technical training programs are valuable staffing resources for VA EM programs seeking to fill vacancies. The San Joaquin Delta College Electron Microscopy Program, Stockton, CA, also offers EM certification and an associate arts degree for students.
The 2018 VHA National Diagnostic EM Program Ad Hoc Review Group Meeting and Workshop was held on June 27, 2018, in Newport, RI, in conjunction with the biennial Society for Ultrastructural Pathology meeting Ultrapath XIX. The VA EM program keynote speakers were Drs. D. Howell, W. Clapp, and G. Herrera, who presented their diagnostic work as part of the Ultrapath session on Transplant EM and Renal Diseases. The VA EM Ad Hoc members' workshop was devoted exclusively to in depth review of FY17 diagnostic cases submitted by each EM Facility as part of the annual peer evaluation.
Microscopy Meetings, Conferences and Workshops- Ultrapath XIX, the biennial meeting of the Society for Ultrastructural Pathology,was held in Newport, RI, on June 24-29, 2018 at the Hotel Viking. The 2018 meeting program is available on the Society website ( www.ultrapath.org). The Ultrapath XX meeting will be held in Amsterdam, Holland, from 7-12 June, 2020. These meetings focus exclusively on application of electron microscopy in pathologic diagnosis and research of human and animal diseases. Ultrastructural Pathology 101: Fundamentals of Diagnostic Electron Microscopy is an intensive 3-day course in diagnostic electron microscopy that was held for the first time in 2015 in Estes Park, Colorado. The course is targeted to non-physician electron microscopists, pathologists in training and others that might benefit from a basic refresher in electron microscopy. The September 2017 course was a resounding success with over 40 participants from the US and abroad. Requests to attend the future courses should be made as soon as possible. Address inquiries to: Gary Mierau, PhD, Director, Electron Microscopy Laboratory, Department of Pathology and Laboratory Medicine, Children's Hospital Colorado (B120), 13123 East 16th Avenue, Aurora, Colorado 80045, Telephone: 720-777-6170. Microscopy and Microanalysis, the annual meeting of the Microscopy Society of America ( http://www.microscopy.org) will take place in Baltimore, Maryland, from August 5-9, 2018. The Diagnostic Microscopy Focused Interest Group (FIG) members will hold several sessions, titled Utilizing Microscopy for Research and Diagnosis of Diseases in Human, Plants and Animals; FIG contact is Gang (Greg) Ning (email@example.com). Information and calendars about other current EM meetings and conferences are available from the Microscopy Society of America. Courses available and schedules at EM teaching facilities may also be obtained on the EM links web page.
Equivalent of Green Fluorescent Protein for Electron Microscopy? The development of a small, highly engineered plant (Arabidopsis thaliana) protein, dubbed "miniSOG," may elevate the abilities of electron microscopy in the same way that green fluorescent protein (GFP) and its relatives have made modern light microscopy in biological research much more powerful and useful ( PLoS Biol 9(4): e1001041. doi:10.1371/journal.pbio.1001041).
EM Retention requirements are on pages 73-74 of VHA HANDBOOK 1106.01 (Jan. 29, 2016)*. A full copy of the Handbook is available on the VA Intranet Diagnostic EM SharePoint Site or the national P&LMS website.
*See example memorandum for appropriate turn-in of EM documents, blocks, slides exceeding retention times.
Check out the TEM cases page. John G. Guccion, M.D., EM Director of the Washington DC Program, contributed a set of twelve interesting cases for your review. In addition a series of SEM/TEM and x-ray microanalysis cases submitted by the Durham EM Program are now available.
Generic Electron Microscopy processing procedures for Kidney biopsy, Tissue and Nerve biopsy are available for review and possible modification for local use. To see examples of generic processing procedures for EM Kidney biopsy, Tissue biopsy and Nerve biopsy click on the underlined links. As other generic procedures are added they will be available on the Generic Procedures page where the above biopsy specimen procedures are listed.
Some CAP inspectors may interpret that Diagnostic EM Programs should have external evaluations of their cases twice a year, rather than the annual review. This question was presented to the CAP accreditation division by Michael Brophy, National Enforcement Officer. See the question and response by CAP (CAP question).
Information on setting up sharing agreements - Need to bring in some additional money to support your EM Program? See the Sharing agreement section for more details.
Please share your good ideas and suggestions with other EM facilities. If you have any ideas or recommendations to share which save time, resources or effort in producing diagnostic EM reports for our patients, please send that information to us for possible addition to this web page. Potential examples include microwave processing procedures, EM specimen submission information/criteria or forms for use by referring facilities, etc.
Please e-mail Edoris.LeFurgey@va.gov with your comments and suggestions.