Re: [Histonet] Ventana Benchmark closed systems vs Open system stainers - a diatribe

From:"Joe Nocito"

I too am from the "golden age" of the Fisher Code-On. That's way it took so 
may years to try the successor "Tek-mate 1000" Was it fully automated? No. 
You had to deparaffinize and retrieve off the instrument, fill the little 
trays with reagents, set up the programs and then it could be started, but 
you could rum multiple programs at the same time.
    Then one day, my Bio-Tek Solution's rep took me out to an expensive 
lunch just to tell me Ventana purchased Bio-Tek. Then, I learned that 
Ventana did such a price increase of the Tekmate's supplies, it was cost 
prohibited to use. okay, so now I have a bad taste in my mouth.
    Flash forward 10 years and now I have to XTs in my lab with 2 
competement IHC techs. Now, we pay for reagents as well as knowledge. But, 
we can only have one run at a time on the machine.
    I know that there is software out there that can minipulate a machine at 
different intervals. Hell, my Sakura DRS 2000 does it, why not an immuno 
machine. If Ventana or any company for that matter, can allow me to perform 
more runs simultaneously, that it something I'll be willing to pay for. Not 
because one company works it's way down from the top.
    There, I've said my piece (or is it peace?) for now. As always, I shall 
over come and conquer. I am a legend in my own world, but they like me 


----- Original Message ----- 
From: "Brian Chelack" 
Sent: Sunday, May 28, 2006 3:55 PM
Subject: [Histonet] Ventana Benchmark closed systems vs Open system 
stainers - a diatribe

> It is interesting to note how firmly people plant themselves on one side 
> or
> the other of the "Ventana Issues". I have worked with many different
> immunostainers, going back to the old capillary gap Fisher Code-Ons. In my
> estimation every company that makes a stainer has to make some sort of
> compromise when it comes to its design. Every stainer has its own set of
> strengths and weaknesses; I have yet to see one that is "perfect". As
> technologists we all want to see the perfect machine that allows us to 
> load
> individual slides whenever we want, process them completely, error free 
> and
> automatically right down to the coverslip, and do it for next to nothing. 
> As
> an added feature the stainer should allow all the IHC technologists to
> maintain the "aura" of being highly skilled irreplaceable technical 
> artists
> who can perform magic on paraffin sections. This means job security 
> because
> department supervisors are certain their labs require the technologists 
> who
> are busily tending to their "automated" machines. This "perfect" company
> then must sell us one of these instruments and be prepared to walk away 
> from
> the marketplace, because we technologists don't want to be "beholdin" to
> them for any further purchases. We are mercenaries who will abandon them 
> in
> an instant for the next company that offers us reagents for 3% cost 
> savings.
> So if I am this company what should I do? Why should I invest a great deal
> of time and money into developing a stainer that provides me with no 
> chance
> for an ongoing revenue stream?
> I have seen companies with good technology (for their times), fade away 
> due
> to an inability to maintain a healthy cash flow. Patents are sold, other
> companies try to adapt the technology to their product lines and life
> staggers on. On the other hand, companies that keep their reagents
> proprietary, and yes expensive, do have the money available to develop 
> their
> product lines and look at new ideas. I think companies like Ventana, do
> charge a lot of money for their reagents, but I also see how companies 
> like
> Dako, with their new Artisan stainer is slowly moving towards generating
> ongoing revenue streams. Watch for the convergence!
> Which one is the best choice?  Well it depends. Every lab requires at 
> least
> one person to turn on the lights and make coffee, so this person is also
> available to perform IHC staining. Typically an IHC lab begins with 
> someone
> doing the IHC staining by hand. If this person is at least moderately
> skilled the lab becomes successful and requests for stains start arriving,
> and arriving and arriving.  Another skilled technologist is hired to no
> avail, before long, both are swamped and begging for more help, but 
> budgets
> are always tight so it must be time for an automated IHC stainer. What
> should we choose?
> Well the ability to stain large numbers of slides is important, right? So 
> we
> look at models that offer the ability to stain many slides at once, but
> these models can only output their slides once or twice per day. This 
> means
> you need to keep your two skilled technologists around in order to manage
> the large bulges of work expelled by the stainers periodically throughout
> the day.
> Is speed important? Well of course it is, but turn around times are
> inversely proportional to the capacity of the equipment. Think about what
> happens to the slide that arrives at the stainer 10 minutes after you hit
> the start button, for that that matter, think about what happens to the
> first slide that arrives at the stainer and then waits until enough other
> slides are present to warrant starting the equipment. It is becoming
> apparent that single piece flow is the most efficient method for improving
> turn around times, but to my knowledge, all the equipment makers (Ventana
> included, see the new BenchMark XT), believe that more slides in a batch 
> is
> better. Histo techs cut one block at a time and Pathologists look at one
> slide at a time, but for some reason we like to batch and queue large
> numbers of slides in the IHC lab.
> Is quality important? Obviously it is.  So why do we need to have highly
> skilled technologists overseeing the "automated" equipment? Lets be honest
> about our "automated" equipment, what we really have are glorified 
> automated
> pipetting devices. Some of them provide the reagents, some we have to make
> up the reagents ourselves, some heat the slide some do not.
> IHC is not automated!
> If it were, the histotech cutting the section could place a bar-coded 
> slide
> into a slot in the stainer as it was cut and the stainer would run the
> entire process, spitting out the completed slide onto the pathologists
> microscope where he/she would examine it. Slides would be delivered to the
> pathologist in a steady stream of 1 every couple of minutes, the process
> would be faster and the entire IHC lab would be eliminated. Oh wait, that
> would mean I would be out of work................... never mind (with
> apologies to SNL).
> Seriously though, the two largest cost drivers in IHC labs are the staff 
> and
> the equipment/reagents. The people who have evolved in the labs generally
> like to tinker with their stains, "I can tweak it a bit to make it do this
> or that". In a perfect world, lab managers would pay big money for a 
> machine
> that was, as described above, "truly automated".  Technologists actually
> don't like not being able to tinker with a stain, add to that the costs 
> for
> the reagents that are so much higher than our home made ones and it's no
> wonder we resist these pieces of equipment. They are not truly automated 
> and
> they limit the technologists ability to prove their value in the lab. As 
> an
> aside have you ever considered the markup on some of the polyclonal rabbit
> antibodies for human diagnostics. I have seen 100 uL of rabbit serum sell
> for hundreds of dollars, do your lab techs complain about these prices?
> Now, I realize that a true research lab operates under a different set of
> parameters and probably does require someone who can tweak a stain. These
> research labs are generally not high volume labs though, and realistically
> many could probably operate manually. It's the high volume labs that run
> 20-30 or more of the same stain every day that really need automation.
> What I hope will happen, is that two or more companies will embrace the
> ongoing revenue stream model currently used by Ventana, and then we should
> see a rapid evolution towards truly automated IHC stainers. Competition is
> always brings out the best in industry. Look at how clinical chemistry
> analyzers now are able to process serum samples, with little need for the
> technologist to fuss with the process.  That should be the goal of the IHC
> stainer manufacturer.
> So what type of stainer should you choose? Well if you already have a good
> technologist or two in the lab and you have no opportunity reduce your
> personnel costs and if money is tight, you will likely choose an open
> system. My experience has been that open systems will lead to somewhat 
> more
> variability in the results obtained, sometimes this can be good and
> sometimes it is bad. I have also seen that companies lose interest in
> product lines that no longer have a high profit potential, so beware of
> obsolescence. If high throughput and quick turn around time is critical,
> then I would recommend multiple units of the smallest volume stainer you 
> can
> get (for more on this read up on LEAN thinking). If accessing or retaining
> highly skilled people are not in your future then you should be moving
> towards the "most automated" equipment like the Ventana machines. If you 
> are
> a research lab with skilled people already in place then resist the move 
> to
> automated equipment for as long as possible. There's just no sense in 
> having
> the highest costs of both worlds.
> As Joe Nocito said earlier this week:
> Let the flaming begin....
> Brian Chelack
> Prairie Diagnostic Services
> 2604-52 Campus Drive
> Saskatoon SK
> S7N 5B4
> 306-966-7241
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