Digital Pathology Blog

I arrived for my away rotation early. I was scheduled to be at the Office of The Chief Medical Examiner (OCME) in Baltimore for the month of July. My first rotation of second year of residency would be spent away from the gross bench and chemistry analyzers. The month was actually fine with me – the OCME office handled deaths from all over the state of Maryland including Baltimore city and county, so there would be a mix of the usual inner city homicides, suicides, drug-related deaths, as well as farming, motor vehicle, and boating accidents at the peak of summer in Maryland. And the OCME was walking distance to Oriole Park and Camden Yards and the Orioles were scheduled to play nearly 20 games that month at home. One of the best smelling ball parks in the country would offset the smells of decomposing bodies pulled from the water or burning buildings. 

Pathologists frequently mention “I consulted on this” or “I sent this case off to a consultant” or “We were consulted about…”. But what does it mean? It is frequently puzzling for clinicians or patients. Does that mean my tissue specimen went to another laboratory? Does that mean slides or images from my case were seen outside the institution? Who gets consulted? Who pays for this?

In medical school, the pathologists would come to lecture during second year, and while they had their own subspecialty or research interests, they would often tell us “Pathology is a lot of fun. All of the interesting cases in the hospital wind up under the microscope and you are respected among your peers.”

According to the College of American Pathologists (CAP) 2013 data, approximately 80 percent of the world’s pathologists are based in the United States. This concentration causes an increased need to access, share, and diagnose images remotely.

In nearly every conversation we have with major hospital centers and pathology labs, the question comes up about how to initiate 2^nd opinion pathology referrals from outside the US. Everybody wants to know: how can we work with China…or India…or other areas of the world where pathology is dramatically underserved? Most US expert centers have a healthy referral business, with slides arriving via mail and FedEx daily/weekly. Going digital in pathology would provide the means to increase referral business by streamlining and accelerating the process, from image acquisition to diagnostic report. 

Bella Lugosi is famously quoted as saying, “I vant to suck your blood.” Maybe he was ahead of his time along with the Twilight crew. Three new papers published a few weeks ago in Nature Medicine and Science show exciting implications on reversing aging in studies of blood exchanges between young and old mice. The studies found that infusing the blood of younger mice into older mice rejuvenated their muscles and brains. The opposite appears to hold true too – infusing blood from older mice into younger mice accelerated the aging process. 

The Affordable Care Act and market changes like baby boomers entering their senior years with a decreasing amount of doctors to care for them are driving a mind-blowing rate of change in healthcare. Medical practices, including pathology, will sink or swim based on how they adapt to the new realities.

There are a lot of stories being written about the human papilloma virus (HPV) test that has been approved by the FDA as a primary screening tool for cervical cancer. We decided to check in with one of the leading cytopathologists in the U.S., Dr. David Wilbur, Director of Pathology Imaging (and former Director of Cytopathology), at Massachusetts General Hospital to get his perspective.

It’s interesting to look beyond the U.S. to see how global digital pathology adoption is progressing. After a three month test pilot last year (with more testing over the next ten months), University Hospitals Coventry and Warwickshire NHS Trust has launched a digital pathology system across its facility with the Omnyx Integrated Digital pathology system from GE Healthcare.

Pathologists, particularly forensic pathologists and medical examiners, seem to provoke endless curiosity from Hollywood television writers. The pathology fascination can be seen in shows throughout the years like Quincy ME, Body of Proof, Rizzoli and Isles, and the CSI shows: