Robotics in the Medical Laboratory

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RANGE
OF
MOVEMENT
ROBOT
DEGREES
OF
TYPE
FREEDOM
CARTESIAN
3
CYLINDRICAL
4
JOINTED
CLIN.
CHEM.
36/9,
1534-1543
(1990)
1534
CLINICAL
CHEMISTRY,
Vol.
36,
No.
9,
1990
Robotics
in
the
Medical
Laboratory
Robin
A.
Felder,
James
C.
Boyd,
KeIth
Margrey,
WillIam
Holman,
and
John
Savory
Robotic
systems
specifically
designed
for
the
automation
of
laboratory
tasks
are
now
available
commercially.
Equipped
with
computer,
analytical
hardware,
and
supporting
software,
these
devices
may
soon
revolutionize
the
concept
of
the
clinical
laboratory
and
usher
in
a
new
era
in
laboratory
testing.
We
review
the
types
of
robots
and
motion-control
software
currently
available
and
discuss
examples
of
their
applications
that
extend
across
many
analytical
areas.
Sev-
eral
ongoing
projects
are
concerned
with
the
systematic
integration
of
robotic
devices
with
other
laboratory
automa-
tion.
The
integrated
robotic
laboratories
emerging
from
this
work
portend
a
bright
future
for
robotic
automation.
Many
challenges
remain,
however,
in
training
the
individuals
needed
to
develop
and
manage
robotic
laboratories,
and
in
making
this
new
technology
cost-efficient.
Clinical
laboratory
automation
is
beginning
a
new
era
with
the
advent
of
programmable
robots.
The
next
decade
will
see
significant
advances
in
laboratory
automation
and
integration
that
will
undoubtedly
improve
efficiency
and
reduce
costs
of
laboratory
testing.
The
clinical
laboratory
in
the
1990s
will
consist
of
automated
sample
delivery,
cod-
ing,
processing,
analysis,
and
reporting.
Although
robotics
has
been
in
place
in
the
industrial
setting
for
over
two
decades,
it
represents
relatively
new
technology
to
the
clinical
laboratory.
In
this
review
and
introduction
to
the
concepts
covered
at
this
Oak
Ridge
Conference,
we
will
discuss
laboratory
robotics
and
peripheral
devices
that
are
useful
to
the
clinical
laboratory
and
describe
examples
of
their
applica-
tions.
The
future
of
clinical
laboratory
robotics
will
be
illustrated
through
examples
of
several
robotics
applica-
tions
that
are
still
in
the
design
phase
and
those
soon
to
be
placed
in
the
clinical
setting.
Robots
are
widely
used
in
industry,
where
repetitive
tasks
are
commonplace.
Light-duty
robots
evolved
from
their
larger
ancestors,
industrial
robots
that
were
designed
to
handle
tasks
such
as
lifting
heavy
objects
or
performing
rapid,
highly
accurate
welding.
Many
industrial
laboratory
robots
are
engineered
for
dedicated
applications
and
so
are
not
suitable
for
the
changing
environment
of
the
clinical
laboratory.
Relatively
recently,
several
robotic
systems-
consisting
of
a
small
laboratory-grade
robotic
arm,
com-
puter,
and
supportive
software-have
been
introduced
spe-
cifically
for
the
automation
of
laboratory
testing.
Most
of
these
robots
are
used
in
industry:
an
estimated
1000-1500
robots
are
already
in
use
in
the
approximately
75
000
industrial
analytical
laboratories
in
the
U.S.
(1).
Using
industry
as
a
model,
hospitals
can
incorporate
robotics
into
University
of
Virginia
Health
Sciences
Center,
Department
of
Pathology,
Box
168,
Charlottesville,
VA
22908.
Received
May
8,
1990;
accepted
July
16,
1990.
various
areas
of
health-care
delivery,
including
the
labora-
tory.
Types
of
Laboratory
Robots
By
definition,
a
robot
is
any
machine
that
can
be
pro-
grammed
to
perform
any
task
with
human-like
skill
(2).
Practically,
the
term
robotics
refers
to
programmable
de-
vices
that
can
perform
a
variety
of
skilled
actions
by
using
a
combination
of
mechanical
and
electronic
components.
Robots
are
often
considered
simply
a
mechanical
extension
of
the
computer.
The
greatest
asset
of
a
robot
is
that
it
can
be
configured
to
perform
a
multiplicity
of
tasks
and
there-
fore
should
wear
out
before
it
becomes
outmoded.
Devices
designed
for
only
one
repetitive
task
are
referred
to
as
hard
automation,
e.g.,
auto-samplers,
pipetters,
and
all
other
instrumentation
with
limited
mechanical
capabili-
ties
or
restricted
programmability.
Laboratory
robots
can
take
many
forms.
Three
basic
configurations
of
robots
have
been
used
in
the
clinical
laboratory
environment
(Figure
1).
We
will
describe
one
example
of
each
type
of
laboratory
robot,
although
many
other
robots
are
available
that
are
suitable
for
the
labora-
tory
environment.
Cartesian
Robots
and
Pipetting
Stations
Cartesian
robots
are
devices
with
three
linear
degrees
of
freedom.
Items
can
be
moved
about
in
a
three-dimensional
5
Fig.
1.
Three
basic
configurations
of
robots
used
in
the
clinical
laboratory
Fig.
2.
Robot
configuration
used
by
Pippenger
(
for
high-pressure
liquid
chromatography
analysis
of
antidepressant
drugs
Photograph
kindly
supplied
by
Drs.
C.
E.
Pippenger
and
F.
Van
Lente
CLINICAL
CHEMISTRY,
Vol.
36,
No.
9,
1990
1535
x,y,z)
space,
but
not
rotated.
Cartesian
robots
are
the
basis
br
sampling
devices
in
many
automated
analyzers.
How-
sver,
cartesian
robots
have
found
more
versatility
in
the
ilimcal
laboratory
as
pipetting
stations,
designed
to
per-
brm
many
liquid-handling
activities.
Examples.
The
Biomek
pipetting
station
(Beckman
In-
ttruments,
Brea,
CA)
is
an
example
of
a
cartesian
robot
that
can
be
programmed
to
perform
various
liquid-
sandling
protocols.
Cartesian
robot-pipetting
stations
al-
Low
placement
of
a
pipette
tip
at
any
point
in
space,
within
-0.2
mm
repeatability,
with
the
capability
of
aliquoting
md
diluting
specimens
and
dispensing
reagents.
Cartesian
Tobot-pipetting
stations
have
as
their
principal
components
nicroprocessor-controlled
stepping
motors
that
drive
liq-
zid-handling
syringes,
pipetting
arms,
and
in
some
units
rnoveable
sample
trays.
The
Biomek
(Figure
1,
top)
is
a
hybrid
robot:
it
has
a
series
of
interchangeable
hands
that
allow
it
to
vary
its
pipetting
capabilities.
However,
the
Biomek
cannot
me-
thanically
manipulate
test
tubes.
In
addition,
it
comes
quipped
with
a
built-in
spectrophotometer.
The
Biomek
nd
other
similar
pipetting
stations
can
be
programmed
to
erform
other
useful
liquid-handling
chores
such
as
wash-
ng
an
antibody-coated
bead,
or
rinsing
the
wells
in
a
nicrotiter
plate.
Recently
the
Biomek
has
been
configured
to
perform
a
nonoclonal
solid-phase
immunoenzymatic
assay
for
carci-
aoembryomc
antigen
(Hybritech
Inc.,
San
Diego,
CA)
(3).
Because
of
the
Biomeks
built-in
spectrophotometer,
the
mtire
assay,
including
bead
washing
and
data
reduction,
is
Esandled
automatically.
There
are
several
examples
in
the
clinical
laboratory
of
the
use
of
pipetting
stations
to
perform
analytical
proce-
ures.
Brennan
et
al.
(4-6)
demonstrated
the
use
of
the
ecan
Sampler
505
(Tecan
AG,
Hombrechtikon,
Switzer-
and)
in
the
screening
test
for
anti-HTLV-ffl
antibodies.
e
procedure
required
placing
a
patients
plasma
sample
n
a
rack,
after
which
the
pipetting
station
diluted
the
lasma
441-fold.
A
barcode
reader
and
pipette
washer
were
trofitted
to
the
device
to
positively
identify
patients
and
eliminate
carryover,
respectively.
The
system
operated
t
approximately
the
same
rate
as
a
trained
medical
chnologist
but
demonstrated
better
precision
and
allowed
chnologists
to
perform
other
tasks.
e
Cylindrical
Robot
The
cylindrical
robot,
exemplified
by
the
Zymate
robot
ymark
Corp.,
Boston,
MA),
works
in
a
cylindrical
perfor-
ce
envelope.
The
four
degrees
of
freedom
exhibited
by
lindrical
robots
(base
rotation,
elevation,
movement
in
d
out
of
a
plane,
and
wrist
roll)
are
usually
sufficient
for
ost
laboratory
operations
(Figure
1,
middle).
The
major
Station
of
these
robots
is
the
lack
of
wrist
pitch,
which
ould
be
useful
for
getting
in
and
out
of
tight
places.
dditional
flexibility
in
task
performance
is
obtained
by
ogramnsing
the
robot
to
use
a
series
of
interchangeable
ands
(a
feature
patented
by
Zymark
Inc.).
Hand
and
ger
orientation
is
determined
by
potentiometric
servo
otors
that
allow
the
robot
to
sense
its
orientation
at
all
mes.
This
arm
is
a
popular
choice
for
simple
repetitive
ks
and
has
been
used
successfully
for
many
sample-
eparation
protocols,
both
in
the
clinical
laboratory
and
in
e
pharmaceutical
industry.
Examples.
Severns
and
Hawk
(7)
investigated
the
use
of
cylindrical
robotic
arm
to
produce
an
automated
blood-
typing
system
that
would
be
affordable
to
most
laborato-
ries.
The
system
consisted
of
an
indexing
rack
for
samples,
which
were
identified
by
a
barcode
reader.
After
significant
development
over
several
years,
the
system
was
described
again,
with
throughput
increased
from
40
to
104
samples
per
hour
(8).
The
device
was
later
commercialized
by
Microbank
(Dynatech
Laboratories,
Chantilly,
VA).
The
success
of
robotic
applications
in
the
blood
bank
is
due
to
the
production-line
nature
of
blood
typing.
Laboratory
services
that
support
blood
banks
require
many
repetitive
analyses
before
the
blood
can
be
used
for
transfusion.
Friedman
and
Severns
estimated
(8)
that,
in
1984,
12
million
units
of
whole
blood
were
collected
in
various
medical
centers,
each
unit
of
which
required
ABO
and
Rh
typing.
The
blood-typing
process
has
been
automated
by
some
manufacturers,
but
these
units
cost
>$100
000
and
so
are
not
accessible
to
most
regional
hospitals
with
small
transfusion
volumes.
Robotic
arms
not
only
are
less
expen-
sive
than
a
dedicated
blood-typing
instrument
but
also
can
be
reprogrammed
when
the
laboratorys
needs
change.
The
cylindrical
robot
has
been
used
in
the
clinical
chem-
istry
laboratory
at
the
Cleveland
Clinic
Foundation
to
prepare
samples
for
an
HPLC
method
in
a
complex
series
of
steps:
sample
extraction,
separation
of
liquid
phases,
and
injection
(9).
These
investigators
incorporated
several
Zy-
mate
robotic
systems
into
a
laboratory
for
the
analysis
of
antidepressants.
Medical
technologists
were
needed
to
pre-
pare
the
reagents,
to
place
necessary
supplies
at
the
desig-
nated
locations
within
reach
of
the
robot,
and
to
evaluate
the
quality
of
the
final
results.
The
robotic
laboratory
was
placed
under
a
fume
hood
to
eliminate
any
toxic
fumes
originating
from
extracted
samples
during
the
evaporation
process
(Figure
2).
The
robot
completed
the
drug
extrac-
tions
and
made
the
sample
injection
into
the
chromato-
graph
by
using
a
specially
designed
injection
hand
(Figure
3).
For
several
years
these
robots
have
been
performing
their
repetitive
tasks
with
only
minor
malfunctions.
Castellani
et
al.
(10)
reported
recently
the
use
of
a
robot
to
perform
preparative
immunologic
precipitations,
with
final
placement
of
the
samples
into
a
rotor
for
subsequent
analysis
(10).
This
robotic
system,
which
consisted
of
a
Zymate
robot
and
a
Cobas-Bio
rotor
(Roche
Diagnostics,
Nutley,
NJ),
was
the
first
reported
system
to
combine
a
clinical
analyzer
and
a
laboratory
robot
(Figure
4).
How-
WASH
STAT
ION
1536
CLINICAL
CHEMISTRY,
Vol.
36,
No.
9,
1990
Fig.
3.
Sample
injection
into
a
high-pressure
liquid
chromatography
system
by
use
of
an
interchangeable
hand
specifically
designed
for
this
function
Photograph
kindly
supplied
by
Drs.
C.
E.
Pippenger
and
F.
Van
Lente
ever,
placing
the
rotor
in
the
analyzer
and
transferring
the
data
to
the
laboratory
computer
were
performed
manually.
Godoiphin
(11)
at
the
Vancouver
General
Hospital
auto-
mated
a
highly
complex
steroid-receptor
analysis,
using
a
Zymate
robotic
system.
The
estrogen
receptor
assay
ordi-
narily
is
a
manual
procedure,
involving
many
critical
steps
such
as
centrifugation,
incubation,
and
subsequent
place-
ment
of
completed
samples
in
scintillation
vials.
In
the
automated
procedure,
the
incubation
water
bath,
centri-
RO8OT
ARSI
WITH
----.
GENERAL
PURPOSE
HANO
I

.
I
NFJUUS#{149}UEECTOQ
iz,TUBE
DISCARD1
ruRNTARLE
U
SAMPLE
ROTOR
L
.:j.
Fig.
4.
Schematic
diagram
of
robot
configuration
used
by
Castellani
et
al.
(10)
for
performing
immunologic
precipitations
in
the
immuno-
chemical
determination
of
cardiac
isoenzymes
Repnnted
from
ref.
10
flige,
and
supply
and
reagent
stations
are
placed
in
a
circular
pattern
around
the
robotic
arm.
The
reagents,
which
are
particularly
labile
in
this
assay,
are
kept
cold
in
an
ice
bath.
Finished
samples
are
added
to
scintillation
vials
by
the
robotic
arm.
Because
more
than
one
rack
of
vials
is
produced
in
a
single
uninterrupted
robotic
proce-
dure,
the
scintillation
vial
racks
are
placed
in
a
tiered
holder
to
allow
the
robot
access
to
two
racks
(Figure
5).
Friedman
and
Severns
(8)
used
a
Zymate
robot
to
dilute
and
transfer
samples
for
blood
grouping
in
the
blood
bank.
For
this
task
the
robot
was
fitted
with
exchangeable
pipet-
tar
hands.
The
robot
was
also
used
to
orient
samples
for
barcode
reading.
In
this
system
the
robot
was
configured
as
a
pipetting
device.
After
the
robot
had
performed
the
liquid
handling,
a
human
operator
proceeded
with
additional
manual
aspects
of
the
test.
As
discussed
earlier,
many
blood-bank
analytical
methods
are
relatively
simple
and
are
used
in
sufficient
numbers
to
warrant
a
dedicated
analyzer
(4).
Articulating
Robots
The
most
versatile
robot
available
to
the
clinical
labora-
tory
is
the
articulating
robot;
it
offers
more
degrees
of
freedom
than
either
the
cartesian
or
the
cylindrical
robots.
The
articulating
robot
has
shoulder,
elbow,
and
wrist
joints,
rotating
on
a
pivoting
base.
Furthermore,
the
robot
has
wrist
pitch-and-roll
maneuvers
that
allow
access
to
areas
often
difficult
to
reach
on
analytical
instruments.
Positional
accuracy
of
0.5mm
or
better
is
obtained
by
using
optically
encoded
discs
that
must
be
set
by
nesting
to
a
home
or
zero
location
each
time
the
robot
is
turned
on.
Examples.
A
recent
example
of
a
sophisticated
articulat-
ing
robot
is
from
Cyberfluor
Inc.
(Toronto,
Ontario,
Cana-
da).
The
Cyberfluor
robot
has
a
high
degree
of
flexibility,
with
five
degrees
of
freedom
(Figure
1,
bottom).
Godolphin
(11)
has
demonstrated
the
use
of
an
articulating
robot
in
a
clinical
laboratory,
evaluating
the
automation
of
sample
processing
at
the
receiving
end
of
the
clinical
laboratory.
Sample
processing
is
currently
the
rats-limiting
step
ir
most
clinical
laboratories.
Using
a
robot
in
conjunctio
with
a
clinical
centrifuge
allows
processing
of
samples
a
they
enter
the
laboratory.
One
advantage
of
an
articulatini
robotic
arm
is
its
ability
to
reach
over
the
rim
and
into
clinical
centrifuge
to
retrieve
samples.
For
a
cylindrica
robot
to
perform
this
task
requires
use
of
a
custom-alterei
centrifuge
or
a
custom-made
robotic
hand.
Godolphin
et
al
(12)
also
conceived
of
a
novel
serial
centrifuge
to
separat
Fig.
5.
Schematic
diagram
of
robot
configuration
used
by
Godolphi
(11)
for
performing
estrogen
receptor
assays
Diagram
kindly
supplied
by
Dr.
William
Godolphin
sera
or
plasma
from
formed
elements
in
the
blood-collection
tube.
The
single-tube
centrifuge
will
eventually
be
incor-
porated
into
a
robotic
sample-handling
system
that
should
not
only
speed
up
laboratory
productivity
but
also
reduce
risk
of
exposure
to
AIDS
and
hepatitis
(12).
Articulating
robots
are
also
beginning
to
be
used
in
the
blood-bank
laboratory.
One
manufacturer
of
blood-banking
automation
(Flow
Laboratories,
McLean,
VA)
markets
a
robot
interfaced
to
various
microplate-handling
devices
(pipetters,
readers,
washers,
centrifuges).
The
entire
device
(the
mosAL)
is
enclosed
in
a
protective
hood,
obviously
designed
to
reduce
operator
exposure
to
contaminants.
Robot
Movement
Establishing
control
of
robot
motion
to
mimic
the
smooth
movement
of
the
human
arm
with
a
high
degree
of
reposi-
tional
precision
is
a
difficult
problem
addressed
by
the
science
of
kinematics
(13).
Kinematics
are
applied
to
the
robot
in
three
levels
of
complexity.
First,
trajectory
plan-
ning
determines
position,
velocity,
and
acceleration
for
each
movement
made
by
the
robotic
manipulators.
Second,
inverse
kinematics
are
applied
to
translate
the
movements
required
in
the
coordinate
system
into
the
joint
movements
required
by
the
particular
geometry
of
the
robot
being
developed.
Finally,
inverse
dynamic
equations
are
applied
to
establish
how
the
robot
moves
in
response
to
various
applied
torques
and
forces.
Each
movement
of
the
robot
is
represented,
therefore,
by
a
set
of
remarkably
complex
equations,
the
implementation
of
which
has
fortunately
been
simplified
through
the
use
of
high-level
computer
languages.
Robot
locomotion
is
a
general
term
applied
to
all
types
of
robot
movement
in
which
the
robot
can
venture
away
from
a
fixed
point.
Locomotion
imparts
another
degree
of
free-
dom
to
the
robot
but
also
allows
an
increase
in
the
variety
of
hardware
with
which
a
robot
can
interact
(14).
Robots
can
be
made
mobile
by
several
methods.
Robotic
arms
can
be
attached
to
linear
tracks
or
to
a
mobile
cart.
In
the
case
of
a
mobile
cart,
the
portion
of
the
robot
that
imparts
mobility
is
considered
a
Automated
Guided
Vehicle
(AGV).
AGVs
either
are
equipped
with
an
automatic
on-
board
guidance
system
or
follow
a
path
on
the
floor
wall
or
ceiling.
Guidance
is
provided
through
various
sensors,
e.g.,
infrared,
video,
magnetic,
or
simple
light
sensors
for
reflec-
tive
tape
paths.
Equipping
AGVs
with
a
robotic
component
roduces
a
mobile
robot.
Some
robots
are
being
designed
to
ave
human-
or
animal-like
gait,
so
that
they
may
climb
stairs,
for
example.
The
study
of
bringing
human-
or
mal-like
gait
to
robotic
machines
is
called
bionics.
A
recent
improvement
in
robot
locomotion
is
the
use
of
inear
tracks.
The
robotic
arms
can
travel
the
length
of
a
inear
track,
either
upright
or
upside
down,
with
positional
recision
of
0.5
mm
(Figure
6).
This
concept
has
altered
the
volution
of
laboratory
design
from
circular
tables
with
the
ed
robot
in
the
middle,
back
to
the
classic
laboratory
nch
stretched
along
the
perimeter
of
the
room.
Ergono-
etric
laboratories
are
now
possible,
such
that
either
hnologists
or
robots
can
operate
the
instruments.
Robots
at
can
travel
the
length
of
a
laboratory
bench
have
rformance
envelopes
(the
areas
in
which
the
robot
can
rform
useful
work)
that
resemble
an
elongated
hemi-
here
instead
of
a
doughnut.
Examples.
Several
attempts
at
robot
locomotion
have
en
tried
in
the
clinical
setting.
Computer-driven
vehicles
t
move
about
the
hospital
corridors
picking
up
speci-
Fig.
6.
Diagrammatic
representation
of
robotic
locomotion
under
computer
control
along
a
linear
track
The
suspension
of
the
robot
from
the
track
takes
up
no
benchtop
space
and
allows
the
robot
to
access
many
different
peripheral
devices
over
a
large
rectangular
work
area.
Adapted
from
Folder
A,
Boyd
J,
Savory
J.
Med
Lab
Products
1987;2(7):18-9;
printed
with
permission
mens
and
delivering
them
to
the
main
laboratory
were
first
popularized
by
Seligson
(15).
Similarly,
Sasaki
(16)
has
designed
robotic
vehicles
that
move
about
the
laboratory,
returning
empty
specimen
racks
to
the
central
specimen-
receiving
area
of
the
lab.
Mobile
robots
that
can
negotiate
the
corridors
of
a
hospital
for
specimen
delivery
have
been
investigated
by
Transitions
Research
Corp.
(TRC,
Dan-
bury,
CT)
and
are
discussed
in
detail
by
Lob
(17).
Unlike
many
mobile
robots,
the
TRC
Helpmate
does
not
rely
on
a
guide
affixed
to
the
floor.
The
TRC
mobile
robot
is
equipped
with
infrared,
ultrasonic,
and
vision
sensors
to
acquire
information
about
the
environment.
With
the
aid
of
a
preprogrammed
knowledge
base
of
the
hospital
layout,
the
robot
arrives
at
its
destination
without
colliding
with
patients
or
objects
in
its
path.
Sensors
The
mechanical
performance
of
the
robot
can
be
en-
hanced
by
adding
sensor
technology
on
the
hands
or
joints
of
the
robot.
Various
mechanical
and
electronic
sensor
systems
may
be
used,
e.g.,
computerized
imaging
systems
to
check
for
sample
integrity
and
container
positioning
for
access
by
a
robot
(18).
Currently,
video
systems
allow
a
robot
the
greatest
degree
of
spatial
resolution
(19).
Several
investigators
are
looking
at
the
feasibility
of
tactile
sensing
in
the
fingertips
of
robotic
fingers.
Tactile
sensing
ap-
proaching
that
of
the
human
finger
is
in
the
foreseeable
future
(20).
The
advantage
of
sensor
technology
is
the
ability
of
the
robot
to
respond
to
changes
in
the
analytical
method.
With
proper
sensor
technology,
closed-loop
operation
of
robots
becomes
a
possibility.
Analytical
data
can
be
checked
by
the
robots
host
computer,
which
is
equipped
with
an
expert
system,
and
corrective
measures
such
as
sample
re-analy-
sis
can
be
initiated
if
necessary.
Many
of
these
enhance-
ments
to
increase
the
intelligence
of
the
robotic
system
have
not
been
examined
in
the
clinical
laboratory
setting.
However,
both
the
Zymate
and
Cyberfluor
robots
have
fingers
that
can
sense
the
presence
or
absence
of
objects
in
their
grasp.
This
feature
is
helpful
if
test
tubes
or
syringes
are
dropped
inadvertently
during
a
procedure.
ProgrammIng
the
Laboratory
Robot
Perhaps
the
single
most
important
factor
that
has
stim-
ulated
the
introduction
of
robotics
into
the
clinical
labora-
tory
has
been
the
development
of
high-level
robot
program-
ming
languages
with
English
language
commands.
For
example,
the
simple
command
GOTO
MIXER
initiates
an
intricate
sequence
of
steps
to
drive
the
robotic
arm
to
the
CLINICAL
CHEMISTRY,
Vol.
36,
No.
9,
1990
1537
I
HIGN
LEVEL
ROBOT
LANGUAGE
.l1CE
DRIVERS
I
ITANGET
DEVICES

I
ROBOT
DRIVER
ROBOT
LANGUAGE
ROBOT
CONTROLLER
Fig.
7.
Representation
of
the
hierarchy
of
software
and
hardware
modules
used
in
controlling
a
jointed
robot
High-level
robot
languages
interact
with
specific
robotic
driver
programs
that
carry
out
the
complex
mathematics
needed
to
convert
requests
for
movement
in
the
xyz
coordinate
system
into
coordinated
movements
of
each
robotic
joint
1538
CLINICAL
CHEMISTRY,
Vol.
36,
No.
9,
1990
mixing
device.
Several
interfaces
away
from
the
users
command,
the
software
generates
electronic
signals
to
the
robot
motion-control
mechanism
to
coordinate
a
smooth
movement
arc
that
terminates
at
a
precise
location
near
the
mixer.
Complex
algorithms
involving
robot
kinematics
translate
computer
machine-code
into
signals
that
control
the
acceleration
after
commencing
the
movement
and
the
deceleration
before
the
robotic
arm
stops
at
the
mixer.
Furthermore,
to
avoid
spilling
any
liquid,
the
robotic
fin-
gers
are
held
parallel
to
the
work
surface
throughout
the
complex
series
of
movements.
Elaborate
procedures
can
be
developed
by
combining
a
series
of
simple
commands,
which
are
programmed
and
tested
individually.
The
robot
can
be
instructed
to
pause
in
a
procedure,
examine
the
status
of
a
sensor
or
instrument,
and
then
proceed
through
a
choice
of
subsequent
programs,
depending
on
the
outcome
of
the
test.
Programmed
intelligence
of
this
sort
allows
highly
adaptive
systems
for
performing
many
assays.
The
integration
of
the
various
levels
of
programming
language
and
the
input
and
output
ports
of
the
robotic
system
are
controlled
by
a
high-level
robot
language.
An
example
of
this
hierarchial-type
software
system
is
shown
in
Figure
7.
Future
robotics
software
is
being
directed
toward
stan-
dardization
and
modularization
of
the
basic
operations
performed
in
the
clinical
laboratory:
sample
manipulation,
liquid
handling,
separation,
conditioning,
weighing,
mea-
suring,
reporting,
and
storing
by
use
of
a
modular
ap-
proach.
High-level
robotic
control
languages
will
reduce
the
time
necessary
for
assay
automation.
Intellibotics
(Ox-
nard,
CA)
has
used
a
computer
graphics
interface
to
sim-
pliIy
writing
robot
programs.
The
programs
can
be
imple-
mented
graphically
before
being
used
to
actually
run
the
robot
(21).
Modular
programming
will
allow
rapid
integra-
tion
of
several
basic
operation
modules
into
a
complete
assay
procedure
with
appropriate
instrumental
status
checks.
Standardization
of
interfaces
with
peripheral
hard-
ware
(i.e.,
centrifuge,
mixer,
and
pipetter)
will
be
essential
for
the
rapid
incorporation
of
various
sample
manipula-
tions
in
the
development
of
robotically
controlled
assays.
User
Interfaces
The
term
user
interface
implies
a
software
design
that
makes
many
of
the
complex
codes
for
robotic
motion
control
and
data
inputloutput
transparent
to
the
user.
One
should
be
able
to
use
simple
English
language
commands
to
train
a
robot
to
perform
any
task
within
its
mechanical
perfor-
JOINT
1
JOINT
2
JOINT
3
JOINT
4
JOINT
5
mance
envelope.
Perkin-Elmer
Corp.,
Zymark,
and
Cyber-
fluor,
Inc.
have
developed
simple-to-use
robotic-control
lan-
guages
accessible
to
most
computer
programmers.
Unfor-
tunately,
no
robot
vendor
has
simplified
all
aspects
of
robotics
software.
In
particular
the
programming
associ-
ated
with
communication
with
other
devices
remains
in-
complete.
Vaughn
at
the
University
of
Virginia
has
investigated
the
use
of
touch
screens
for
robot
programming.
The
use
of
digitized
images
(e.g.,
a
picture
of
the
robot
and
peripheral
equipment
on
the
computer
screen)
should
allow
the
user
to
point
to
destinations
in
the
picture
to
which
the
robot
will
then
physically
move
(22).
Graphic
image
interfaces
should
reduce
the
time
needed
to
train
laboratory
technologists
to
implement
new
procedures.
Training
a
laboratory
robot
to
move
to
specific
coordinates
on
the
robotic
work-surface
can
be
effected
through
either
a
teaching
pendant
(a
group
of
switches
on
a
remote
control)
or
directly
through
the
robotic
keyboard.
The
robot
is
positioned
by
the
trainer
to
a
certain
location
and
then
the
coordinate
is
entered
into
the
computer
via
a
switch
or
press
of
a
key
on
the
keyboard.
A
second
coordinate
may
then
be
entered
in
a
similar
man-
ner.
Using
simple
commands
from
the
keyboard,
one
re-
plays
the
coordinates
and
the
robot
will
move
as
instructed.
Because
robots
are
inherently
blind
and
without
tactile
senses,
they
will
collide
with
any
obstacles
in
the
path
between
the
two
points.
Thus
trainers
must
include
a
third
point
in
the
robot
program
that
will
allow
a
collision-free
trajectory.
A
recent
innovation
in
robotic
training
is
the
limp
mode
used
by
the
CR8
robot
marketed
by
Cyber-
fluor.
In
this
mode
a
robot
trainer
can
simply
grasp
the
robot
arm
and
move
it
to
a
location.
A
press
of
a
button
automatically
enters
the
position
into
the
robot
software,
where
it
will
be
repeated
once
the
software
routine
is
started.
Some
future
prospects
for
robot
training
may
couple
hand
movements
with
digitized
images
of
the
work
surface
(23).
The
monitor
will
display
a
picture
of
the
robotic
laboratory
from
a
choice
of
perspectives
(e.g.,
top
or
side
view).
A
trainer
then
moves
his
or
her
hands
on
the
computer
monitor
in
the
path
the
robot
will
take
during
the
execution
of
a
procedure.
Imaginative
methods
to
train
robots
will
simplifr
and
accelerate
the
programming
of
new
procedures.
Efficient
robotic
laboratories
use
procedures
that
are
reduced
to
LUOs
(laboratory
unit
operations)
(7,24);
these
are
used
repeatedly
or
recombined
in
a
different
order
as
laboratory
procedures
change.
Creating
new
procedures
is
simplified
by
the
modular
design
of
the
robotic
laboratory.
The
most
basic
LUOs
encompass
the
moving
of
items
around
the
laboratory
bench,
or
manipulation.
A
subcate-
gory
of
this
LUO
is
robotic
interaction
with
a
matrix.
Many
designers
of
robotic
software
have
simplified
the
steps
necessary
to
define
and
interact
with
a
matrix,
such
as
a
test-tube
rack,
because
retrieving
samples
is
universal
to
almost
all
procedures.
LUOs
common
to
the
clinical
labo-
ratory
are
listed
in
Table
1.
To
be
successful,
implementa-
tion
of
laboratory
robotics
requires
careful
planning,
atten-
tion
to
detail,
and
specialized
training
of
staff
and
skilled
support
personnel.
The
Integrated
RobotIc
Laboratory
Once
a
robotic
laboratory
is
operational,
communicatio
between
the
robots
host
computer
and
computers
outsid
the
robotic
lab
becomes
essential
(1).
Not
only
must
th
patients
information
be
sent
to
remote
locations
but
al
Table
1.
ClInical
Laboratory
Unft
Operations
Labeling
Sorting
Processing
Centrifugation
Precipitating
Aliquotting
Pipetting
Pouring
Analyzing
Storing/retrieving
Reporting
Discarding
information
must
be
retrieved
from
outside
sources.
Through
a
suitable
communications
network,
data
can
be
uploaded
from
robotic
laboratories
to
nursing
stations
or
to
the
main
laboratory
computer,
or
downloaded
from
various
sources,
e.g.,
the
hospital
information
system
or
the
main
laboratory
computer
(25).
Many
commercially
available
networks
are
available
that
include
software
and
hardware
devices.
One
computer
is
usually
dedicated
as
a
file
server
or
traffic
director.
Data
can
be
transferred
into
the
net-
work
through
many
communications
protocols,
but
two
popular
and
time-tested
systems
are
ethernet
and
token
ring.
Either
protocol
will
perform
well
in
robotic
labora-
tories
but
must
be
evaluated
for
speed
and
the
capacity
to
handle
many
computers.
Examples.
To
date,
the
clinical
laboratory
with
the
great-
est
degree
of
robotics
integration
is
that
of
Dr.
Sasaki
at
the
Kochi
Medical
School
in
Japan
(26).
In
his
laboratory
many
labor-intensive
laboratory
procedures
have
been
auto-
mated
by
use
of
a
variety
of
robots.
Patients
specimens
are
transported
to
the
robotic
system
via
conveyor
belt
(16).
After
sample
accessioning
and
centrifugation,
samples
are
placed
in
numbered
racks
that,
in
turn,
are
placed
on
conveyor
belts
at
the
front
end
of
the
laboratory,
to
be
transported
to
the
site
of
analysis.
Thus
the
samples
are
transported
while
the
robots
remain
fixed
in
the
center
of
a
table
and
sample
the
specimens
as
they
arrive
into
the
robot
area.
Samples
are
then
automatically
prepared
for
ABO
blood
testing
and
AIDS
screening
by
two
modified
D-Tran
RT-3000S
industrial
robots
(Seiko,
Osaka,
Japan).
The
results
of
the
completed
serological
tests
are
read
by
a
technician,
using
an
automatic
reader,
and
passed
on
to
the
laboratory
computer.
The
complete
analysis
is
performed
without
the
aid
of
a
technologist,
except
for
the
verification
of
the
final
results.
We
consider
Dr.
Sasakis
laboratory
a
prototype
of
robotic
laboratories,
one
that
will
significantly
reduce
employee
exposure
to
virus-contaminated
blood
specimens.
Even
so,
blood
processing
still
poses
the
great-
oat
exposure
risk
to
technologists
and
remains
a
labor-
intensive
area
of
the
laboratory.
Most
clinical
robotic
applications
have
centered
on
com-
plex
procedures
in
the
central
laboratory.
However,
the
benefits
of
using
robots
for
simple
tasks
include
abbrevi-
ated
development
time
and
less-error-prone
robotic
proce-
dures.
At
the
University
of
Virginia
we
are
investigating
the
concept
of
using
robots
for
simple
repetitive
tasks,
such
as
introducing
samples
into
whole-blood
analyzers,
thus
freeing
medical
technologists
for
more
complex
assays
(27,
28).
The
use
of
robots
to
place
samples
in
whole-blood
analyzers
has
the
potential
to
improve
patient
care
by
bringing
the
laboratory
closer
to
the
patients
bedside.
The
concept
of
decentralizing
clinical
laboratories
by
setting
up
a
series
of
satellite
laboratories
near
patients
in
locations
that
require
rapid
turnaround
of
test
results
is
appealing.
However,
the
cost
of
staffing
numerous
satellite
laboratories
clearly
cannot
be
justified
under
current
cost
constraints.
Robots
may
provide
an
alternative
to
the
personnel
required
to
interface
between
the
collected
sam-
ple
and
its
introduction
into
the
automated
analyzer.
Sev-
eral
laboratories
are
being
developed
close
to
critical-care
wards
that
will
rely
on
robots
for
handling
all
specimens
brought
to
the
laboratory
for
analysis.
Integration
of
the
many
facets
of
sample
entry
and
analysis
are
the
key
features
of
robotic
satellite
laboratories.
Samples
can
be
delivered
by
any
member
of
the
clinical
staff
to
the
nearest
robotic
laboratory,
with
each
laboratory
being
equipped
with
a
user-interaction
station
similar
in
design
and
func-
tion
to
an
automated
bank
teller
machine.
After
the
user
places
a
sample
in
the
depository
and
chooses
the
analyses
desired
from
a
menu,
the
robot
automatically
introduces
the
sample
into
the
analytical
instrument.
The
robotic
controlling
software
is
programmed
to
use
only
instru-
ments
that
have
been
previously
calibrated
and
quality
controlled,
either
automatically
or
by
the
robot.
Patients
results
are
then
passed
electronically
to
the
satellites
central
computer,
which
is
located
in
the
central
clinical
laboratory
and
staffed
by
trained
technologists.
All
results
are
to
be
verified
by
the
technologist
who
has
responsibility
for
monitoring
the
function
of
these
laboratories.
The
host
computer
should
be
designed
to
compare
the
reported
data
with
established
normal
ranges
and
with
previous
results
from
the
same
patient.
Satellite
central
will
electronically
order
repeat
analysis,
or
request
the
introduction
of
a
quality-control
specimen,
or
even
direct
instrument
repair
by
the
robot.
Another
approach
to
the
integrated
laboratory
is
to
combine
the
services
of
two
robots.
Two
robots
working
in
tandem
can
pass
work
completed
in
one
area
to
a
second
step
in
another
area.
Elsewhere
(29)
we
investigated
the
use
of
a
programmable
pipetting
station
in
combination
with
a
robotic
arm
to
increase
laboratory
efficiency
for
determining
glycohemoglobin
concentrations
(Figure
8).
Fig.
8.
Integration
of
a
programmable
pipetting
station
with
a
robotic
arm
as
investigated
by
Felder
et
al.
(2
for
determination
of
glycohemoglobin
After
extraction
of
glycohemoglobin
at
the
pipetting
station,
eluates
were
transferred
by
the
robotic
arm
to
a
spectrophotometer
equipped
with
a
sample
changer
and
automatic
data-reduction
system
CLINICAL
CHEMISTRY,
Vol.
36,
No.
9,
1990
1539
1540
CLINICAL
CHEMISTRY,
Vol.
36,
No.
9,
1990
The
glycohemoglobin
assay
is
an
example
of
solid-phase
extraction,
a
manually
intensive
analytical
method
com-
monly
used
in
many
laboratories.
Extraction
of
glycohemo-
globins
was
accomplished
by
automatic
transfer
of
samples
to
extraction
columns,
washing,
and
then
elution
into
spectrophotometer
tubes
by
using
a
custom-designed
trol-
ley
system.
After
the
eluates
were
collected,
a
robotic
arm
placed
them
into
a
spectrophotometer
equipped
with
a
sample
changer
and
automatic
data-reduction
system.
Re-
sults
by
the
manual
and
robotic
procedures
were
compara-
ble.
While
one
analytical
method
is
being
processed
by
the
pipetting
station,
the
robot
will
be
preparing
reagents
for
the
next
analytical
run.
Total
automation
is
possible
with
the
advantage
of
serialized
batch
throughput
(Figure
9).
One
commercially
available
system
combines
a
program-
mable
pipetting
station,
a
microplate
reader,
a
laboratory
balance,
an
incubator,
and
a
robot
into
an
integrated
device
(Synchron
Instruments,
Etten-luer,
Netherlands).
Using
a
cylindrical
robot
on
a
linear
track
allows
five
degrees
of
freedom.
Electronic
communication
is
provided
through
multiplexed
RS-232
interface
boards
in
two
microcomput-
ers.
This
integrated
approach
to
robotics
is
the
first
exam-
ple
of
its
kind,
to
our
knowledge.
As
more
clinical
labora-
tories
incorporate
robotics,
we
will
gain
a
more
complete
understanding
of
the
impact
of
robots
on
patient
care.
SpecIfIc
Tasks
for
Robots
Assay
Optimization
One
of
the
most
time-consuming
tasks
in
the
medical
laboratory
is
assay
optimization.
Each
analysis
must
com-
prise
that
combination
of
reagents,
temperature,
time,
and
appropriate
detection
conditions
that
will
afford
the
opti-
mal
quantitative
assessment
of
a
bioanalyte.
Robotic
sys-
tems
can
be
programmed,
with
appropriate
input
from
measuring
devices,
to
change
each
variable
in
an
analyti-
cal
run
and
to
determine
the
effect,
whether
toward
or
away
from
the
desired
result.
The
robot
that
has
been
programmed
with
the
result
sought
by
the
laboratory
scientist
can
then
adjust
the
variables,
re-measure,
and
continue
the
process
until
the
optimum
conditions
are
determined.
A
simplex
(30)
or
more
complex
algorithm
can
be
used
to
instruct
the
robot
to
what
degree
and
in
which
direction
to
alter
analytical
variables.
Spectrophotometric
sample-preparation
procedures
in-
volving
multiple
variables
have
been
optimized
by
using
robotics
(31).
Expert
system
software
involving
simplex
statistical
techniques
in
conjunction
with
a
robotic
arm
was
Batch
LAi-{I---
LJ
-
Lii
-
-
[Ij
Siiil
[M-LiEci-i
-Ri-[J-liI
Se,iilized

Batch
Fig.
9.
Diagrammatic
representation
of
serialized
batch
processing
Each
operational
step
is
symbolized
by
a
letter.
Robotic
programming
often
allows
different
operational
steps
to
be
performed
in
tandem,
thus
achieving
the
advantages
of
serialized
batch
processing
used
as
an
integrated
system
to
develop
laboratory
proce-
dures
in
the
chemistry
laboratory.
The
investigators
dis-
covered
in
the
course
of
these
studies
that
many
assays
could
be
optimized
by
either
fixed
or
variable
simplex
algorithms.
One
advantage
of
robotic
sample
optimization
was
that
the
procedures
were
accomplished
in
the
evening
hours
when
the
laboratory
was
unattended;
more
impor-
tantly,
the
optimal
conditions
were
found
without
the
tedium
involved
in
determining
these
conditions
manually.
In
clinical
laboratories
robotic
optimization
algorithms
could
be
used
to
optimize
robotic
procedure
when
lot
num-
bers
of
reagents
are
changed
or
when
other
assay
pertur-
bations
outside
operator
control
are
introduced.
Before
HPLC
analysis
the
optimization
of
sample
extrac-
tion
by
solid-phase
cartridges
was
tedious
and
time-con-
suming.
Many
different
cartridges
with
different
solid
phases
had
to
be
tried
under
various
extraction
conditions.
Johnson
et
al.
(32)
demonstrated
that
a
Zymark
robot
and
several
custom-made
devices
could
be
used
to
alter
the
composition
of
the
elution
buffers
and
the
type
of
packing
in
the
columns
until
optimum
conditions
were
met,
or
until
it
was
determined
that
the
extraction
could
not
be
optimized
with
the
available
reagents.
Robotic
Automation
of
HPLC
HPLC
is
commonly
used
in
both
the
clinical
laboratory
and
the
pharmaceutical
industry
(33).
Because
of
the
di-
versity
of
analyses
that
can
be
performed,
HPLC
has
remained
popular
despite
its
relatively
slow
throughput
and
manually
intensive
sample
preparation.
However,
the
use
of
robotics
has
substantially
reduced
the
labor
compo-
nent
of
HPLC
in
pharmaceutical
and
industrial
settings.
Almost
1500
robots
are
already
in
use
in
industrial
analyt-
ical
laboratories
(1).
Analysis
of
specimens
by
HPLC
is
accomplished
serially
and
therefore
is
amenable
to
robotic
automation.
The
manipulative
steps
of
HPLC
can
be
broken
down
into
five
LUOs
(Table
2)
(8).
The
many
LUOs
of
HPLC
require
custom-made
devices
that
perform
specific
tasks.
Many
peripheral
devices
are
available
that
perform
specific
LUOs
and
are
designed
to
interact
with
robots.
Zymark
Corp.
has
pioneered
the
use
of
dedicated
hands
and
devices
for
per-
forming
HPLC
analysis;
their
patented
robot
can
be
pro-
grammed
to
change
hands
to
accomplish
different
tasks.
Obtaining
the
sample
Table
2.
HPLC
LUOs
Determining
sample
quantity
(weight
or
volume)
Checking
sample
quality
(i.e.,
sample
color,
turbidity,
or
odor)
Extraction
or
processing
(solid
or
liquid
phase)
Addition
of
extraction
solvent
Homogenization
Extraction
Phase
separation
(centrifugation)
Evaporation
Reconstitution
or
dissolution
Storage
Transfer
to
storage
vial
Desiccating
Injection
Autosampler
Direct
injection
Data
reduction
CLINICAL
CHEMISTRY,
Vol.
36,
No.
9,
1990
1541
An
HPLC
robotic
system
may
initiate
an
analysis
with
a
hand
designed
to
grasp
test
tubes
for
liquid
extraction
and
finish
the
analysis
with
a
hand
specifically
designed
to
inject
specimens
into
the
HPLC
injection
port.
Other
dedi-
cated
peripheral
devices
have
also
been
configured
for
robotic
operation;
e.g.,
Whittaker
(34)
demonstrated
the
use
of
microcomputer-operated
microsampler
in
conjunc-
tion
with
a
Zymark
cylindrical
robot,
and
Johnson
et
al.
(32)
investigated
the
optimization
of
solid-phase
extraction
by
robot.
Although
robotic
processing
of
samples
for
HPLC
analy-
sis
is
often
slower
than
what
a
trained
technologist
could
do,
the
rate-limiting
step
is
usually
the
chromatographic
separation.
Several
investigators
have
attempted
to
im-
prove
analytical
throughput
by
several
techniques.
In
one
laboratory
(35),
five
HPLC
separation
columns
were
con-
nected
to
an
autoswitching
device
under
computer
control;
analyses
could
be
varied
not
only
by
change
of
column
but
also
by
changing
the
buffer
system
through
a
computer-
driven
valve
assembly.
A
combination
of
two
HPLC
devices
coupled
with
a
cylindrical
robot
configured
in
a
Pytechnol-
ogy
(Zymark)
design
improved
throughput
in
an
assay
for
testing
drug
uniformity
(36).
Many
HPLC
procedures
have
been
automated
with
robotics,
e.g.,
drug
testing
in
biolog-
ical
fluids
(37),
pesticide
analysis
(38),
and
pharmaceutical
process
control
(39).
Although
many
examples
exist
for
industrial
HPLC
robotic
applications,
only
one
working
robotic
HPLC
device
has
been
described
in
the
clinical
laboratories.
Pippenger
(9)
and
Van
Lente
at
the
Cleveland
Clinic
Foundation
automated
a
procedure
for
quantifying
tricyclic
antidepressants
in
biological
fluids
by
using
a
cylindrical
robot
to
perform
extractions
with
organic
sol-
vent,
evaporate
the
organic
phase,
and
reconstitute
the
extract
with
analysis
buffer.
The
robotic
system
was
in-
stalled
in
a
fume
hood
to
prevent
exposure
of
technologists
to
harmful
organic
vapors.
Sample
injection
into
the
HPLC
was
accomplished
by
using
an
injection
hand
specifically
designed
to
perform
this
operation.
Robotics
and
Immunoassay
One
area
in
the
clinical
laboratory
that
has
been
slow
to
automate
has
been
the
immunoassay
laboratory,
primarily
because
of
the
difficulty
in
producing
reagents
with
the
stability
necessary
for
automated
clinical
immunoassays
(40).
Robotics
devices
have
been
manufactured
primarily
for
microtiter
plate
technology,
to
reduce
the
many
labor-
intensive
steps
necessary
for
monoclonal
antibody
produc-
tion.
Pipetting
stations
are
used
in
many
laboratories
to
add
radioactive
trace
and
antibody
solutions
to
reaction
tubes,
but
all
other
processing
steps
are
usually
completed
manually.
The
future
may
see
increased
use
of
robotics
in
combination
with
pipetting
stations
for
immunoassays,
a
combination
of
robotic
automation
that
allows
for
more
rapid
throughput
with
maximum
flexibility.
A
recently
developed
robotically
operated
microplate
processor
that
could
easily
automate
enzyme-linked
immunoassays
was
described
by
Spermon
(Organon
Teknika)
in
this
confer-
ence
(unpublished).
Robotics
in
the
Diagnostic
DNA
Laboratory
There
are
very
few
examples
of
robotics
automation
of
DNA
analysis.
The
paucity
of
automation
in
this
area
is
due
to
the
relatively
recent
use
of
DNA
analysis
in
the
clinical
laboratory,
the
manually
intensive
nature
of
DNA
testing,
and
the
complexity
of
automating
difficult
proce-
dures
such
as
gel
electrophoresis.
Automation
of
various
aspects
of
the
Southern
blotting
technique
was
described
here
by
Mayrand
et
al.
(manuscript
in
preparation).
Se-
quencing
the
human
genome
is
going
to
present
an
enor-
mous
challenge
to
DNA
laboratories.
Automation
of
this
technique
is
a
prerequisite
to
successful
completion
of
this
project
(41).
Hoods
laboratory
at
the
California
Institute
of
Technology
has
succeeded
in
automating
the
polymerase
chain
reaction,
a
key
step
in
sequencing
of
the
human
genome
(42).
The
Human
Impact
of
RobotIcs
Training
programs
in
robotics
and
computer
systems
will
be
an
obvious
need.
A
recent
survey
of
robotics
educational
programs
(43)
found
approximately
68
educational
institu-
tions
(48
in
the
U.S.)
offering
advanced
educational
courses
in
robotics
and
robotics-related
engineering.
The
greatest
increase
in
the
number
of
educational
institutions
on
this
list
occurred
in
1983,
when
there
was
recognition
of
the
need
to
provide
the
burgeoning
field
with
robotics-qualified
graduates.
However,
fewer
than
25
graduates
with
Ph.D.
degrees
have
emerged
from
institutions
with
robotics
pro-
grams
each
year
over
the
last
four
years,
and
none
of
the
respondents
to
the
survey
had
a
research
interest
in
clini-
cal
laboratory
robotics.
There
is
a
need
for
training
pro-
grams
that
will
produce
technologists
at
the
M.S.
or
Ph.D.
level,
who
can
design
and
implement
robotic
systems
for
clinical
laboratories.
Very
few
clinical
laboratories
have
educational
programs
with
personnel
qualified
to
teach
courses
on
robotics
or
computer-related
applications.
Med-
ical
technologists
of
the
future
must
receive
at
least
a
little
training
in
this
emerging
field
to
be
competitive
for
exist-
ing
jobs.
Over
the
last
several
years,
there
has
been
a
steady
reduction
in
the
availability
of
medical
technologists
(44).
The
shortage
has
been
caused
by
many
factors:
a
severe
reduction
in
the
number
of
training
programs;
the
avail-
ability
of
many
more
career
choices
to
women,
who
have
traditionally
become
medical
technologists;
the
hard
work
and
frequent
evening
and
night
shifts,
less
desirable
than
daylight
Monday
through
Friday
jobs;
and
the
threat
of
exposure
to
fatal
infectious
agents.
Furthermore,
the
pro-
liferation
of
automated
instruments
has
made
the
job
of
medical
technologist
less
challenging.
Laboratory
robotics
can
have
a
multifaceted
impact
on
job
satisfaction
in
the
field
of
medical
technology
(45).
In
future
laboratories,
robots
will
perform
the
repetitive
non-
stimulating
tasks,
freeing
technologists
to
use
their
skills
in
method
development
and
in
manual
assays
requiring
laboratory
skills.
The
evening
and
night
shifts
can
be
configured
to
operate
by
robot,
with
the
day-shift
human
workers
replenishing
supplies
and
servicing
faulty
equip-
ment.
Robots
can
handle
the
contaminated
specimens
in
enclosed
ventilated
spaces,
improving
laboratory
safety.
The
field
of
laboratory
medicine
will
then
attract
techni-
cally
oriented
individuals
with
strengths
in
analytical
chemistry,
computers,
and
robotics.
Effects
of
Robots
on
Laboratory
Economics
It
has
been
several
years
since
Diagnosis
Related
Groups
(DRGs)
were
introduced
to
reduce
the
cost
of
health
care.
Under
this
prospective
payment
system,
many
changes
were
instituted
that
altered
both
the
design
of
clinical
analyzers
and
the
way
in
which
laboratories
were
orga-
nized.
Much
effort
has
been
expended
trying
to
reduce
the
1542
CLINICAL
CHEMISTRY,
Vol.
36,
No.
9,
1990
cost
of
labor
by
centralizing
laboratory
services
and
by
designing
large
clinical
analyzers
so
that
the
laboratory
labor
force
could
be
consolidated
into
a
centralized
area.
Unfortunately,
despite
these
cost-cutting
measures,
there
has
not
been
a
dramatic
reduction
in
the
labor
force
within
the
clinical
laboratories
(46).
The
combination
of
increased
numbers
of
newly
available
laboratory
tests
and
subse-
quent
production
of
larger,
more
technically
versatile
in-
struments
has
increased
the
need
for
trained
technologists
for
operation
and
maintenance.
The
American
Hospital
Association
estimates
that
the
labor
cost
in
clinical
laboratories
averages
50%
of
total
disbursement
spent
on
clinical
laboratory
services.
Over
$25
billion
is
spent
every
year
in
laboratory
testing;
there-
fore,
reducing
laboratory
labor
costs
by
$5-b
billion
could
significantly
affect
the
cost
of
health
care.
Fortunately,
advances
in
the
availability,
affordability,
and
flexibility
of
robotic
systems
are
allowing
the
automation
of
laboratory
services
that,
until
now,
could
be
provided
only
by
skilled
technologists.
Implementation
of
new
robotic
laboratory
procedures,
however,
has
its
own
costs.
One
to
two
personnel
full-time
equivalents
(FFEs)
are
required
for
each
robotic
method
for
the
duration
of
the
installation
procedure.
Several
months
are
often
required
for
trained
personnel
to
complete
each
project.
Management
supervision
is
required
to
maintain
a
perspective
of
project
continuity
in
relation
to
the
general
configuration
of
the
laboratory.
Once
the
method
is
produc-
ing
data,
then
persons
knowledgeable
in
the
system
design
must
be
in
place
to
repair
or
modify
procedures
as
needs
arise.
Those
who
maintain
the
robotic
procedures
can
also
be
used
to
develop
additional
methods.
As
the
automated
methods
begin
to
operate
autonomously,
labor
needs
will
decrease.
The
Future
of
Robots
in
the
Clinical
Laboratory
Increased
automation
of
the
laboratory
by
use
of
robotics
will
increase
efficiency
while
freeing
the
clinical
chemist
to
employ
his
or
her
skills
more
fruitfully
in
method
develop-
ment,
research,
and
interactions
with
the
hospital
medical
staff
There
is
growing
awareness
of
the
potential
that
robotics
will
have
in
the
clinical
laboratory
through
inte-
gration
with
automated
analyzers
and
computer
systems.
What
will
the
robotic
laboratory
of
the
future
look
like?
Hospital
laboratories
will
begin
to
be
located
farther
from
the
main
facility
because
the
labor
component
of
staffing
satellite
laboratories
will
have
been
greatly
reduced.
In-
strument
manufacturers
will
see
the
need
for
analyzers
that
are
robot-friendly
and
allow
for
simplified
standard
electronic
and
mechanical
interfacing.
Robots
will
become
more
versatile,
to
the
point
of
performing
even
complete
instrument
repair.
Laboratories
will
be
equipped
with
many
task-oriented
robotic
stations,
e.g.,
the
serum-pro-
cessing
robot
(Serumax)
offered
by
Medical
Robotics
(Lex-
ington,
KY)
and
the
specimen
storage
and
retrieval
robot
offered
by
Republic
Storage
Systems
(Canton,
OH).
In
addition,
accessioning
and
processing
robots
will
prepare
samples
for
transport
by
robotic
carts.
Analysis
will
be
performed
by
a
combination
of
mobile
robot
and
dedicated
analyzer.
Robotic
training
will
be
performed
off-site,
possi-
bly
through
a
graphic
computer
interface
using
artificial
reality
images
(images
depicting
the
object
to
be
used).
Laboratory
results
will
be
reviewed
by
computer
algo-
rithms
or
expert
systems
in
the
larger
laboratory
computer,
which
will
alert
the
clinical
pathologist
to
unusual
results.
A
larger
variety
of
analyses
will
be
available
to
the
patient
with
rapid
turnaround
because
each
laboratory
will
not
be
limited
by
the
labor
costs
of
offering
little-used
tests.
The
result
will
be
more
efficient
health-care
delivery
at
reduced
cost.
We
thank
Vicki
Hodges
for
her
expert
assistance
in
preparing
the
manuscript,
and
a
grant
from
Perkin-Elmer
Corp.
and
the
University
of
Virginia.
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