Digital Pathology Blog

Digital pathology offers significant advantages to pathology laboratories within academic institutions. In addition to clinical activities, for which digital pathology has already shown significant improvements in workflow efficiency and accuracy, such laboratories have missions of research and education, both of which can also be enhanced in the digital environment.

Case-based research projects and educational activities require the use of whole slide images (WSIs) derived from the clinical workflow. But cases flowing into these activities have specific requirements and workflows of their own.

We were privileged to present at the Digital Pathology and AI forum hosted by The Pathologist. In our portion of the forum, Dr. Wilbur focused on how the use cases and workflow solutions of digital pathology compare to those in the clinical environment. Dr. Wilbur focuses on how the use cases and workflow solutions of digital pathology compare to those in the clinical environment. While both of these are well established in the clinical setting, image management systems need some additional features to satisfy the requirements for research. Use cases and workflows are similar in how the user interacts with the digital environment but can be quite different in how they relate to the ultimate task and output.

Don’t get me wrong based on the title; I am not advocating for proficiency testing (PT). After Medical Boards, Resident In-Service and Board exams, I never thought I would be thinking about any more testing at all. There are better ways to test for ongoing real proficiency. Exercises that test “real-world” skills, such as focused review of signed out cases or concurrent reviews - with feedback – not only lead to better outcomes (patient safety) but also improve practice (constructive feedback). But testing is an unfortunate part of modern life. It’s a metric, and regulators like metrics. For years we dealt with the specter of impending gynecologic cytology PT. Based on the complexity of the federally mandated glass slide testing format, the organizations capable of producing such a monumental effort appeared to reach a détente with CMS, and no testing took place for many years after the federal regulation went into effect. However, when one organization came up with a program, the seeming détente was at an end, and CAP and ASCP were essentially forced to enter the fray.

Much of the excitement related to digital pathology comes from the ability to rapidly move cases from one place to another. Remote access from home, speedy consultations, rapid review of archival material, and access to cases for clinical conferences are just a few of the benefits that accrue from moving from glass slide analog to a digital slide environment. All of these workflows can be accomplished with glass slides but require the presence of the physical case material. With digitization the need for the physical case is negated which leads to the obvious advantages that slides need not ever be “pulled” from the files, and multiple individuals can view the same case at the same time – think about slides traveling to conferences or for consultation which then are needed immediately for clinical care or quality assurance activities. Clearly the digital pathology laboratory facilitates these processes and makes them more efficient (and safe).

Authored by:

David C. Wilbur, M.D.
Chief Scientist, Corista LLC
Professor of Pathology Emeritus
Harvard Medical School

The microscope has been around for hundreds of years and has reached a plateau of efficiency. Certainly, in my own practice over the last 40 years, the physical process of microscopy has not changed. I still use today the microscope I bought as a resident. Sure, some advances have been made, like tilting heads and automatic turret changes, but these are designed to prevent chronic issues, such as neck and back pain and carpal tunnel syndrome, respectively. They have little to do with the daily efficiency of the process.