Digital Pathology Blog

Yogi Berra, the Hall of Fame New York Yankees catcher has famously said “It's tough to make predictions, especially about the future”.

The Jetsons had us believing that by 2020 we would have instant food, video phones and flying cars. Two out of three isn’t bad. So far. Some innovative folks are working on drone-like vehicles that can sustain human flight. Let’s see what happens this year with that.

Ten years ago, digital pathology was leaving infancy and becoming a toddler, learning to walk and run and read and write and communicate. The notion that slide images could be viewed from anywhere, anytime, was still a novel idea, not so much from a technological perspective, but rather from a professional one.

Pathologists have long consulted with their colleagues on difficult cases, and today, with their decreasing numbers and the increase in cancer cases world-wide, the ability to collaborate with colleagues at an international level is key to ensuring patients have access to the best diagnostic expertise available no matter where they are located.

Many large medical centers offer pathology consultation services throughout the US and international communities. In addition to formal consult cases, many pathologists share insights with their colleagues in remote locations, benefitting patients as well as the pathologists who learn from each other in these collaborations.

The key to unlocking the broad benefits of digital pathology, including more efficient use of resources, easy access to colleagues & experts, faster clinical workflows — depends on having an image management system providing broad access to every image in the repository for users to view and share.

Access to healthcare services is in the midst of a fundamental change. Independent community hospitals and academic health centers are consolidating into larger networks across the nation. Furthermore, these networks are also developing global affiliations and partnerships to increase access to diagnostic care worldwide. As a result, patient point-of-service, laboratory services and the professional review of a case may exist in independent locations, sometimes spread over large geographic distances. Pathology department transformations embody this shift.

Multidisciplinary Tumor Boards (MTBs) are a standard of practice in all academic medical centers. Studies show that they contribute to improved diagnoses and treatment plans and often lead to improved patient outcomes.¹ Moreover, these conferences provide valuable real-life education and training to residents and fellows in all represented disciplines.

Historically, pathologists have encountered unique challenges when participating in MTBs. Even with access to digital images for their presentations, the images are often time consuming to attain and in a static image format. Navigation to other regions of interest within the slide is often not possible, and the patient’s case data is usually in a separate lab information system (LIS). Assembling the case, often in Powerpoint, is time consuming, limiting and frustrating.

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.

Quality is Job 1

This of course was Ford Motor Company’s marketing slogan in the early 1980s. The message was clear – in the wake of some issues, Ford was going to build in quality to its automobiles rather than make it a checkbox at the end of the process. Over the years, Ford prospered while its major domestic competitors, General Motors and Chrysler, struggled to compete with Ford as well as foreign automakers.

The acceptance of digital pathology and its implementation across the United States have been met with a fair amount of challenges. Many equate digital pathology’s evolution in the laboratory with radiology’s move from film to digital media. Despite obvious advantages like immediate availability of images for viewing and image storage being reduced to computer drives as opposed to rooms full of film, it took time for radiology to convert to using digital media as a routine matter of business. Pathology is experiencing much of the same resistance.

I have been attending tumor boards on a weekly basis in some capacity or another for over 20 years, since starting my pathology residency. Prior to then, I observed as a medical student on a regular basis. Even if I was on a rotation, like family practice or pediatrics or OB/Gyn, if I had the time, I would try to attend one of the many tumor boards on the hospital campus. I kept the schedule in my PalmPilot Personal Digital Assistant at that time.

Digital imaging, when most of us consider it in medicine, is primarily used in radiology. Radiology has taken the lead on digital imaging for decades.