What do you get when you cross an inveterate problem-solver with a pathologist devoted to efficiency? A Pathinnovator!
Ifeanyi Victor Nwadukwe, Pathologist and Founder of NCRatio, Inc., slots easily into this category. Frustrated with the margin for human error in pre-analytics, he set about developing an AI and robotics platform that automates small biopsy grossing.
As Nwadukwe prepares for pilot testing of the system in the lab, he took time out to chat to The Pathologist about the innovation process, and how robotics and AI are shaping the future of pathology.
What inspired you to develop an automated sample preparation system?
The origin story goes back to my days as a pathology resident in a small program in Ohio. In medical school, I enjoyed anatomy labs and the chance to explore internal structures firsthand. So when I entered residency, I thought working in the gross room would be a natural extension of that interest.
But the reality was different. The gross room is exactly how it sounds. There are amputated limbs, a brain in a bucket of formalin, pungent smells – it’s a strange, sometimes unsettling place. For me, the fascinating part was examining diseased structures, but I quickly realized that most of my time wasn’t spent on large, complex specimens. Instead, I was processing endless small biopsies.
These tiny specimens – skin punches, cervical biopsies, and other fragments – don’t require elaborate descriptions. Day after day, I was repeating the same task: removing tissue fragments from a formalin container, placing them into a cassette, and writing the same stock description. I’d do this a hundred, sometimes two hundred times a day. It was mind-numbing and, frankly, soul-crushing.
To make matters worse, many labs can’t afford to have pathologists’ assistants handling small biopsies; they reserve them for larger, more complex resections. Instead, the task often falls to lab assistants with limited training. While human error is inevitable, the consequences can be devastating. In one case, two biopsies were switched, and a patient underwent surgery for what turned out to be a fungal infection – misdiagnosed as cancer.
On top of that, lab staffing shortages mean high turnover in gross rooms, especially for those tasked with small biopsies. At one of my previous jobs, if the lab fell behind, pathologists themselves had to step in and do the grossing. It was tedious, repetitive work, and a poor use of our time and training.
That’s when it struck me: no one should be spending their career this way. With today’s technology, there’s no reason small biopsy grossing can’t be automated. Robots are more than capable of transferring tissue from a container into cassettes, and AI can ensure accuracy and consistency. Combining the two seemed like the perfect solution to a problem that had plagued pathology labs for decades.
Credit: Ifeanyi Victor Nwaduke
How did you approach the development phase?
The development process began modestly – just me and a small team of engineers. I pitched the idea to my current partners with nothing more than a sketch. From there, we started brainstorming, and I brought them into the lab to show them exactly what the small-biopsy workflow looks like in practice.
By late 2024, we had created a basic prototype. We began 3D-printing the parts, assembling them, and experimenting with how they fit together. The design was intentionally modular: separate units that could later be integrated into a fully automated workflow. Now, we’ve reached the stage where the system is assembled, and the next challenge is to get all the components communicating seamlessly.
Our goal is to launch pilot testing in my current lab later this year. That will provide crucial insights into how the system performs in real-world conditions – questions like: How fast does it need to operate? Where should cameras be positioned? Where are the error points and failure risks?
How did you get it off the ground?
For now, the project is self-funded. I’ve spoken with a few potential investors, but I’ve been cautious about committing. Timing-wise, I’m also transitioning into a lab director role, so my bandwidth is limited. Still, I recognize that investment will likely be necessary soon, and part of this process is building visibility and gauging interest.
The early response has been encouraging. Since posting a short video of the system online, I’ve had colleagues reaching out to ask when it will be available. Right now, it’s about engaging the community, understanding the needs, and collecting feedback – particularly around biopsy volume and workflow requirements.
Credit: N:C Ratio
What have been some of the challenges so far?
One of the biggest challenges has been communication with collaborators. Very few engineers have experience with the specific workflows of a histology lab, especially when it comes to tissue handling. In fact, I generally needed to start each conversation with an explanation of pathology, biopsies, and grossing.
I needed to convey the highly specialized nature of the work, its unique demands, and the consequences when things go wrong. For example, if a cassette doesn’t close properly and tissue is lost, the consequences for a patient can be devastating. There’s no margin for error.
It was also important to emphasize which parts of the process must be fail-proof, and which ones can tolerate minor issues that a technician can fix later. Translating that level of detail to people who don’t live in the lab every day has been a learning process.
Conversations with investors presented similar challenges. Many of them don’t know what happens to tissue after it’s removed. One of my early investor conversations was with an OB-GYN doctor who was completely unfamiliar with pathology workflows. I ended up making videos just to demonstrate the process and explain why automation could have such an impact.
So the real challenge has been bridging those gaps – helping engineers, investors, and collaborators outside of pathology understand both the technical requirements and the clinical importance of what we’re building.
And some of the rewards…?
For me, the biggest reward has been the creativity involved – taking an idea from sketches and concepts to something that actually comes to life. Watching the designs we imagined with the engineering team transform into a functioning system has been incredibly satisfying.
Equally motivating is the thought that, one day, this platform will make a tangible difference in the lab. I see it as a companion tool for pathology assistants and grossing technicians, helping reduce their exposure to hazardous chemicals, streamlining their workflow, and easing the burden of repetitive tasks. By doing so, labs can scale more efficiently without being constrained by staffing shortages.
Being part of that change – helping shape the way pathology adapts to new challenges – is what keeps me motivated. It’s not just about building a machine; it’s about building something that could meaningfully improve how labs operate and, ultimately, how patients are served.
What advice would you give to pathologists with innovator aspirations?
Pathology training certainly doesn’t teach us creativity, but it does provide an overview of the entire pathology workflow and its inherent problems. The people who do the work are absolutely the best people to come up with solutions to those problems. As leaders of laboratory medicine, we should be driving the conversation about the future of pathology.
And this is the best time in the history of medicine to be an innovator – because we now have the technology available to make those leaps. And it’s affordable. Most scientists now have access to artificial intelligence and robotics, and to the experts who know how to put them to work.
Whether I'm successful or not, I want to serve as an example of someone who is trying to use readily available technologies to improve laboratory workflows and patient safety. Hopefully I inspire someone who's been sitting on a similar project to get up and make it happen.
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